Whole Food Plant-Based Plate

Diet Reference Archive: plate and portion tool

Whole Food Plant-Based Plate

A patient handout from the American College of Lifestyle Medicine that pictures a meal made only of whole plant foods: fruit and vegetables, whole grains, and legumes, nuts and seeds, with water to drink and herbs and spices for flavor. It is a picture of the College's dietary position rather than a diet with rules of its own, and clients may call it the ACLM plate or the lifestyle medicine plate.

Family: Plate and portion tools Promoted by: American College of Lifestyle Medicine First appeared: the earliest version found for this page is dated 2019; the current version is dated 2024 Whole Food Plant-Based Plate handout: not rated, because no study found for this page tested it. The GRADE ratings below concern dietary patterns or diet scores, not the plate; see the comparison-specific rows

ON THIS PAGE

1. In brief
2. Overview
3. In practice
4. For the coach
5. The evidence (opens on request)
6. Mechanisms (opens on request)
7. Risks, contraindications and myths (opens on request)
8. Key terms
9. Review questions
10. References and Resources
11. Evidence rating and review record

The summary and sections 1 to 3 are the short version and are open when the page loads. Sections 4 to 6 hold the research detail, the biology, and the cautions. Each of those opens when you select its heading, and you can read the page without opening them. Back to the Diet Reference Archive index.

In brief

What is it? A one-page picture from the American College of Lifestyle Medicine of a meal built only from whole plant foods: fruit and vegetables, whole grains, and legumes, nuts and seeds, with water to drink. It shows no meat, fish, eggs, dairy or added oil. The College calls it "A Whole Food, Plant-Based Plate," and clients may call it the ACLM plate.

Does it work? No study found for this page tested the plate itself; one small study handed it out as one part of a larger program. What has been tested is eating this way. In trials lasting 12 to 26 weeks, vegan diets lowered HbA1c, a blood test of average blood sugar, and LDL cholesterol a little more than the comparison diets in adults with overweight or type 2 diabetes, with no clear effect on blood pressure. These findings concern blood-test and blood-pressure changes, not proof that this plate prevents heart attacks, strokes or deaths. Long-term studies link healthful plant-based eating with less heart disease and type 2 diabetes, which is an association, not proof.

Is it safe? For most adults the foods on the plate are ordinary foods, but an eating pattern with no animal foods needs planning, most clearly for vitamin B12. The main cautions are for people taking medicines that lower blood sugar, blood pressure medicine or warfarin, and people whose needs are higher or more particular, such as during pregnancy, in childhood and in older age.

Who should not do it without talking to a doctor or dietitian first? People on blood pressure medicine, insulin, a sulfonylurea or a meglitinide; people on warfarin; people with kidney disease; anyone pregnant or breastfeeding; children and teenagers; older adults with a small appetite or weight they are losing without meaning to; and anyone with a history of disordered eating.

Related pages: Mediterranean Diet, Diabetes Plate Method, and the Harvard Healthy Eating Plate, MyPlate, Whole-Food Plant-Based Diet and Vegan Diet pages. Full list on the archive index.

1. Overview

What you eat

The current version of the plate, dated 2024, is a photograph of a round platter heaped with whole plant foods, with 3 labels around it: fruit and vegetables, whole grains, and legumes, nuts and seeds. Two more labels say to drink water and to add herbs and spices. The text under the picture asks for "a wide array of fiber-filled, nutrient-dense, and antioxidant-rich whole plant foods at every meal" and lists examples for each group (American College of Lifestyle Medicine, 2024c).

• Fruit and vegetables. Dark leafy greens such as spinach, kale and arugula, broccoli, squash, zucchini, carrots, tomatoes, beets, peppers, mushrooms, onions, celery, cauliflower, cucumbers, white and sweet potatoes, green peas and cabbage, along with whole plant fats such as avocados and olives. Fruits include apples, bananas, grapes, citrus, berries, peaches, pears, pineapple, kiwi, plums, watermelon and mangoes.
• Whole grains. Amaranth, barley, brown rice, buckwheat, bulgur, millet, popcorn, rye, quinoa, whole oats, and whole grain breads, tortillas, cereals and flours.
• Legumes, nuts and seeds. Beans of many kinds, black-eyed peas, chickpeas, split peas, lentils, edamame, tofu and tempeh; almonds, pistachios, walnuts, pecans, cashews, peanuts and nut butters; and pumpkin, sunflower, chia, flax and hemp seeds.
• Water, with herbs and spices to add flavor.

Unlike the earlier version, the 2024 picture draws no lines between sections and gives no fixed proportions for the whole plate. Its back page, like the 2019 version's, includes a sample goal of making half the dinner plate vegetables on 5 nights in a week (American College of Lifestyle Medicine, 2019, 2024c). The 2019 version showed a plate divided into sections: fruits and vegetables filled half, plant proteins a quarter and whole grains a quarter (American College of Lifestyle Medicine, 2019). A copy of the 2019 version is still posted on a university health plan's website (American College of Lifestyle Medicine, 2019), so a client may bring either one.

What you avoid or limit

The plate itself lists no forbidden foods. What it leaves out is the message: no meat, poultry, fish, eggs or dairy appears anywhere on it, and there is no bottle of oil. The College's 2026 dietary position, which the plate puts into a picture, says the core of the diet should be whole and minimally processed plant foods, and that it should "minimize red and processed meats, foods high in saturated fat, and ultra-processed foods containing added sugars, sweeteners, unhealthy fats/oils, refined carbohydrates, and excess sodium" (American College of Lifestyle Medicine, n.d.-c).

How strict that is depends on the handout. The 2019 plate pointed readers to a dietitian for help moving to "a 100% plant-based dietary lifestyle" (American College of Lifestyle Medicine, 2019); the 2024 plate speaks of moving to "a more whole food, plant predominate dietary pattern" (American College of Lifestyle Medicine, 2024c). The College's Dietary Spectrum handout lists red meats, poultry, eggs and dairy among foods to "decrease or avoid" and says "any movement toward a WFPB eating plan is positive" (American College of Lifestyle Medicine, 2024a). The current materials describe a direction, not a line a person must cross.

Where it came from

The plate is a picture of the College's dietary position statement. The American College of Lifestyle Medicine is a professional society for lifestyle medicine, which the College describes as "an evidence-based medical specialty that applies therapeutic lifestyle interventions to treat, reverse, and prevent chronic conditions" (American College of Lifestyle Medicine, n.d.-e). In 2018 the College announced its first dietary position: "For the treatment, reversal and prevention of lifestyle-related chronic disease, the ACLM recommends an eating plan based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds" (American College of Lifestyle Medicine, 2018).

The 2019 plate printed that position under the subtitle "Nutrition Prescription for Treating & Reversing Chronic Disease" (American College of Lifestyle Medicine, 2019). The 2024 version has no subtitle on its front, but its back page still reproduces the College's 2018 dietary position, including its treatment-and-reversal wording (American College of Lifestyle Medicine, 2024c). In February 2026 the College replaced the one-sentence position with a 4-part statement written by a panel of physicians, dietitians, chefs, health coaches and researchers (Karlsen, 2026). The College's own site has called the handout "the lifestyle medicine plate" (Crocker, 2025). The current version is hosted on the College's learning site; its member resource library requires a log-in, and this page could not open it.

What it claims to do

The plate's claims are the College's claims, stated as its position, not findings. The 2019 subtitle called the plate a "nutrition prescription for treating & reversing chronic disease" (American College of Lifestyle Medicine, 2019), and the 2024 version repeats the 2018 position, "for the treatment, reversal, and prevention of lifestyle-related chronic disease" (American College of Lifestyle Medicine, 2024c). The 2026 statement places healthy eating on a continuum running "from health promotion and prevention to treatment and reversal of lifestyle-related chronic disease," and says food as medicine is best delivered by "an interprofessional healthcare team all working within their scope of practice" that ideally includes registered dietitian nutritionists (American College of Lifestyle Medicine, n.d.-c).

What it gets right

The plate's food groups are the ones most clinical guidelines agree on. A 2023 review of 78 clinical practice guidelines, written by College researchers and cited on the back of the 2024 plate, found that guidelines most often recommended vegetables (74 percent), fruit (69 percent) and whole grains (58 percent), and that about half endorsed patterns centered on plant foods (Cara et al., 2023). The American Heart Association's 2026 guidance, which this program uses for nutrition claims, includes plenty of vegetables and fruits, mostly whole grains, healthy protein sources, and minimally processed foods among its 9 features of a heart-healthy pattern (Lichtenstein et al., 2026).

The handout is also practical. Its back page suggests moving step by step, from the plant-based meals a person already enjoys to new ones, with tips for eating out and with family, and it sends the reader to a registered dietitian nutritionist or regular health care provider for the change itself (American College of Lifestyle Medicine, 2024c). That last line lets a coach honor a client's interest in the plate without taking on a role that belongs to someone else.

How clients describe it, and what it gets confused with

Clients say "the ACLM plate," "the lifestyle medicine plate," "the plant-based plate," "whole food plant-based" or "WFPB," or "the handout from my lifestyle medicine doctor." Some will have the 2019 divided plate and some the 2024 photograph.

It is often confused with other plate pictures that divide the plate differently: the Harvard Healthy Eating Plate, MyPlate and the Diabetes Plate Method, each with its own page in this archive. It is also confused with the vegan diet, which can include highly processed foods (the Vegan Diet page), and with the whole food, plant-based eating pattern itself, which the Whole-Food Plant-Based Diet page covers; this page covers the handout. Full Plate Living, a free program from a different nonprofit, the Ardmore Institute of Health, that the College's pages mention, is not this plate either (American College of Lifestyle Medicine, n.d.-d).

2. In practice

A typical day of eating

A day built on the plate might look like this. Breakfast is oats with berries and ground flax. Lunch is one of the College's "nourish bowl" ideas, such as romaine, grilled peppers, roasted sweet potato, black beans, salsa and lime juice (American College of Lifestyle Medicine, 2024b). Dinner is lentil and vegetable soup with whole grain bread and a salad, and a snack might be an apple with peanut butter. Water is the drink. What a real day looks like depends on what the person already eats and who cooks; the handout's first step is to keep the plant-based meals a person already enjoys (American College of Lifestyle Medicine, 2024c).

Cost, products, and who profits

The plate itself is a free handout, and the foods on it are ordinary groceries. No study found for this page measured the cost of eating by the plate. In a crossover trial of a closely related pattern in adults with overweight, food costs fell by about $1.80 a day, or 19 percent, on a low-fat vegan diet and did not change clearly on a Mediterranean diet, mostly through buying less meat, dairy and added fat (Kahleova et al., 2024). Costs were estimated from food records using national average prices, and the trial was funded by the Physicians Committee for Responsible Medicine, the nonprofit that paid or was led by several of its authors.

The College describes itself as a nonprofit offering education, practice resources and a professional network, and its site sells conference registration with continuing education credit (American College of Lifestyle Medicine, n.d.-a). A client following the plate needs none of these. The real cost is time: cooking beans and whole grains takes planning, and the plate's own tips suggest batch preparation (American College of Lifestyle Medicine, 2024c).

Environmental footprint

No study found for this page measured the environmental footprint of following the plate. A systematic review of studies that modeled shifts from typical Western diets to more sustainable patterns found that greenhouse gas emissions and land use could fall by as much as 70 to 80 percent and water use by as much as 50 percent, with medians of about 20 to 30 percent, and that reductions were generally proportional to how far animal foods were cut (Aleksandrowicz et al., 2016). These are modeled population estimates, not measurements in people. The College's position that individual and planetary health are "inextricably linked" is its stated position, not a finding (American College of Lifestyle Medicine, n.d.-c).

Cultural fit

Because the plate is built from food groups rather than dishes, it can hold many food traditions: beans with rice or tortillas, lentil dal, tofu stir-fries and bean stews already fit it, and the College's bowl guide offers burrito, Mediterranean and Asian peanut versions (American College of Lifestyle Medicine, 2024b). The harder fit is for cuisines and family meals in which animal foods carry meaning or much of the protein. The College's patient page offers Spanish versions of several handouts, but this page did not find a Spanish plate among them (American College of Lifestyle Medicine, n.d.-b).

What makes people stop

No study found for this page asked why people stop using the plate. In the New Zealand BROAD trial of a whole food plant-based program, 75 percent of participants completed the study to 6 months (Wright et al., 2017). Beyond that, what follows is observation: eating out, family meals in which others eat differently, cooking time, and the feeling that the plate is all or nothing. The 2024 handout's tips address several of these directly (American College of Lifestyle Medicine, 2024c).

What happens when you stop

No study found for this page followed people after they deliberately stopped using the plate. In the BROAD trial, the intervention group's average body mass index was 4.2 points lower than at the start at 12 months, close to the 4.4-point fall at 6 months; the control group was not followed to 12 months, so this shows how results held within one group, not a comparison (Wright et al., 2017).

Common variations

• The 2019 adult plate, a plate divided into halves and quarters with the subtitle "Nutrition Prescription for Treating & Reversing Chronic Disease" (American College of Lifestyle Medicine, 2019).
• The 2024 adult plate, a photograph with 3 food group labels, no section lines and no subtitle on the front; its back page still prints the College's 2018 dietary position (American College of Lifestyle Medicine, 2024c).
• The College's Dietary Spectrum handout, which shows a scale from typical American eating to a whole food plant-based eating plan (American College of Lifestyle Medicine, 2024a).
• The College's nourish bowl guide, which builds a meal in a bowl from the same food groups (American College of Lifestyle Medicine, 2024b).
• Other plates with different purposes: the Harvard Healthy Eating Plate, MyPlate and the Diabetes Plate Method, each with its own page in this archive.

3. For the coach

SCOPE OF PRACTICE

A health and wellness coach does not prescribe, adjust, endorse, or discourage the plate or the eating pattern it shows, and does not diagnose or treat. Lifestyle medicine is a medical specialty; when the College speaks of treating or reversing disease, it is describing clinical work done by licensed clinicians. With the client's permission, a coach can share the College's public description of the plate and explore how the client wants to use it. The coach helps the client understand what they have chosen, notice how it is going, and decide what to do next.

The plate needs a physician, a registered dietitian or another licensed professional in pregnancy, breastfeeding, childhood, kidney disease, or older age with a small appetite. A client taking blood pressure medicine, warfarin, insulin, a sulfonylurea or a meglitinide keeps the prescriber informed before a substantial change in eating; the coach does not adjust medication. A real concern about eating behavior goes through the coach’s own referral process, or to the client's clinician under an existing care plan.

Who does what

The physician or prescribing clinician

Decides whether a change in eating is medically safe for this person, orders and reads the labs that matter (HbA1c, blood lipids, kidney function, and vitamin B12 status where it is a concern), and adjusts medicines that a change in eating can affect, including insulin, sulfonylureas, meglitinides, warfarin and blood pressure medicines. A lifestyle medicine physician who prescribes the pattern for a condition is doing clinical work.

The registered dietitian nutritionist

Designs and monitors the individual eating plan, checks that it meets the person's needs for protein, vitamin B12, calcium, vitamin D, iron and other nutrients, and adapts it to a diagnosed condition, a pregnancy, a child's growth, kidney disease or a food tradition. Both the College's 2026 position and the 2024 plate name dietitians as the professionals who help with the change (American College of Lifestyle Medicine, n.d.-c, 2024c).

The health and wellness coach

Helps the client explore their own reasons for the plate, test it against their values and their actual week, build the habits that make it workable, and notice how it is going. For this plate, that might mean exploring which meals already fit and how the household eats. The coach holds the referral line when medication, pregnancy, a child's eating, unplanned weight loss or eating distress comes up.

What a client bringing this plate needs

A client who brings the plate is often motivated by something specific: a diagnosis, a clinician's advice, a documentary, or concern for animals or the environment. Some were handed it by a lifestyle medicine clinic as part of treatment; others found it online. What they usually need is help with the gap between a picture and their kitchen: what to cook on a busy evening, how to eat with family members who do not want to change, and what to do on the days it does not happen. Questions about nutrients, protein or supplements can be written down for the dietitian or clinician. The coaching conversation offers what a handout cannot: clarity about the client's own reasons, a realistic look at how the plate fits their life, and a plan they own.

What to ask

• "What drew you to this plate, and what do you hope it will do for you?"
• "Which meals you already eat are closest to it?"
• "If you decide to try it, what would a first step look like that fits the way your household eats?"
• "Who on your health care team knows you are thinking about this change, and how would you like to tell them?"

Referral red flags

Any of these means the client involves their clinician or dietitian, or for eating behavior the coach’s own referral process, rather than continuing with coaching alone.

• A client on insulin, a sulfonylurea or a meglitinide who plans a substantial change in eating. These medicines can cause low blood sugar, and a large change in what and how much a person eats can change what their dose should be (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).
• A client who reports being shaky, dizzy, confused or unusually irritable, which can be signs of low blood sugar (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.). The first step is the one in the client's own diabetes plan for treating it, with emergency help if the symptoms are severe or the client cannot manage the episode; telling the prescriber is the separate step that follows.
• A client on warfarin who plans to eat a lot more leafy green vegetables. The medicine's patient information asks people to keep vitamin K foods consistent from week to week and to talk to their doctor before changing their diet (American Society of Health-System Pharmacists, n.d.).
• A client who is pregnant or breastfeeding, a parent planning to raise a child on the plate, or an older adult with a small appetite, who is following the plate without individual guidance.
• A client with kidney disease, whose eating plan is set by the kidney care team.
• Weight the client is losing without meaning to, or tiredness that does not lift, each a reason to involve the clinician rather than a diagnosis.
• Eating that has become frightening, rigid or secret, or a list of permitted foods that keeps shrinking. This goes through the coach’s own referral process, or to the client's clinician under an existing care plan.

Special populations

Pregnancy and breastfeeding

No study found for this page tested the plate in pregnancy. A 2024 systematic review found only 6 studies of vegan diets in pregnancy; vegan participants ate less protein and several micronutrients than omnivores, vitamin B12 supplements appeared to keep their B12 levels adequate, and their babies had lower birth weights, but the studies were too few and too varied for firm conclusions (Meulenbroeks et al., 2024). The Academy of Nutrition and Dietetics' 2025 position on vegetarian and vegan patterns covers nonpregnant, nonlactating adults (Raj et al., 2025). Eating in pregnancy and while breastfeeding is planned with the obstetric team and a dietitian.

Children and adolescents

No study found for this page tested the plate in children. A 2025 systematic review of 20 studies comparing vegetarian and omnivorous children and adolescents in high-income countries found higher fiber intake and more energy from carbohydrate in the vegetarian children, and lower intakes of vitamin B12 and vitamin D as a potential risk (Reis et al., 2025). A child's eating plan is set with the child's clinician and a dietitian.

Older adults

No trial found for this page tested the plate in older adults alone. In a cohort of 26,318 women in the United Kingdom aged 35 to 69 at the start, vegetarian women had a higher rate of hip fracture than regular meat-eaters (hazard ratio 1.33, 95 percent confidence interval 1.03 to 1.71), an association that does not show the diet caused the fractures (Webster et al., 2022). For an older adult with a small appetite or low body weight, a change to plant-only eating is planned with a dietitian.

Athletes and people with high activity

No study found for this page tested the plate in athletes. A 2025 meta-analysis of 8 randomized trials with 188 adults found no clear difference in muscular strength between plant-based and omnivorous diets (López-Moreno et al., 2025). Those trials were small, and an athlete's energy and protein needs are planned individually with a sports dietitian.

People taking medication for diabetes, blood pressure, or blood thinning

Insulin, sulfonylureas and meglitinides can cause low blood sugar (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.), and warfarin works best when vitamin K intake stays steady (American Society of Health-System Pharmacists, n.d.). A client taking blood pressure medicine, warfarin, insulin, a sulfonylurea or a meglitinide keeps the prescriber informed before a substantial change in eating, not after a problem appears. The coach does not adjust medication.

People with kidney disease

The kidney care team sets the eating plan for each person with kidney disease, because needs depend on the stage of the disease, lab results and dialysis. Plant foods are not a hazard for everyone with kidney disease, and they are not a decision for the coach.

People with a history of disordered eating

The plate has no counting, but it removes whole groups of foods, and any set of food rules can become rigid for some people. Cross-sectional studies link vegetarian and vegan diets with higher orthorexia symptom scores, a preoccupation with eating "correctly," but not clearly with general eating disorder symptoms (section 4). A coach who notices distress around eating uses their own referral process, or works within the client's existing care plan.

Client misconceptions

"If it's plant-based, it's healthy." A plant-based pattern built on refined grains, sweets and sugary drinks went with more heart disease, not less (Satija et al., 2017). The plate's word "whole" matters.

"Research proves this plate reverses disease." No study found for this page isolated the plate's effect. The 13 vegan-diet trials in the Cochrane review reported changes in risk markers but no cardiovascular events or deaths (Rees et al., 2021); they do not establish that the plate reverses disease. Section 6 traces where the claim comes from.

"I can't stay strong without meat." Small trials found no clear difference in strength between plant-based and omnivorous diets (López-Moreno et al., 2025); individual protein needs are a dietitian's question.

🤝 COACHING CONNECTION

Denise brings the College's plate to her coaching session. "My new doctor gave me this. She said if I eat like this I might not need my blood pressure pills. But my husband won't touch beans." The coach asks what Denise took from the visit and what matters most to her about it. Denise says she wants to be around for her grandchildren and that she already likes lentil soup. She decides to start with 2 lentil-soup dinners a week that her husband can add chicken to, and to write down her questions about her blood pressure medicine to ask at her next appointment rather than stopping anything herself. The coach gives no advice about her food or her medicine.

4. The evidence

(select the heading to open or close this section)

No study found for this page isolated the effect of giving someone the plate handout. The research summarized here concerns vegan and vegetarian dietary programs and plant-based diet scores. Shorter trials show modest falls in HbA1c and LDL cholesterol in some comparisons, with no clear effect on blood pressure. The 13 vegan-diet trials in the Cochrane review reported no cardiovascular events or deaths. The broader review includes a multicomponent trial that also reported cardiac events; that trial does not establish an effect of this plate. Cohort studies link healthful plant-based eating with lower rates of several diseases and death, which is association rather than proof. The eating pattern itself has its own page in this archive, Whole-Food Plant-Based Diet.

A study that used the handout

One study found for this page handed out the plate: in the NUTRIVENTION trial, every participant received the College's plate handout along with 12 weeks of delivered high-fiber, plant-based meals and 24 weeks of coaching (Shah et al., 2026). It had no comparison group, enrolled 23 adults with blood conditions that can precede multiple myeloma, and tested feasibility and blood markers; 20 participants were assessed at 12 weeks and 18 at 52 weeks. It shows the handout is used inside clinical programs, and nothing about the handout's own effect.

Evidence from randomized controlled trials

A trial assigns people to an eating pattern or to something else by chance, which is the strongest way to test whether the pattern causes a result.

Most dietary interventions summarized here were vegan, while the Koch review also included vegetarian interventions, and a few trials tested a whole food plant-based diet by name. Many included classes, cooking lessons, meal plans or provided food, so they tested programs rather than a picture.

Blood sugar and other markers in the blood

A 2022 systematic review pooled 11 randomized trials lasting 12 to 26 weeks in adults with overweight or type 2 diabetes, comparing vegan diets with the person's usual diet or another diet, such as a conventional diabetes, Mediterranean or low-fat diet. HbA1c fell 0.18 percentage points more on the vegan diets (95 percent confidence interval 0.07 to 0.29), and LDL cholesterol 0.24 mmol/L more, about 9 mg/dL (0.07 to 0.40 mmol/L); no clear difference in blood pressure was detected. Using GRADE, the authors rated the HbA1c and blood pressure evidence moderate certainty and the cholesterol evidence low (Termannsen et al., 2022).

The authors noted that some control diets restricted calories and others did not, and that differences in energy intake may explain part of the effect. The review's summary table labels its cholesterol differences in mmol/mol, while its text gives mmol/L, the correct unit; this page uses the text.

A 2021 Cochrane review included 13 randomized trials of vegan diets with at least 12 weeks of follow-up. Against no or minimal intervention, in people without heart disease, over 16 to 26 weeks, a vegan diet probably led to a small fall in LDL cholesterol, 0.22 mmol/L (0.11 to 0.32), rated moderate certainty, with no clear effect on blood pressure, rated low. Against other diets, there was probably little or no difference in LDL cholesterol. None of the 13 trials reported heart attacks, strokes or deaths, and the authors judged the information insufficient for conclusions about cardiovascular risk factors (Rees et al., 2021).

A 2023 meta-analysis of 30 randomized trials of vegetarian or vegan diets against omnivorous diets reported LDL cholesterol 0.30 mmol/L lower (0.19 to 0.40), with lower apolipoprotein B, another marker of cholesterol-carrying particles, and no clear difference in triglycerides; its authors found signs that small trials with larger effects may be overrepresented (Koch et al., 2023).

The 30-trial review covered interventions lasting 10 days to 5 years. It included a 5-year trial combining a low-fat whole-food vegetarian diet with exercise, stress management, smoking cessation and group support. That trial reported cardiac events and deaths, but could not separate the effect of diet from the other program components (Ornish et al., 1998). It did not test the College's plate.

In the New Zealand BROAD trial, 65 adults with obesity or overweight and a cardiometabolic condition were randomized to usual care or usual care plus a 12-week community program of twice-weekly sessions with cooking lessons and a whole food plant-based diet without calorie limits, with vitamin B12 supplements. At 6 months HbA1c was 5 mmol/mol lower than with usual care, while the difference in total cholesterol, 0.45 mmol/L, was not statistically clear (Wright et al., 2017). The program asked people to avoid added oils and discouraged nuts and avocados, a stricter version than the plate.

A later New Zealand waitlist-controlled trial enrolled 56 adults, most of whom were Māori, in a 10-week whole food plant-based community program developed with local cultural input. It did not detect clear between-group differences in HbA1c or total cholesterol at 10 weeks. Body weight fell 3.3 kg more in the intervention group at 10 weeks (95 percent confidence interval 0.8 to 5.7 kg), reported as a measurement. After waitlisted participants were offered the program, follow-up described changes within the combined intervention group and was no longer a randomized comparison (Smith et al., 2025). This tested a supported program, not the plate handout.

In a 74-week U.S. trial, 99 adults with type 2 diabetes were randomized to a low-fat vegan diet or to the American Diabetes Association's 2003 guidelines. Changes in HbA1c from the start to the last available value were 0.34 and 0.14 points lower, a difference that was not statistically clear; when values were taken before any change in diabetes medicine, the vegan group's HbA1c fell 0.40 points against essentially no change, and before changes in cholesterol medicine LDL cholesterol fell 13.5 mg/dL on the vegan diet against 3.4 mg/dL (Barnard et al., 2009). Those secondary analyses carried forward each participant's last value before a medication change, a method the authors note can under- or overestimate an effect.

Cancer

No randomized trial found for this page reported cancer outcomes; the single-arm NUTRIVENTION study tracked blood markers of a condition that can precede myeloma and does not establish an effect on cancer (Shah et al., 2026).

Body weight, as measured

In the 2022 review, body weight fell 4.1 kg more on the vegan diets (2.4 to 5.9 kg), rated moderate certainty after lowering for inconsistency (Termannsen et al., 2022). In BROAD, body mass index fell 3.9 points more than with usual care at 6 months (Wright et al., 2017). In the 74-week U.S. trial, weight fell within both groups, 4.4 and 3.0 kg, with no statistically clear difference (Barnard et al., 2009). The archive reports weight as a measurement, never as a goal or a sign of success.

Mortality

None of the 13 vegan-diet trials in the Cochrane review reported deaths or cardiovascular events (Rees et al., 2021). The multicomponent trial described above does not establish a separate dietary effect (Ornish et al., 1998). This evidence does not establish an effect of the College's plate on mortality.

Eating behavior and wellbeing

Quality of life had improved by 52 weeks in the NUTRIVENTION study, though without a comparison group that change cannot be separated from the meals and attention the program provided (Shah et al., 2026). Studies of eating disorder symptoms in people following vegetarian or vegan diets compare groups at one point in time. A 2026 meta-analysis of 26 such studies found higher orthorexia symptom scores among vegetarians and vegans than omnivores, with high inconsistency and low study quality (Díaz-Goñi, Bizzozero-Peroni, et al., 2026); another, of 24 studies, found no clear difference in general eating disorder symptoms (Díaz-Goñi, Mesas, et al., 2026). Neither can say whether the diet or the symptoms come first.

Evidence from long-term prospective cohort studies

A cohort study follows people who already eat a certain way and records what happens to them. It can show that a pattern goes with an outcome; it cannot by itself show that the pattern caused it. Cohort studies of plant-based eating mostly score each person's diet on a plant-based diet index rather than classifying them as following a plate, and some indexes reward foods the plate leaves out, such as vegetable oils, tea and coffee.

Cardiometabolic outcomes

In 3 large U.S. cohorts of health professionals, 209,298 adults free of chronic disease were followed for up to 28 years, with 8,631 new cases of coronary heart disease. People scoring highest on a healthful plant-based diet index, which rewarded whole grains, fruits, vegetables, nuts, legumes, oils, tea and coffee and penalized refined grains, sweets, sugary drinks, fries and animal foods, had a 25 percent lower rate of coronary heart disease than those scoring lowest (hazard ratio 0.75, 0.68 to 0.83). People scoring highest on an unhealthful plant-based index, which rewarded refined grains, sweets, sugary drinks and potatoes, had a 32 percent higher rate (1.32, 1.20 to 1.46) (Satija et al., 2017). The comparison is between the highest and lowest tenths of each score.

A 2019 meta-analysis of 9 prospective studies with 307,099 participants found that higher adherence to plant-based dietary patterns went with a 23 percent lower risk of type 2 diabetes (relative risk 0.77, 0.71 to 0.84), and a 30 percent lower risk when the pattern was defined by healthful plant foods (0.70, 0.62 to 0.79) (Qian et al., 2019). This page read that meta-analysis's abstract.

Cancer

A 2026 meta-analysis of 7 prospective studies found that vegetarians had a 13 percent lower rate of cancer overall than non-vegetarians (relative risk 0.87, 0.84 to 0.91, 4 studies), and vegans a 23 percent lower rate (0.77, 0.70 to 0.85, 3 studies), with lower rates of several specific cancers; the authors judged the evidence probable for vegetarian diets and total, colorectal, colon and breast cancer, using the World Cancer Research Fund's criteria, not GRADE, and noted that body mass index explained a moderate part of the associations (Aune et al., 2026). This page read that meta-analysis's abstract.

Body weight, as measured

The cohort studies found for this page treated body weight as something to adjust for rather than an outcome; in the cancer meta-analysis, body mass index explained a moderate part of the lower cancer rates (Aune et al., 2026).

Mortality

A 2025 meta-analysis of 11 cohort studies found that people with the highest scores on a plant-based diet index had a 15 percent lower rate of death from any cause than those with the lowest (hazard ratio 0.85, 0.80 to 0.90), and those with the highest healthful index score a 14 percent lower rate (0.86, 0.81 to 0.92), while the highest unhealthful index score went with a 20 percent higher rate (1.20, 1.11 to 1.31) (Mo et al., 2025). This page read that meta-analysis's abstract.

Highlighted studies

These 4 studies carry the most weight for this page. The first is the only study found that handed out the plate; the others tested or measured the pattern it shows.

On a narrow screen, scroll the table sideways to see every column.

Highlighted studies for the Whole Food Plant-Based Plate

Study	Design	Sample size	Duration	Finding	The limitation that matters
Shah et al., 2026, the NUTRIVENTION trial (United States)	Single-arm trial, no comparison group; the plate handout given to every participant	Adults with conditions that can precede multiple myeloma and a body mass index of 25 or more: 23 enrolled; 20 assessed at 12 weeks and 18 at 52 weeks	12 weeks of meals, 24 weeks of coaching, follow-up to 52 weeks	All 20 participants assessed at 12 weeks met the target of at least 70 percent of energy from minimally processed plant foods. Selected blood markers changed, and quality of life improved by 52 weeks.	No comparison group, and the plate was one small part of a program that provided meals and coaching
Termannsen et al., 2022 (systematic review)	Meta-analysis of 11 randomized trials, vegan diets against usual or other diets	Up to 780 adults with overweight or type 2 diabetes per outcome	12 to 26 weeks	HbA1c 0.18 points lower (moderate certainty); LDL cholesterol 0.24 mmol/L lower (low certainty); no clear difference in blood pressure (moderate certainty)	Short trials, mixed comparison diets, and energy intake that differed between groups
Wright et al., 2017, the BROAD trial (New Zealand)	Randomized controlled trial: community whole food plant-based program against usual care	65 adults with obesity or overweight and a cardiometabolic condition	12-week program, measured at 6 months, intervention group followed to 12 months	HbA1c 5 mmol/mol lower than usual care at 6 months; total cholesterol difference not statistically clear	Small, one practice, a stricter diet than the plate (no added oil, nuts discouraged), and 25 percent dropout
Satija et al., 2017 (United States)	Prospective cohort analysis of 3 cohorts	209,298 health professionals	Up to 28 years	Highest against lowest healthful plant-based index: 25 percent lower rate of coronary heart disease; unhealthful index: 32 percent higher	Association only, in health professionals; the index rewards oils, tea and coffee and does not exclude animal foods

Head to head

The searches for this page found no trial comparing the College's plate with another plate picture. The comparisons that exist are between eating patterns: against conventional diabetes diet guidance, the overall HbA1c difference with the low-fat vegan diet was not statistically clear; a secondary analysis carrying forward each participant's last value before a diabetes-medication change favored the vegan group, but that method can under- or overestimate an effect (Barnard et al., 2009); against other diets, the Cochrane review found probably little or no difference in LDL cholesterol (Rees et al., 2021). The Mediterranean Diet page covers the Mediterranean pattern's own trials.

Comparing the pictures themselves shows where they differ. Both the College's plate and the Harvard Healthy Eating Plate give the largest share to vegetables and fruit, include whole grains, and show water. Harvard's protein quarter includes fish and poultry; the College's shows only plant protein. Harvard shows healthy oil and limits dairy to 1 or 2 servings a day; the College's shows neither. Harvard says potatoes do not count as vegetables; the College's lists them (Harvard T.H. Chan School of Public Health, n.d.-a; American College of Lifestyle Medicine, 2024c).

In Harvard's own comparison, MyPlate does not separate potatoes from other vegetables, says nothing about oils, recommends dairy at every meal, and lets any protein source fill its protein section (Harvard T.H. Chan School of Public Health, n.d.-b); that is Harvard's description of MyPlate, not MyPlate's own. When this page was written, the MyPlate.gov home page carried only a banner sending readers to RealFood.gov for the new edition of the Dietary Guidelines for Americans (U.S. Department of Agriculture, n.d.).

Where the evidence is absent

• No study found for this page tested the plate handout on its own, or compared it with another plate picture; the one study that used it gave it to everyone as part of a larger program.
• The 13 vegan-diet trials in the Cochrane review reported no cardiovascular events or deaths. The broader review includes a multicomponent trial that also reported cardiac events; that trial does not establish an effect of this handout.
• The searches found no trial isolating the plate handout's effect. The evidence summarized for selected populations concerns vegan or vegetarian dietary patterns, not this handout.
• Most trials enrolled adults with overweight or type 2 diabetes, and most were short.
• No study found for this page measured the cost or the environmental footprint of eating by the plate, or followed people after they deliberately stopped using it.
• The searches for this page found no published critique of the plate itself; the limits named here are the ones the research reports.

5. Mechanisms

(optional reading; select the heading to open or close this section)

This section explains how the eating pattern the plate shows is thought to work. You can skip it. Nothing in the coaching sections depends on it.

Established mechanisms

This page found no study that tested how the plate itself works. In trials of vegetarian or vegan diets compared with omnivorous diets, LDL cholesterol and apolipoprotein B concentrations were lower (Koch et al., 2023). Apolipoprotein B is a protein on cholesterol-carrying lipoprotein particles, and its concentration is used to estimate the number of those particles. These are changes in blood markers, not a test of the plate's mechanism. The American Heart Association's guidance to choose sources of unsaturated fat in place of saturated fat describes the same direction (Lichtenstein et al., 2026).

Proposed mechanisms

Several explanations are plausible but were not tested directly in the studies found for this page. Termannsen and colleagues proposed that differences in macronutrients and energy intake between the vegan and control diets may account for part of the fall in weight and HbA1c (Termannsen et al., 2022). The NUTRIVENTION study proposed that fiber changes gut bacteria and immune function, with its strongest evidence for that from mice (Shah et al., 2026). A proposed mechanism never supports a claim in section 4.

6. Risks, contraindications and myths

(select the heading to open or close this section)

None of the sources opened for this page carries a warning from a professional or regulatory body about the plate itself, so this section has no heading for one. The Academy of Nutrition and Dietetics' position is that, in adults, "appropriately planned" vegetarian and vegan patterns can be nutritionally adequate and can offer long-term health benefits (Raj et al., 2025); the cautions below concern what appropriate planning means.

Nutrient gaps

The plate's food lists name no fortified food or supplement. The College's own article on plant-based nutrition describes a whole food plant-based diet as one that excludes animal foods "with certain selective supplementation of vitamins B12. Sometimes D" (American College of Lifestyle Medicine, 2023), and trials of the pattern supplied vitamin B12 to their participants (Wright et al., 2017). Reviews of vegetarian children and of vegan pregnancies identified lower intakes of vitamin B12 and vitamin D, and of protein and several micronutrients, respectively (Meulenbroeks et al., 2024; Reis et al., 2025). The plate itself does not mention supplements; a client's needs are a question for their clinician or dietitian.

Who should not follow it without medical supervision

The groups listed under Special populations in section 3: people on blood pressure medicine, insulin, a sulfonylurea, a meglitinide or warfarin; people with kidney disease; anyone pregnant or breastfeeding; children and teenagers; older adults with a small appetite; and anyone with a history of disordered eating.

Medication interactions

The plate does not interact with any medicine directly; what matters is that following it can change what and how much a person eats. In the BROAD trial, participants' general practitioners made all prescribing decisions (Wright et al., 2017). That is a reason for the client to keep the prescriber informed before a substantial change, not a reason to avoid the plate. A coach never adjusts or comments on a dose, and a possible low blood sugar episode is handled first under the client's own diabetes plan, as section 3 describes (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Signs it is going wrong

Shakiness, dizziness or confusion in someone taking diabetes medicine calls for the response in the client's own diabetes plan, with emergency help when needed, followed by informing the prescriber. Persistent tiredness and weight the client is losing without meaning to are reasons to involve the clinician.

If a permitted-food list is shrinking, meals cause distress, or the client avoids eating with others, the coach asks what the behavior is for, whether it causes distress, whether it narrows eating, and whether it interferes with daily life. Meal timing, food preferences or social circumstances can have ordinary explanations. A real eating-behavior concern goes through the coach’s own referral process, or to the client's clinician under an existing care plan. These observations are not diagnoses, and unintended weight loss is never a goal or a sign that the plate is working.

Myths and where they came from

Myth: "If it's plant-based, it's healthy."

Where it came from: a broad belief this page did not trace to a single source. What is true: in the U.S. cohorts that separated healthful from unhealthful plant foods, a plant-based pattern built on refined grains, sweets, sugary drinks and potatoes went with a higher rate of coronary heart disease (Satija et al., 2017). The plate's word "whole" is the point.

Myth: "This plate is proven to reverse disease."

Where it came from: the plate's 2019 subtitle and the College's position statements, which use the word "reversal" for clinical treatment (American College of Lifestyle Medicine, 2018, 2019). What is true: no study found for this page isolated the plate's effect. The vegan-diet reviews chiefly establish changes in risk markers (Rees et al., 2021; Termannsen et al., 2022), and the 13 trials in the Cochrane review reported no cardiovascular events or deaths (Rees et al., 2021). The multicomponent vegetarian trial described in section 4 cannot establish the effect of this plate (Ornish et al., 1998).

Myth: "You can't build strength without animal protein."

Where it came from: a common belief this page did not trace to a single source. What is true: a meta-analysis of 8 small randomized trials found no clear difference in muscular strength between plant-based and omnivorous diets (López-Moreno et al., 2025). Individual protein needs, especially in older age, are still a dietitian's question.

7. Key terms

Whole Food Plant-Based Plate

The American College of Lifestyle Medicine's patient handout picturing a meal of fruit and vegetables, whole grains, and legumes, nuts and seeds, with water, herbs and spices; the College titles it "A Whole Food, Plant-Based Plate."

Lifestyle medicine

A medical specialty that uses changes in eating, activity, sleep, stress, substance use and social connection to prevent and treat chronic disease, practiced by licensed clinicians.

Whole food, plant-based (WFPB)

An eating pattern built on minimally processed plant foods; the College's own materials range from excluding animal foods to keeping them to a minimum. The pattern has its own archive page, Whole-Food Plant-Based Diet.

Vegan diet

An eating pattern that excludes all foods of animal origin, whether or not the remaining foods are whole or processed.

HbA1c

A blood test that reflects average blood sugar over the past few months; a marker, not a disease outcome.

LDL cholesterol

Cholesterol carried in low-density lipoprotein particles, a marker of heart disease risk; a change in LDL is not itself a change in heart attacks or strokes.

Plant-based diet index

A score researchers give each person's diet for how much it leans toward plant foods; the healthful version rewards whole plant foods and the unhealthful version rewards refined ones.

Single-arm trial

A study in which everyone receives the same program and there is no comparison group, so changes cannot be separated from time, attention or chance.

Vitamin B12

A vitamin found naturally in animal foods rather than plant foods; the College's 2023 article on plant-based nutrition says people eating this way need it from supplements, fortified foods or both (American College of Lifestyle Medicine, 2023).

8. Review questions

1. Describe the American College of Lifestyle Medicine's plate: the food groups it shows, what it leaves out, and 2 ways the 2024 version differs from the 2019 version. Name 3 differences between this plate and the Harvard Healthy Eating Plate.
2. For readers who open section 4: what did the trials of vegan diets compare, what did they measure, for how long, and what did they not report? Why are the ratings on this page not ratings of the plate?
3. A client says, "My lifestyle medicine doctor gave me this plate, and I take insulin. I want to go fully plant-based starting tomorrow." What does the coach explore, and where is the referral line?
4. For readers who open section 6: where does the claim that this plate reverses disease come from, and what does the research found for this page show instead?

9. References and Resources

Aleksandrowicz, L., Green, R., Joy, E. J., Smith, P., & Haines, A. (2016). The impacts of dietary change on greenhouse gas emissions, land use, water use, and health: A systematic review. PLOS ONE, 11(11), Article e0165797. https://doi.org/10.1371/journal.pone.0165797

American College of Lifestyle Medicine. (n.d.-a). ACLM brand usage guide for partners and collaborators. lifestylemedicine.org/aclm-brand-usage-guide-for-partners-and-collaborators

American College of Lifestyle Medicine. (n.d.-b). Lifestyle medicine for patients. lifestylemedicine.org/patient

American College of Lifestyle Medicine. (n.d.-c). Recommendations and standards. lifestylemedicine.org/about-aclm/research-and-quality/recommendations-standards

American College of Lifestyle Medicine. (n.d.-d). Virtual lifestyle medicine intensivist fellowship. lifestylemedicine.org/academic-integration/virtual-lifestyle-medicine-intensivist-fellowship

American College of Lifestyle Medicine. (n.d.-e). What is lifestyle medicine? lifestylemedicine.org/about-lifestyle-medicine

American College of Lifestyle Medicine. (2018, September 25). American College of Lifestyle Medicine announces dietary lifestyle position statement for treatment and potential reversal of disease [Press release]. PRWeb. prweb.com/releases/american_college_of_lifestyle_medicine_announces_dietary_lifestyle_position_statement_for_treatment_and_potential_reversal_of_disease/prweb15786205.htm

American College of Lifestyle Medicine. (2019). A whole food, plant-based plate: Nutrition prescription for treating & reversing chronic disease [Infographic]. Copy hosted by The Ohio State University Health Plan. osuhealthplan.com/sites/default/files/2020-09/aclm-plategraphic-adult.pdf

American College of Lifestyle Medicine. (2023, March 1). The benefits of plant-based nutrition. lifestylemedicine.org/benefits-plant-based-nutrition

American College of Lifestyle Medicine. (2024a). Dietary spectrum [Infographic]. lifestylemedicine.org/wp-content/uploads/2026/02/Dietary-Spectrum.pdf

American College of Lifestyle Medicine. (2024b). Nourish bowl guide [Infographic]. lifestylemedicine.org/wp-content/uploads/2026/02/Nourish-Bowls.pdf

American College of Lifestyle Medicine. (2024c). A whole food, plant-based plate [Infographic]. learning.lifestylemedicine.org/sites/default/files/media/2025-07/ACLM-PlateGraphic-Adult24%20%281%29_0.pdf

American Society of Health-System Pharmacists. (n.d.). Warfarin. MedlinePlus, National Library of Medicine. medlineplus.gov/druginfo/meds/a682277.html

Aune, D., Schlesinger, S., & Sobiecki, J. G. (2026). Vegetarian and vegan diets and cancer incidence: A systematic review and meta-analysis of prospective studies. European Journal of Epidemiology, 41(5), 531-545. https://doi.org/10.1007/s10654-026-01380-8

Barnard, N. D., Cohen, J., Jenkins, D. J. A., Turner-McGrievy, G., Gloede, L., Green, A., & Ferdowsian, H. (2009). A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: A randomized, controlled, 74-wk clinical trial. The American Journal of Clinical Nutrition, 89(5), 1588S-1596S. https://doi.org/10.3945/ajcn.2009.26736H

Cara, K. C., Goldman, D. M., Kollman, B. K., Amato, S. S., Tull, M. D., & Karlsen, M. C. (2023). Commonalities among dietary recommendations from 2010 to 2021 clinical practice guidelines: A meta-epidemiological study from the American College of Lifestyle Medicine. Advances in Nutrition, 14(3), 500-515. https://doi.org/10.1016/j.advnut.2023.03.007

Crocker, S. (2025, June 26). Delivering lifestyle medicine to the community: A YMCA example. American College of Lifestyle Medicine. lifestylemedicine.org/delivering-lifestyle-medicine-to-the-community-a-ymca-example

Díaz-Goñi, V., Bizzozero-Peroni, B., Visier-Alfonso, M. E., Jiménez-López, E., Fernández-Rodríguez, R., López-Gil, J. F., Martins-de-Passos, T. O., González, A. D., Martínez-Vizcaíno, V., & Mesas, A. E. (2026). The associations between vegetarian and vegan diets and orthorexia nervosa symptoms in adults: A systematic review and meta-analysis. International Journal of Eating Disorders, 59(3), 409-423. https://doi.org/10.1002/eat.24596

Díaz-Goñi, V., Mesas, A. E., Jiménez-López, E., Olivo-Martins-de-Passos, T., Peral-Martínez, F., Peraile-Huerta, A. M., Visier-Alfonso, M. E., Garrido-Miguel, M., & Bizzozero-Peroni, B. (2026). Are vegetarian and vegan diets associated with eating disorder symptoms? A systematic review and meta-analysis. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70158

Harvard T.H. Chan School of Public Health. (n.d.-a). Healthy Eating Plate. The Nutrition Source. nutritionsource.hsph.harvard.edu/healthy-eating-plate

Harvard T.H. Chan School of Public Health. (n.d.-b). Healthy Eating Plate vs. USDA's MyPlate. The Nutrition Source. nutritionsource.hsph.harvard.edu/healthy-eating-plate-vs-usda-myplate

Kahleova, H., Sutton, M., Maracine, C., Nichols, D., Monsivais, P., Holubkov, R., & Barnard, N. D. (2024). Food costs of a low-fat vegan diet vs a Mediterranean diet: A secondary analysis of a randomized clinical trial. JAMA Network Open, 7(11), Article e2445784. https://doi.org/10.1001/jamanetworkopen.2024.45784

Karlsen, M. (2026, February 9). ACLM releases updated dietary position statement. American College of Lifestyle Medicine. lifestylemedicine.org/aclm-releases-updated-dietary-position-statement

Koch, C. A., Kjeldsen, E. W., & Frikke-Schmidt, R. (2023). Vegetarian or vegan diets and blood lipids: A meta-analysis of randomized trials. European Heart Journal, 44(28), 2609-2622. https://doi.org/10.1093/eurheartj/ehad211

Lichtenstein, A. H., Khera, A., Anderson, C. A. M., Appel, L. J., DeSilva, D. M., Gardner, C., Hu, F. B., Jones, D. W., Petersen, K. S., & American Heart Association. (2026). 2026 dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation, 153(18), e1285-e1295. https://doi.org/10.1161/CIR.0000000000001435

López-Moreno, M., Rossi, E. V., López-Gil, J. F., Marrero-Fernández, P., Roldán-Ruiz, A., & Bertotti, G. (2025). Are plant-based diets detrimental to muscular strength? A systematic review and meta-analysis of randomized controlled trials. Sports Medicine: Open, 11(1), Article 62. https://doi.org/10.1186/s40798-025-00852-7

Meulenbroeks, D., Otten, E., Smeets, S., Groeneveld, L., Jonkers, D., Eussen, S., Scheepers, H., & Gubbels, J. (2024). The association of a vegan diet during pregnancy with maternal and child outcomes: A systematic review. Nutrients, 16(19), Article 3329. https://doi.org/10.3390/nu16193329

Mo, Q., Wu, J., Lu, Y., & Zhang, X. (2025). Plant-based diets and total and cause-specific mortality: A meta-analysis of prospective studies. Frontiers in Nutrition, 12, Article 1518519. https://doi.org/10.3389/fnut.2025.1518519

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Low blood glucose (hypoglycemia). National Institutes of Health. niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia

Ornish, D., Scherwitz, L. W., Billings, J. H., Brown, S. E., Gould, K. L., Merritt, T. A., Sparler, S., Armstrong, W. T., Ports, T. A., Kirkeeide, R. L., Hogeboom, C., & Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23), 2001-2007. https://doi.org/10.1001/jama.280.23.2001

Qian, F., Liu, G., Hu, F. B., Bhupathiraju, S. N., & Sun, Q. (2019). Association between plant-based dietary patterns and risk of type 2 diabetes: A systematic review and meta-analysis. JAMA Internal Medicine, 179(10), 1335-1344. https://doi.org/10.1001/jamainternmed.2019.2195

Raj, S., Guest, N. S., Landry, M. J., Mangels, A. R., Pawlak, R., & Rozga, M. (2025). Vegetarian dietary patterns for adults: A position paper of the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics, 125(6), 831-846.e2. https://doi.org/10.1016/j.jand.2025.02.002

Rees, K., Al-Khudairy, L., Takeda, A., & Stranges, S. (2021). Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews, 2021(2), Article CD013501. https://doi.org/10.1002/14651858.CD013501.pub2

Reis, D., Schwermer, M., Nowak, L., Naami, N., Zuzak, T. J., & Längler, A. (2025). Vegetarian diet and dietary intake, health, and nutritional status in infants, children, and adolescents: A systematic review. Nutrients, 17(13), Article 2183. https://doi.org/10.3390/nu17132183

Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., Rexrode, K. M., Rimm, E. B., & Hu, F. B. (2017). Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. Journal of the American College of Cardiology, 70(4), 411-422. https://doi.org/10.1016/j.jacc.2017.05.047

Schünemann, H., Brożek, J., Guyatt, G., & Oxman, A. (Eds.). (2013). GRADE handbook: Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (Updated October 2013). The GRADE Working Group. gdt.gradepro.org/app/handbook/handbook.html

Shah, U. A., Cogrossi, L. L., Garcés, J. J., Policastro, A., Castro, F., Derkach, A., Fei, T., DeWolf, S., Grioni, M., Sisti, S., Blaslov, J., Adintori, P. A., Hosszu, K. K., McAvoy, D., Baichoo, M., Cross, J. R., Paredes, J., Anuraj, A., Raj, S. S., . . . Bellone, M. (2026). A high-fiber, plant-based diet in myeloma precursor disorders: Results from the NUTRIVENTION clinical trial and preclinical Vk*MYC model. Cancer Discovery, 16(4), 697-720. https://doi.org/10.1158/2159-8290.CD-25-1101

Smith, M., Wright, N., McHugh, P., Duncan, B., & Chwyl, C. (2025). Randomised waitlist-controlled trial of a 10-week community programme using a plant-based diet in a predominantly Māori population in Tairāwhiti (Gisborne). BMJ Open, 15(6), Article e080946. https://doi.org/10.1136/bmjopen-2023-080946

Termannsen, A. D., Clemmensen, K. K. B., Thomsen, J. M., Nørgaard, O., Díaz, L. J., Torekov, S. S., Quist, J. S., & Faerch, K. (2022). Effects of vegan diets on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews, 23(9), Article e13462. https://doi.org/10.1111/obr.13462

U.S. Department of Agriculture. (n.d.). MyPlate. myplate.gov

Webster, J., Greenwood, D. C., & Cade, J. E. (2022). Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: Results from the UK Women's Cohort Study. BMC Medicine, 20(1), Article 275. https://doi.org/10.1186/s12916-022-02468-0

Wright, N., Wilson, L., Smith, M., Duncan, B., & McHugh, P. (2017). The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutrition & Diabetes, 7(3), Article e256. https://doi.org/10.1038/nutd.2017.3

Evidence rating and review record

Each row identifies the method, source, outcome and comparison being rated. Ratings from different tools are not interchangeable. A rating may come from a named published review or from this page's own judgment. The banner gives no rating, because no study found for this page tested the plate itself, and every row except the first concerns an eating pattern or a diet score, not the handout. A high rating means the research is solid; it does not mean the pattern is right for everyone, and it does not mean a coach should recommend it.

Every rated row on this page was rated with GRADE, which uses the same 4-level scale as the clinical guidelines you will meet in practice. High means further research is very unlikely to change the conclusion. Moderate means further research may change it. Low means further research is likely to change it. Very low means the conclusion is uncertain. GRADE rates each outcome separately, so a pattern can be high for one outcome and very low for another. The cancer findings in section 4 use the World Cancer Research Fund's criteria, not GRADE, and are not rated in this table.

On a narrow screen, scroll the table sideways to see every column.

Evidence ratings, their sources and reasons

Outcome	Certainty	Who rated it, and for which comparison	Why it is rated this way
Any outcome of using the plate handout itself, the subject of the banner	Not rated	No rating. The question would be what happens when adults are given the College's plate, against no handout or another plate picture.	The searches for this page found no study that tested the plate. The one study that used it gave it to every participant inside a single-arm program with provided meals and coaching (Shah et al., 2026), so it cannot show the handout's effect.
HbA1c	Moderate	Termannsen et al., 2022, with GRADE. Vegan diets against the participants' usual diet or another diet, in adults with overweight or type 2 diabetes; 9 trials, 687 people; 12 to 26 weeks. This is the review's rating of its own comparison, not a rating of the plate.	The review authors' rating: randomized trials start high, lowered 1 level for imprecision. Difference 0.18 percentage points lower (0.07 to 0.29). Reported as theirs, not re-rated by this page.
LDL cholesterol	Low	Termannsen et al., 2022, with GRADE. The same comparison; 8 trials, 684 people.	The review authors' rating: lowered 1 level for imprecision and 1 for inconsistency. Difference 0.24 mmol/L lower (0.07 to 0.40). LDL is a marker in the blood; this rating says nothing about heart attacks or strokes. Reported as theirs.
LDL cholesterol, against no or minimal intervention	Moderate	Rees et al., 2021, Cochrane review, with GRADE. Vegan dietary intervention against no or minimal intervention, in adults without cardiovascular disease; 4 trials, 449 people; 16 to 26 weeks.	The review rated this moderate certainty, lowering 1 level for imprecision because of small sample size. A small fall, 0.22 mmol/L (0.11 to 0.32). Reported as theirs.
Blood pressure, against no or minimal intervention	Low	Rees et al., 2021, Cochrane review, with GRADE. The same comparison; 3 trials, 372 to 374 people; 16 to 26 weeks.	The review rated this low certainty, lowering 2 levels for imprecision because of small samples and confidence intervals compatible with benefit and harm. No clear effect detected on systolic or diastolic blood pressure. Reported as theirs.
Body weight, as measured	Moderate	Termannsen et al., 2022, with GRADE. The same comparison as the HbA1c row; 10 trials, 697 people.	The review authors' rating: lowered 1 level for inconsistency, since results varied widely between trials. Difference 4.1 kg lower (2.4 to 5.9). Reported as a measurement, not a goal. Reported as theirs.
Coronary heart disease, healthful plant-based index	Low	This page's own judgment. Adults in 3 U.S. cohorts of health professionals; highest against lowest tenth of a healthful plant-based diet index; new coronary heart disease over up to 28 years (Satija et al., 2017). This rates the association in those cohorts, not the effect of the plate.	Observational studies start low. Not lowered for risk of bias: diet was assessed repeatedly, coronary heart disease was confirmed by physicians who did not know participants' diets, the analysis adjusted for many other risk factors, and results held in sensitivity analyses. Not lowered for inconsistency: each of the 3 cohorts showed a lower rate in the top tenth (hazard ratios 0.68, 0.53 and 0.84). Not lowered for imprecision, publication bias or indirectness to the index itself. Not raised for the dose-response trend, which GRADE allows (Schünemann et al., 2013), because confounding by other healthy habits could remain and produce a graded association; for the same reason this row rates an association, not a cause. The index rewards oils, tea and coffee and does not exclude animal foods, so it is indirect evidence about the plate; that is why this row is not used as a rating of the plate. Assigned from the evidence by this page, October 2, 2026; reasons restated October 4, 2026.
Cardiovascular events and deaths in the vegan-diet trials in the Cochrane review	Not rated	No rating. Vegan dietary interventions against no or minimal intervention or another dietary intervention in Rees et al. (2021).	None of the review's 13 trials reported these outcomes, so there was no outcome evidence to rate. This row does not describe all vegetarian lifestyle-program trials or rate the plate.

How this archive talks about weight. This page reports what studies measured, including body weight, and does not treat weight change as a goal or as a measure of a pattern's success. Weight a person loses without meaning to can be a sign of a health problem, and where it is, the page names it as a reason to see a clinician. People are described the way the study described them.

Image use. This page describes the plate and links to the College's own copy rather than reproducing it. The 2024 version carries the line "© 2024. American College of Lifestyle Medicine," and the 2019 version "All rights reserved"; neither grants permission to reproduce it (American College of Lifestyle Medicine, 2019, 2024c). The College's guidance to partners says its resources may be shared but not edited, shortened or copied into new designs, and recommends downloading them directly from the College (American College of Lifestyle Medicine, n.d.-a).

Status: reviewed and approved by James Peth, MS, MPH, PhD, on October 6, 2026, after a combined final review and a limited recheck. Written October 2, 2026. Reviewed in a combined final review with the MyPlate and Harvard Healthy Eating Plate pages, completed October 4, 2026, and repaired October 4, 2026. Of the 8 rows, 2 are not rated, 5 are published reviews' own ratings reported as theirs, and 1, for coronary heart disease, is this page's own judgment, assigned from the evidence. No rating label changed.

What changed: The statements about cardiovascular events and deaths are now limited to the 13 vegan-diet trials in the Cochrane review, and a 5-year multicomponent program trial that reported cardiac events and deaths is described as testing a program, not diet alone or the plate (Ornish et al., 1998); the not-rated events row is narrowed to match. A later New Zealand community trial was added (Smith et al., 2025). The definition of apolipoprotein B, the NUTRIVENTION participant numbers and the timing of its quality-of-life result, the limits of a medication-related analysis in the 74-week trial, the 2024 handout's front and back, and the Cochrane rating reasons from its full text were corrected. Blood pressure medicine was added to the medication rule, and the passage on signs that something is going wrong now separates physical symptoms from eating behaviors. The banner and the rating table's introduction now name the rating method.

Updated October 21, 2026: The American Heart Association is now named as an author of its 2026 dietary guidance statement (Lichtenstein et al., 2026), as the publisher's citation credits it. No content changed.

Next scheduled review: Each year, because the College updates its handouts and positions. Pages built on annual guidance are rechecked each year.

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Diet Reference Archive | One James

Prepared by James Peth, MS, MPH, PhD

© 2026–2027 One James. All rights reserved.

This page is for education and coaching practice. It is not medical or dietary advice.