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For a taste of the bistro, try Tyler Florence's ultimate French Onion Soup recipe, topped with nutty Gruyï¿½re croutons.

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Get Sausage Stuffed Onion Recipe from Food Network

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For a taste of the bistro, try Tyler Florence's ultimate French Onion Soup recipe, topped with nutty Gruyï¿½re croutons.

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Growing onions is simple: If you can poke a hole into the ground, you can grow an onion from a little plant. Most of our onion varieties are sold as little seedlings in bare-root bundles; each plant will start growing within days after you plant. If you can't plant your onions right away, remove their bindings and place them in a bucket with 2 inches of moist soil in the bottom. Keep them in a cool, bright place but out of direct sun until you are ready to plant. A sunny basement is ideal.

Quick Guide to Growing Onions

Plant onions in early spring once the ground is workable. In-ground gardens and raised beds are both excellent options for growing onions.

Space onion plants 6 inches apart in rows that are 12 inches apart. Grow them in a sunny spot that has fertile, well-drained soil with a pH of 6.0 to 6.8.

Improve your native soil by mixing in several inches of aged compost or other rich organic matter.

Onions aren't great at taking up water, so it's important to keep soil moist so their shallow roots can drink up. Water whenever the top inch of soil becomes dry.

For best results, keep your growing onions fed with a continuous-release plant food.

Onions can be eaten at nearly any size so harvest when they're the right size for your next culinary creation.

Soil, Planting, and Care

Most gardeners want sweet onions, and the sweetness of an onion is determined by both nature and nurture. For the mildest onions, start with a variety known to produce sweet, mild-flavored bulbs such as Texas Sweet (at southern latitudes) or Walla Walla (at northern latitudes). For great results, start with Bonnie Plants® onion slips, strong plants grown by a company that has been helping home gardeners for over a century.

Growing onions requires abundant sun and good drainage, and they grow best when the soil pH ranges between 6.0 and 6.8. Raised beds or raised rows made by mounding up soil are ideal, especially if your soil is heavy clay. Fill raised beds with a soil designed to be just the right weight and texture for raised beds, such as Miracle-Gro® Performance Organics® Raised Bed Mix. For mounded rows, mix a 3-inch layer of compost or aged compost-enriched Miracle-Gro® Performance Organics® All Purpose In-Ground Soil into the top 6 inches of soil. Set plants 1 inch deep, so that their roots are well covered with soil but the top of the plant's neck is not buried too deeply. You don't want the part of the neck where the leaves grow away from the clear sheath to collect soil or water down between the young leaves, or they can rot. Space plants 6 inches apart in furrows 12 inches apart. Plants grow best when, in addition to being grown in top-quality soil, they're fed with just the right plant food. To ensure growing onions get all the nutrition they need, feed regularly throughout the season with Miracle-Gro® Performance Organics® Edibles Plant Nutrition Granules, following label directions.

Onions roots are shallow and not very efficient at taking up moisture, so they need a steady supply of water to grow without interruption. Although they actually recover well from drought and start growing again when watered, it is best to keep the soil consistently moist until the bulbs enlarge.

You may mulch with a light layer of weed-free and herbicide-free grass clippings or another fine mulch. Onions naturally push toward the surface as they form bulbs, and it's best if the tops of the bulbs are allowed to bask in dry sun. Remove mulch that might keep the expanding bulbs excessively moist.

Seedlings that are about the diameter of a pencil produce the biggest, most beautiful bulbs, so some gardeners sort seedlings by size before planting. Plant the largest ones together only 2 inches apart to start enjoying as green onions in just two or three weeks. Very small seedlings set at close spacing can serve as a second crop of scallions. Use the pencil-sized plants to grow full-sized onions that will produce extra-juicy slices.

Troubleshooting

As onions leaves expand, they may be found by tiny black onion thrips, which suck sap from onion leaves. These are hard to see because they hide down in the folds and neck of the leaves. Also be on the lookout for aphids. Finally, weak plants that slowly wilt may be infested with onion root maggots, the larvae of a common fly. Contact your regional Extension agency for details on how to control these pests.

Harvest and Storage

You can harvest young onions just a few weeks after planting if you want to use them as "spring onions" or scallions. There is no perfect size, just pull when they are big enough to suit you.

For full-sized bulbs, let onions grow and mature. They are ready to harvest when the bulbs are big and the tops begin to turn yellow and fall over. Pull them up, shake off the soil, and lay them out to cure with the tops still attached. Any warm, airy location is a good place to do this; you can even sling them over a fence as long as they aren't rained upon. Bulbs must stay dry and have good air circulation. As the onions cure, the roots will shrivel and the necks above the bulbs will slowly dry - a natural process that helps to seal the top of the bulb, making the onions less likely to rot. After 7 to 10 days, clip off the tops of the onions and the roots with pruning shears, remove as much dry dirt as possible without taking off the papery outer skins, and store your onions in a cool place. Very sweet, juicy onions may be stored, wrapped in newspaper or paper towels, in the fridge.

Uniform and easy to grow, onion transplants will get off to a fast start. Separate before planting.

Onions can be grown in raised beds, which offer superior drainage.

These are young onions growing on a furrow, or mounded row.

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How to Grow Onions | Onion Planting & General Growing Tips

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Growing onions is simple: If you can poke a hole into the ground, you can grow an onion from a little plant. Most of our onion varieties are sold as little seedlings in bare-root bundles; each plant will start growing within days after you plant.

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Onions-you probably either love them or hate them. But if you fall into the latter category, you might want to reconsider. Onions are very good for you, and adding this nutrient-packed, aromatic vegetable into your meal rotation is a smart (and tasty) move. Simply put, "onions are low in calories and rich in potassium and vitamins B6 and C," says Jennifer Weis, RD, LDN, founder and owner of Jennifer Weis Nutrition. Thanks to its nutritional value, accessibility, and delicious flavor, it's no wonder this versatile bulb is a staple in cuisines across the world and forms the flavor base for a wide variety of dishes.

Walk into your grocery store's produce aisle or stroll through the local farmers market and you'll likely see a plethora of onion options-there are actually 21 different types! Onions are a vegetable species within the genus allium, along with similar aromatic bulbs like garlic, leeks, chives, and shallots. (While these other well-known veggies aren't onions themselves, they are in the same vegetable family and yield many health benefits, too.) Whole onions should last in your pantry or other cool, dry, dark place ( not the fridge) for about two weeks-but don't store them next to potatoes, which emit gas and moisture that can quickly spoil onions. If you have leftover onion that's already been cut, pop it in a resealable bag in the fridge to stay fresh for about a week (you can also store it in a container in the freezer).

Here are some of the top nutritional benefits that onions provide. If you're looking for more reasons to pick up an onion or two next time you're at the store, you're in the right place.

Nutritional Benefits of Onions

Onions help improve heart health.

Eating onions can have a healthy impact on your cardiovascular system. Specifically, research has found that the polyphenol called quercetin that's in onions helps reduce high blood pressure and triglyceride levels. Darker-colored onions, like red onions and chartreuse onions, contain the highest amounts of quercetin. Research from the American Chemical Society has also found that the "tearless onion" can help protect against heart disease.

Onions are rich in antioxidants for immune health, anti-inflammation, and more.

Onions are packed with disease- and free-radical-fighting antioxidants, which help repair and protect damaged cells in your body. They're one of the best sources of flavonoids (including quercetin), phytochemicals with powerful antioxidant properties.

According to a review published in the Journal of Agriculture and Food Chemistry, onions contain at least 25 different flavonols. "Red and yellow onions are richer in those antioxidants than other types of onions. In fact, yellow onions may contain almost 11 times more antioxidants than white onions," says Sara Peternell, MNT, board-certified holistic nutritionist specializing in family nutrition. A diet rich in antioxidants can help reduce inflammation and thwart free-radical damage, which leads to a strong immune system and better overall health.

Onions may reduce cancer risk.

There's been some interesting research conducted on how onions may play an important role in helping to prevent cancer. A study out of the University of Guelph concluded that red onions, specifically, are the most effective at reducing colon and breast cancer cells. This is once again due to the high levels of quercetin and anthocyanin (another type of antioxidant flavonoid).

Another study published in Cancer Prevention Research found that one to seven servings of allium veggies, like onions, is rich in organosulfur and flavonols-compounds that have been found to have tumor-inhibiting components.

How to Cook With Onions

Raw yellow onions tend to be the sweetest variety, making them a great addition to salsas. Cooked yellow onions make a savory base for soups, stews, and sauces. Onions are also delicious on their own, roasted, grilled, or sauteed.

Top sandwiches and burgers with grilled (or raw!) onions to up the zest factor. For a tangy burst of flavor-and beautiful color-add pickled red onions to grain bowls, fish or pork tacos, or alongside any meaty main. If you're a little uneasy about adding onions into your at-home menu, start by keeping the cooking process simple. Weis recommends slicing the onions into discs, brushing them with olive oil, seasoning with salt and pepper, and grilling both sides.

Check out these creative recipes-starring the humble onion-that are bursting with flavor and nutrients.

Pineapple, Swordfish, and Red Onion Kebabs

These easy kebabs pack in a lot of flavor without too much work, thanks to a flavorful marinade for the swordfish, juicy pineapple, and charred red onion. If this recipe doesn't scream "summertime," we don't know what does. Get the recipe.

Deeply Caramelized Onion Dip

Patience is the key to this addictive dip: Cook the onions low and slow, stirring frequently-no shortcuts allowed. Serve with thick-cut potato chips and crisp veggies. Get the recipe.

Slow Cooker Cuban Black Bean Chili

Like most soul-warming soups and stews, this black bean chili starts with a base of onions and other veggies for savory, full-bodied flavor.

Caramelized Onion and Sour Cherry Tartine

Impress the entire table with this well-balanced stunner. In one bite you get crispy-buttery sourdough bread, tangy cherries, sweet-savory onions, sharp white cheddar, and woody thyme. Get the recipe.

Should anyone avoid onions?

It's true that onions aren't for everyone. If you feel like onions don't sit well with you, it's not all in your head. Some people are very sensitive to the oligosaccharides, a fructan found in onions. Karen Graham, RDN, a functional medicine dietitian, says that onions can be problematic for many people, causing gas, bloating, constipation, and diarrhea, and that about 30 percent of people tested for food intolerances in her practice have an issue with onions.

The green tops of scallions are not usually a problem, she says, so that may be a good place to start to add onion flavor and nutrients into meals.

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Onions Are Extremely Good for You-Here Are 3 Healthy Benefits to Prove It

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Onions-you probably either love them or hate them. But if you fall into the latter category, you might want to reconsider. Onions are very good for you, and adding this nutrient-packed, aromatic vegetable into your meal rotation is a smart (and tasty) move.

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If you have ever cooked using recipes from your mom, grandma, Pinterest or really from anywhere, you may have noticed a common theme. Most, if not all, of these recipes will instruct you to heat your pot, pan or Dutch oven with oil then add chopped onions, which you will sauté for a few minutes until softened. Onions are a kitchen staple that appear in many dishes, and there's a reason for that. If you are concerned about your health, you will want to consider adding more onions to your diet. The antioxidants and anti-inflammatory properties onions contain make consuming onions great for your heart health. Not only that, but they are also highly nutritious and delicious! This article will provide you with ten health benefits of onions.

1. Have Many Antioxidants

Antioxidants may help prevent cell damage by fighting free radical molecules. Free radicals are developed when the body is exposed to radiation or tobacco smoke. These molecules can cause diabetes, heart disease, and cancer. By eating onions you can help your body fight free radicals and improve your overall health.

2. Help with Blood Sugar Levels

If you have diabetes, onions are an excellent way to help keep your blood sugar levels steady. The flavonoids in onions work to keep the blood glucose levels stabilized. If levels are low, you might experience symptoms such as fatigue, anxiety, headache, and many other signs.

3. Improved Digestive Health

Onions contain a high amount of prebiotics and fiber. In the body, this helps improve gut health by aiding in digestion, strengthening the immune system, and lowering inflammation.

4. Loaded with Nutrients

Onions are considered to be nutrient-dense food. This means that they contain a small number of calories and a large number of nutrients. They are a great source of potassium and manganese. Potassium helps to increase energy and your metabolism. Manganese helps the body create connective tissue, aids in bone health, and lowers the chance of forming blood clots.

5. Anti-Inflammatory Properties

Onions contain an antioxidant called quercetin. Quercetin is an anti-inflammatory and works to fight off inflammation within the body. It is great at lowering swelling, helping with arthritis, and treating bladder infections.

6. May Keep Certain Cancers at Bay

If you are concerned about your risk of developing cancer, you may want to consume more onions. Researchers found moderate consumption of onions appeared to reduce the risk of colorectal, laryngeal, and ovarian cancers.

7. Reduces Risks of Alzheimer's Disease

Studies have been conducted to discover the relationship between quercetin and Alzheimer's disease. These studies showed a significant association between consuming foods high in quercetin, such as onions, and having a lower chance of developing Alzheimer's.

8. Great Source of Vitamin C

Did you know that onions contain a high amount of vitamin C? Vitamin C is essential for your body to function properly. It helps the formation of blood vessels, improves your immune system, and builds cartilage.

9. Supports Bone Health

Studies have proven that onions improve bone density in some people. As a result, the consumption of onions may help strengthen the bones and reduce risk of fractures for people over the age of 50.

10. Antibacterial

The antibacterial properties of Allicin in onions help the colon fight off harmful bacteria. Allicin is the compound that gives off the unique strong smell of an onion. You can think of Allicin as your fighter against toxins and sicknesses. Now that's something to cry happy tears about! After reading about the ten health benefits that onions provide, you may be wondering how you can add more onions to your daily diet. A simple and quick way to start consuming more onions is using Spice World Easy Onion! You no longer have to deal with the hassle of peeling and chopping onions as your eyes well up with tears. All you need to do is squeeze the bottle for minced onions in an instant. It doesn't get easier than that! If you would like to learn more about Spice World's new onion product and reap the benefits of incorporating more onions in your meals, visit us online for recipes and tips on how to add onion to your weekly meals.

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10 Health Benefits of Onions - Spice World

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If you have ever cooked using recipes from your mom, grandma, Pinterest or really from anywhere, you may have noticed a common theme. Most, if not all, of these recipes will instruct you to heat your pot, pan or Dutch oven with oil then add chopped onions, which you will sauté for a few minutes until softened.

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Onions are a food that a lot of kids who are picky eaters have challenges eating. Crunchy, slightly acidic, tangy, onions have a flavor that is strong! For that matter a lot of adults who are picky eaters really hate onions. As a parent can be super frustrating, as onions flavor so many recipes.

But using this one tip that changed things with my kid, you might just be able to turn family's opinions of onions around. I've also included a few additional parenting tips that help picky eaters learn to come around to onions.

Onions seem to be a food that many picky eaters struggle with. As a parent can be super frustrating, as onions flavor so many recipes.

My One Big Trick That Helps Picky Eaters Like Onions

To help my picky eater like onions, I started buying sweet onions almost exclusively. These white onions are also called Vidalias, Walla Wallas, Texas Sweets and Mauis in the stores. Sweet onions have a mild onion flavor that is slightly sweet.

When cooked, sweet onions don't have the same flavor bite that a standard yellow or white onion has. Sweet onions contain less sulfur, which is what gives most onions the pungent flavor.

Due to their sweet flavor, you can also get away with just a quick sautee rather than having to fully cook them until caramelized for busy weeknights. To make a good caramelized onion does take an extra few minutes with sweet onions as they have more water than other onions.

Sweet onions are delicious and can be subbed cup for cup in recipes such as in this turkey chili recipe.

Still struggling with onions? Here are a few other tips you can try to help picky eaters like (or at least tolerate) onions.

Other Picky Eater Tips For Onions

Dice Onions Small

Many kids are intimidated by large chunks of onion in food, and it can pack a powerful flavor. Try dicing onions extra fine, and then cooking over medium heat for a few minutes until they are translucent before adding them to your meal.

Try Different Types of Onions

Here are a few other types of onions you can try in your cooking they all have different amounts of bite to them, and your picky eater may tolerate one and not another. Here are a few types of onions to try.

Green Onions - Cook with the white bulb making sure to remove roots. Garnish dishes with the green tops. These mild onions are also sometimes called scallions.

Leeks - Cook with the white bulk removing the roots. Slice and dice all parts up to the leaves. Leeks also tend to have a mild flavor, but are pretty crunchy and best served in cooked dishes.

Chives - Use chives as a garnish diced finally, more like an herb. Chives are great for finishing dishes or mixing a little into cold salads.

Purple Onions - These look exactly like white or yellow onions but with a fun purple color. Served raw in salads or cooked in recipes, purple onions have a bite! When I serve purple onions to picky eaters, I try to make sure they have been cooked low and slow so the flavor is less strong. This type of onion is also a favorite in guacamole or pickled at our house.

Pearl Onions - Also known as baby or button onions. These small bulbs are great for roasting whole in a sheet pan meal, throwing in the bottom of the instant pot or crockpot, or cooking with a quick chop. Some people also pickle this type of onion.

Try Gardening

Green Onions and chives are both very easy to grow in pots year round. Encourage your picky eater to help you care for a prep your onions and they may just surprise you.

Soak Onions In Cold Water

I worked at a deli for a while when I was young, and we cut a LOT of onions for salads, and those suckers can burn your eyes. We'd peel the giant onions, and plunge them into an ice bath for a while, overnight when possible. That cold water helps to take some of the bite out of raw onions and may help with recipes such as garnish for turkey burgers, salsa, guacamole or fresh pasta salad or any recipe where you may include raw onions.

Other Articles You Will Love:

* The Container System That Changed My Life With My Picky Eater

* 13 Life Skills To Teach Your Kid While Grocery Shopping

* 4 Easy Ways To Make Lunchbox Sandwiches Fun With The Lunch Punch

* How To Make Easy To Peel Hard Boiled Eggs Fast

Does your family like onions? Do you have a picky eater in your family who can't stand raw onions? Do you have any tips for ideas that helped? Drop them down in the comments!

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This One Trick Helps Picky Eaters Who Hate Onions

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Onions are a food that a lot of kids who are picky eaters have challenges eating. Crunchy, slightly acidic, tangy, onions have a flavor that is strong! For that matter a lot of adults who are picky eaters really hate onions. As a parent can be super frustrating, as onions flavor so many recipes.

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How to Harvest and Store Onions Properly

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How to Harvest and Store Onions Properly

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How to Select Onions in the Grocery Store

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How to Select Onions in the Grocery Store

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Tips for  picking the best Onion in a Grocery Store

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You've Been Storing Onions Wrong Your Entire Life

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This full-flavored recipe is the result of my mom’s love of pasta and our love of cooking together. With a bit of pepper heat and smoky bacon, the entree is excellent alone or paired with grilled chicken. —Lacy Jo Matheson, Sault Ste. Marie, Michigan

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This sauteed onions recipe comes out golden brown and tender every time! Here's how to saute onions for a side dish, sandwich topping, and more.

Here's another in our kitchen basics: and this one is a skill every home cook should know. How to sauté onions! These easy Sauteed Onions are a building block of the kitchen: you can use them on sandwiches, in grilled cheese, in dips, or even as a side dish. They're tender, golden brown, and make anything more rich and savory: yet they only take 10 minutes to whip up! Here's all about how to saute onions.

Sauteed onions vs caramelized onions: what's the difference?

First thing to note: sauteed onions are not caramelized onions. What's the difference?

Sauteed onions are cooked only 10 minutes in the skillet, so they hold their shape. The onion flavor is more pronounced than a caramelized onion.

Caramelized onions are cooked for about 40 to 50 minutes over low heat until they completely break down. They are dark brown and have a very soft, mushy texture and intensely sweet flavor.

Looking for caramelized onions instead? Go to Perfect Caramelized Onions.

How to saute onions

Caramelized onions are great and all: but most of the time, we don't have 40 to 50 minutes to spare! That's where these sauteed onions come in. You can use them as a side dish or a sandwich component, and they only take 10 minutes to cook. Here's what to know about sauteed onions:

Use butter for best flavor, but olive oil works too. There's something about the rich savory flavor of butter. But olive oil is nearly as good!

Keep the heat on medium high. Don't go higher or the onions will burn before they're tender!

Cook until browned and tender, about 10 minutes. Keep an eye on it and taste test at the end. You may find you want to go a little longer: that's ok too.

How to cut onions: a primer!

If you asked us one of the top skills for any home cook, we'd say: "how to cut an onion!" Yes, onions are required in so many great recipes that it's almost impossible to get anywhere without this building block skill. For this sauteed onions recipe, we like to cut the onions in a style called French cut. This makes lovely sliver shapes of the onions, which looks more attractive than the long strings you get when you cut the other way. Here's how to cut an onion...the best way:

Slice off the ends, then cut in half: Once the ends are removed, stand the onion on its flat cut side and cut it down the center.

Remove the paper. With your fingers, remove the paper and outer layer of the onion.

Cut following the curve of the onion. Place the onion on its flat side then cut slices following the curve of the onion, from the tip to the root. Want to see? Go to minute 1:40 of this How to Cut an Onion video.

Optional adder: balsamic vinegar!

Want to jazz up your sauteed onions? Add a hint of balsamic vinegar! When you are about 5 minutes into the saute, add 1 tablespoon balsamic vinegar. It will evaporate for the rest of the cooking, but leave behind a tangy, sweet essence to the sauteed onions. It's one of our favorite treats!

Speaking of, you can also add a splash of red wine to onions while you're cooking them! It infuses a bit of complexity into the flavor as well.

Ways to serve sauteed onions

OK, you've got your sauteed onions: now how to serve them? There are endless ideas of ways to use sauteed onions: and we'd love to hear yours! Tell us in the comments below. Here are a few of our top ways to enjoy them:

What else would you use them for? Let us know in the comments below. Or, keep reading for a few variations...

Variations on sauteed onions

Onions are fantastic at playing second fiddle. In fact, they're one of the best supporting characters in all of your pantry ingredients! There are a few ways we love to combine sauteed onions with other veggies. Here's what to try:

Sauteed mushrooms and onions: Dare we say, these are even better than plain onions! These mushrooms and onions make a killer side to steak or vegan dishes.

Sauteed peppers and onions: Bell peppers are even sweeter with onions along for the ride. Try these sauteed peppers and onions.

This sauteed onions recipe is...

Vegetarian, vegan, plant-based, dairy-free, and gluten-free.

Simple Sauteed Onions

More with onions

Love onions, or got some to use up? Here are more tasty onion recipes:

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This sauteed onions recipe comes out golden brown and tender every time! Here's how to saute onions for a side dish, sandwich topping, and more. Here's another in our kitchen basics: and this one is a skill every home cook should know. How to sauté onions!

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Abstract

The objective of this article is to present to physicians an update on plant-based diets. Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of obesity, diabetes, and cardiovascular disease. For these reasons, physicians looking for cost-effective interventions to improve health outcomes are becoming more involved in helping their patients adopt healthier lifestyles. Healthy eating may be best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods. We present a case study as an example of the potential health benefits of such a diet. Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA 1C, and cholesterol levels. They may also reduce the number of medications needed to treat chronic diseases and lower ischemic heart disease mortality rates. Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.

Introduction

In the HBO documentary The Weight of the Nation, it was noted that if you "go with the flow" in the US, you will eventually become obese. 1 In 2011, Witters reported that in some areas of the country, the rate of obesity is 39% and is increasing at a rate of 5% per year. 2 Risks of obesity, diabetes, hypertension, and cardiovascular disease, along with their ensuing complications (eg, behavioral health and quality-of-life problems) often go hand-in-hand and are strongly linked to lifestyle, especially dietary choices. 3 Of all the diets recommended over the last few decades to turn the tide of these chronic illnesses, the best but perhaps least common may be those that are plant based.

Despite the strong body of evidence favoring plant-based diets, including studies showing a willingness of the general public to embrace them, 4 many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses. This could be because of a lack of awareness of these diets or a lack of patient education resources.

National dietary guidelines for active living and healthful eating are available at www.ChooseMyPlate.gov. 5 A typical healthful plate of food is 1/2 plant foods (nonstarchy vegetables and fruits), 1/4 whole grains or unprocessed starchy food, and 1/4 lean protein.

The goal of this article is to review the evidence supporting plant-based diets and to provide a guideline for presenting them to patients. We start with a case study and conclude with a review of the literature.

Case Study

A 63-year-old man with a history of hypertension presented to his primary care physician with complaints of fatigue, nausea, and muscle cramps. The result of a random blood glucose test was 524 mg/dL, and HbA 1C was 11.1%. Type 2 diabetes was diagnosed. His total cholesterol was 283 mg/dL, blood pressure was 132/66 mmHg, and body mass index (BMI) was 25 kg/m ². He was taking lisinopril, 40 mg daily; hydrochlorothiazide, 50 mg daily; amlodipine, 5 mg daily; and atorvastatin, 20 mg daily. He was prescribed metformin, 1000 mg twice daily; glipizide, 5 mg daily; and 10 units of neutral protamine Hagedom insulin at bedtime. His physician also prescribed a low-sodium, plant-based diet that excluded all animal products and refined sugars and limited bread, rice, potatoes, and tortillas to a single daily serving. He was advised to consume unlimited non-starchy vegetables, legumes, and beans, in addition to up to 2 ounces of nuts and seeds daily. He was also asked to begin exercising 15 minutes twice a day.

The patient was seen monthly in his primary care clinic. Over a 16-week period, significant improvement in biometric outcome measures was observed. He was completely weaned off of amlodipine, hydrochlorothiazide, glipizide, and neutral protamine Hagedorn insulin. Follow-up blood pressure remained below 125/60 mmHg, HbA 1C improved to 6.3%, and total cholesterol improved to 138 mg/dL. Lisinopril was gradually decreased to 5 mg daily and his diabetes is controlled with metformin alone, 1000 mg twice daily.

Definitions of Plant-Based Diets

The presented case is a dramatic example of the effect a plant-based diet can have on biometric outcomes like blood pressure, diabetes, and lipid profile. The reduction in HbA 1C from 11.1% to 6.3% in 3 months is much better than would be expected with monotherapy with metformin 6 or daily exercise. 7 The improvement in blood pressure observed over a 4-month period with few medications is also rarely encountered in clinical practice and is likely related to a low-sodium diet and the avoidance of red meat. Because the patient was not obese and did not have significant weight loss with the diet, the dramatic improvements appear to be related to the quality of his new diet.

A healthy, plant-based diet aims to maximize consumption of nutrient-dense plant foods while minimizing processed foods, oils, and animal foods (including dairy products and eggs). It encourages lots of vegetables (cooked or raw), fruits, beans, peas, lentils, soybeans, seeds, and nuts (in smaller amounts) and is generally low fat. 8, 9 Leading proponents in the field have varying opinions as to what comprises the optimal plant-based diet. Ornish et al recommends allowing animal products such as egg whites and skim milk in small amounts for reversal of disease. 10, 11

Esselstyn, who directs the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute, recommends completely avoiding all animal-based products as well as soybeans and nuts, particularly if severe coronary artery disease is present. 12

Despite these smaller differences, there is evidence that a broadly defined plant-based diet has significant health benefits. It should be noted that the term plant-based is sometimes used interchangeably with vegetarian or vegan. Vegetarian or vegan diets adopted for ethical or religious reasons may or may not be healthy. It is thus important to know the specific definitions of related diets and to ascertain the details of a patient's diet rather than making assumptions about how healthy it is. The following is a brief summary of typical diets that restrict animal products. A key distinction is that although most of these diets are defined by what they exclude, the plant-based diet is defined by what it includes.

Vegan (or total vegetarian): Excludes all animal products, especially meat, seafood, poultry, eggs, and dairy products. Does not require consumption of whole foods or restrict fat or refined sugar.

Raw food, vegan: Same exclusions as veganism as well as the exclusion of all foods cooked at temperatures greater than 118°F.

Lacto-vegetarian: Excludes eggs, meat, seafood, and poultry and includes milk products.

Ovo-vegetarian: Excludes meat, seafood, poultry, and dairy products and includes eggs.

Lacto-ovo vegetarian: Excludes meat, seafood, and poultry and includes eggs and dairy products.

Mediterranean: Similar to whole-foods, plant-based diet but allows small amounts of chicken, dairy products, eggs, and red meat once or twice per month. Fish and olive oil are encouraged. Fat is not restricted.

Whole-foods, plant-based, low-fat: Encourages plant foods in their whole form, especially vegetables, fruits, legumes, and seeds and nuts (in smaller amounts). For maximal health benefits this diet limits animal products. Total fat is generally restricted.

Benefits of Plant-Based Diets

The goal of our diet should be to improve our health. In this section, we will review the literature for key articles that demonstrate the benefits of plant-based diets. Our review consists of existing studies that include vegan, vegetarian, and Mediterranean diets.

Obesity

In 2006, after reviewing data from 87 published studies, authors Berkow and Barnard 13 reported in Nutrition Reviews that a vegan or vegetarian diet is highly effective for weight loss. They also found that vegetarian populations have lower rates of heart disease, high blood pressure, diabetes, and obesity. In addition, their review suggests that weight loss in vegetarians is not dependent on exercise and occurs at a rate of approximately 1 pound per week. The authors further stated that a vegan diet caused more calories to be burned after meals, in contrast to nonvegan diets which may cause fewer calories to be burned because food is being stored as fat. 13

Farmer et al 14 suggest that vegetarian diets may be better for weight management and may be more nutritious than diets that include meat. In their study, they showed that vegetarians were slimmer than their meat-eating counterparts. Vegetarians were also found to consume more magnesium, potassium, iron, thiamin, riboflavin, folate, and vitamins and less total fat. The authors conclude that vegetarian diets are nutrient dense and can be recommended for weight management without compromising diet quality. 14

In 2009, Wang and Beysoun 15 analyzed the nationally representative data collected in the 1999-2004 National Health and Nutrition Examination Survey. The aim of their study was to analyze the associations between meat consumption and obesity. Using linear and logistic regression analyses, they showed that there was a positive association between meat consumption and obesity. 15

The Oxford component of the European Prospective Investigation into Cancer and Nutrition assessed changes in weight and BMI over a five-year period in meat-eating, fish-eating, vegetarian, and vegan men and women in the United Kingdom. During the five years of the study, mean annual weight gain was lowest among individuals who had changed to a diet containing fewer animal foods. The study also reported a significant difference in age-adjusted BMI, with the meat eaters having the highest BMI and vegans the lowest. 16 Similar results were reported by the Adventist Health Study. 17

According to Sabaté and Wien, 18 "Epidemiologic studies indicate that vegetarian diets are associated with a lower BMI and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI. Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. Plant-based diets are low in energy density and high in complex carbohydrate, fiber, and water, which may increase satiety and resting energy expenditure." 18 The authors conclude that plant-based dietary patterns should be encouraged for optimal health.

Diabetes

Plant-based diets may offer an advantage over those that are not plant based with respect to prevention and management of diabetes. The Adventist Health Studies found that vegetarians have approximately half the risk of developing diabetes as nonvegetarians. 19 In 2008, Vang et al 20 reported that nonvegetarians were 74% more likely to develop diabetes over a 17-year period than vegetarians. In 2009, a study involving more than 60,000 men and women found that the prevalence of diabetes in individuals on a vegan diet was 2.9%, compared with 7.6% in the nonvegetarians. 17 A low-fat, plant-based diet with no or little meat may help prevent and treat diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance.

Barnard et al 21 reported in 2006 the results of a randomized clinical trial comparing a low-fat vegan diet with a diet based on the American Diabetes Association guidelines. People on the low-fat vegan diet reduced their HbA 1C levels by 1.23 points, compared with 0.38 points for the people on the American Diabetes Association diet. In addition, 43% of people on the low-fat vegan diet were able to reduce their medication, compared with 26% of those on the American Diabetes Association diet. 18

Heart Disease

In the Lifestyle Heart Trial, Ornish 10 found that 82% of patients with diagnosed heart disease who followed his program had some level of regression of atherosclerosis. Comprehensive lifestyle changes appear to be the catalyst that brought about this regression of even severe coronary atherosclerosis after only 1 year. In his plant-based regimen, 10% of calories came from fat, 15% to 20% from protein, and 70% to 75% from carbohydrate, and cholesterol was restricted to 5 mg per day.

Interestingly, 53% of the control group had progression of atherosclerosis. After 5 years, stenosis in the experimental group decreased from 37.8% to 34.7% (a 7.9% relative improvement). The control group experienced a progression of stenosis from 46.1% to 57.9% (a 27.7% relative worsening). Low-density lipoprotein had decreased 40% at 1 year and was maintained at 20% less than baseline after 5 years. These reductions are similar to results achieved with lipid-lowering medications. 10, 11

In the Lyon Diet Heart Study, a prospective, randomized, secondary prevention trial, de Lorgeril found that the intervention group (at 27 months) experienced a 73% decrease in coronary events and a 70% decrease in all-cause mortality. The intervention group's Mediterranean-style diet included more plant foods, vegetables, fruits, and fish than meat. Butter and cream were replaced with canola oil margarine. Canola oil and olive oil were the only fats recommended. 22

In 1998, a collaborative analysis using original data from 5 prospective studies was reviewed and reported in the journal Public Health Nutrition. It compared ischemic heart disease-specific death rate ratios of vegetarians and nonvegetarians. The vegetarians had a 24% reduction in ischemic heart disease death rates compared with nonvegetarians. 23 The lower risk of ischemic heart disease may be related to lower cholesterol levels in individuals who consume less meat. 24

Although vegetarian diets are associated with lower risk of several chronic diseases, different types of vegetarians may not experience the same effects on health. The key is to focus on eating a healthy diet, not simply a vegan or vegetarian diet. 25

High Blood Pressure

In 2010, the Dietary Guidelines Advisory Committee performed a literature review to identify articles examining the effect of dietary patterns on blood pressure in adults. Vegetarian diets were associated with lower systolic blood pressure and lower diastolic blood pressure. 26 One randomized crossover trial found that a Japanese diet (low sodium and plant based) significantly reduced systolic blood pressure. 27

Mortality

The Dietary Guidelines Advisory Committee also performed a 2010 literature review to determine the effect of plant-based diets on stroke, cardiovascular disease, and total mortality in adults. They found that plant-based diets were associated with a reduced risk of cardiovascular disease and mortality compared with non-plant-based diets. 26

The benefit of plant-based diets on mortality may be primarily caused by decreased consumption of red meat. 28 Several studies have documented the benefits of avoiding excessive consumption of red meat, which is associated with an increased risk of all-cause mortality and an increased risk of cardiovascular mortality. 29 Low meat intake has been associated with longevity. 30

In 2012, Huang et al 31 performed a meta-analysis to investigate cardiovascular disease mortality among vegetarians and nonvegetarians. They only included studies that reported relative risks and corresponding 95% confidence intervals. Seven studies with a combined total of 124,706 participants were analyzed. Vegetarians had 29% lower ischemic heart disease mortality than nonvegetarians. 31

Health Concerns About Plant-Based Diets

Protein

Generally, patients on a plant-based diet are not at risk for protein deficiency. Proteins are made up of amino acids, some of which, called essential amino acids, cannot be synthesized by the body and must be obtained from food. Essential amino acids are found in meat, dairy products, and eggs, as well as many plant-based foods, such as quinoa. 32 Essential amino acids can also be obtained by eating certain combinations of plant-based foods. Examples include brown rice with beans, and hummus with whole wheat pita. Therefore, a well-balanced, plant-based diet will provide adequate amounts of essential amino acids and prevent protein deficiency. 33

Soybeans and foods made from soybeans are good sources of protein and may help lower levels of low-density lipoprotein in the blood 34 and reduce the risk of hip fractures 35 and some cancers.

Vegetarian diets were associated with lower systolic and diastolic blood pressure ...

A study in the Journal of the American Medical Association 36 reported that women with breast cancer who regularly consumed soy products had a 32% lower risk of breast cancer recurrence and a 29% decreased risk of death, compared with women who consumed little or no soy. 36 An analysis of 14 studies, published in the American Journal of Clinical Nutrition, showed that increased intake of soy resulted in a 26% reduction in prostate cancer risk. 37

Because of concerns over the estrogenic nature of soy products, women with a history of breast cancer should discuss soy foods with their oncologists. Also, overly processed, soy-based meat substitutes are often high in isolated soy proteins and other ingredients that may not be as healthy as less processed soy products (ie, tofu, tempeh, and soy milk).

Iron

Plant-based diets contain iron, but the iron in plants has a lower bioavailability than the iron in meat. Plant-based foods that are rich in iron include kidney beans, black beans, soybeans, spinach, raisins, cashews, oatmeal, cabbage, and tomato juice. 38 Iron stores may be lower in individuals who follow a plant-based diet and consume little or no animal products. However, the American Dietetic Association states that iron-deficiency anemia is rare even in individuals who follow a plant-based diet. 39

Vitamin B₁₂

Vitamin B ₁₂ is needed for blood formation and cell division. Vitamin B ₁₂ deficiency is a very serious problem and can lead to macrocytic anemia and irreversible nerve damage. Vitamin B ₁₂ is produced by bacteria, not plants or animals. Individuals who follow a plant-based diet that includes no animal products may be vulnerable to B ₁₂ deficiency 40 and need to supplement their diet with vitamin B ₁₂ or foods fortified with vitamin B ₁₂. 41

Calcium and Vitamin D

Calcium intake can be adequate in a well-balanced, carefully planned, plant-based diet. People who do not eat plants that contain high amounts of calcium may be at risk for impaired bone mineralization and fractures. However, studies have shown that fracture risk was similar for vegetarians and nonvegetarians. The key to bone health is adequate calcium intake, which appears to be irrespective of dietary preferences. 42 Some significant sources of calcium include tofu, mustard and turnip greens, bok choy, and kale. Spinach and some other plants contain calcium that, although abundant, is bound to oxalate and therefore is poorly absorbed. 43

Vitamin D deficiency is common in the general population. Plant-based products such as soy milk and cereal grains may be fortified to provide an adequate source of Vitamin D. 44 Supplements are recommended for those who are at risk for low bone mineral density and for those found to be deficient in vitamin D.

Fatty Acids

Essential fatty acids are fatty acids that humans must ingest for good health because our bodies do not synthesize them. Only two such essential fatty acids are known: linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid). Three other fatty acids are only conditionally essential: palmitoleic acid (a monounsaturated fatty acid), lauric acid (a saturated fatty acid), and gamma-linolenic acid (an omega-6 fatty acid). Deficiency in essential fatty acids may manifest as skin, hair, and nail abnormalities. 45

The fatty acids that vegans are most likely to be deficient in are the omega-3 fats (n-3 fats). Consumptions of the plant version of omega-3 fats, alpha-linolenic acid, are also low in vegans. Adequate intake of n-3 fats is associated with a reduced incidence of heart disease and stroke. Foods that are good sources of n-3 fats should be emphasized. They include ground flax seeds, flax oil, walnuts, and canola oil. 46

Conclusion

A healthy, plant-based diet requires planning, reading labels, and discipline. The recommendations for patients who want to follow a plant-based diet may include eating a variety of fruits and vegetables that may include beans, legumes, seeds, nuts, and whole grains and avoiding or limiting animal products, added fats, oils, and refined, processed carbohydrates. The major benefits for patients who decide to start a plant-based diet are the possibility of reducing the number of medications they take to treat a variety of chronic conditions, lower body weight, decreased risk of cancer, and a reduction in their risk of death from ischemic heart disease.

A plant-based diet is not an all-or-nothing program, but a way of life that is tailored to each individual. It may be especially beneficial for those with obesity, Type 2 diabetes, high blood pressure, lipid disorders, or cardiovascular disease. The benefits realized will be relative to the level of adherence and the amount of animal products consumed. Strict forms of plant-based diets with little or no animal products may be needed for individuals with inoperable or severe coronary artery disease. Low-sodium, plant-based diets may be prescribed for individuals with high blood pressure or a family history of coronary artery disease or stroke. A patient with obesity and diabetes will benefit from a plant-based diet that includes a moderate amount of fruits and vegetables and minimal low-fat animal products. Severe obesity may require counseling and initial management with a low-calorie diet or very-low-calorie diet and the supervision of a physician's team. Patients with kidney disease may need a plant-based diet with special restrictions, for example fruits and vegetables that are high in potassium and phosphorus. Finally, patients with thyroid disease will need to be careful when consuming plants that are mild goitrogens, like soy, raw cruciferous vegetables, sweet potatoes, and corn. These patients should be informed that cooking these vegetables inactivates the goitrogens.

Physicians should advocate that it is time to get away from terms like vegan and vegetarian and start talking about eating healthy, whole, plant-based foods (primarily fruits and vegetables) and minimizing consumption of meat, eggs, and dairy products. Physicians should be informed about these concepts so they can teach them to staff and patients.

A registered dietitian should be part of the health care team that designs a plant-based diet for patients with chronic disease, especially if multiple medications are involved. Depending on the underlying conditions, patients with chronic disease who take multiple medications need close monitoring of low blood sugar levels, low blood pressure, or rapid weight loss. If these occur, the physician may need to adjust medications. In some cases, such as the one presented here, the need for certain medications can be eliminated altogether. Although the risk of deficiencies may be low, health care teams need to be aware that a motivated patient on a strict plant-based diet may need monitoring for deficiencies of certain nutrients, as outlined above.

The purpose of this article is to help physicians understand the potential benefits of a plant-based diet, to the end of working together to create a societal shift toward plant-based nutrition. There is at least moderate-quality evidence from the literature that plant-based diets are associated with significant weight loss and a reduced risk of cardiovascular disease and mortality compared with diets that are not plant based. These data suggest that plant-based diets may be a practical solution to prevent and treat chronic diseases.

Further research is needed to find ways to make plant-based diets the new normal for our patients and employees. We cannot cure chronic diseases, but we may be able to prevent and control them by changing how we eat. With education and monitoring for adherence, we can improve health outcomes. Patterns of families and other colleagues who may be reluctant to support the efforts of individuals who are trying to change are a challenge to be overcome.

We should invite our colleagues, patients, and their families to a shared decision-making process with the goal of adopting a plant-based diet and a regular exercise program. We should invite health care teams to complete a course on healthy eating and active living. We should encourage staff to be knowledgeable about plant-based nutrition. Finally, we should encourage performance-driven measurable outcomes, which may include:

1. the percentage of physicians who have completed a course on nutrition that includes a discussion of the benefits of a plant-based diet and exercise;

2. the percentage of our hospitals, cafeterias, and physicians' meeting facilities that serve meals that are consistent with a plant-based diet;

3. the percentage of patients on a physician panel who are obese and who have completed a course on weight management and nutrition that emphasizes a plant-based diet; and

4. the percentage of patients in a physician panel with high blood pressure, diabetes, high cholesterol, or cardiovascular disease who completed a course on nutrition that emphasizes a plant-based diet.

Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. If we are to slow down the obesity epidemic and reduce the complications of chronic disease, we must consider changing our culture's mind-set from "live to eat" to "eat to live." The future of health care will involve an evolution toward a paradigm where the prevention and treatment of disease is centered, not on a pill or surgical procedure, but on another serving of fruits and vegetables.

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.

Footnotes

Disclosure Statement
The author(s) have no conflicts of interest to disclose.

Medicine

Let food be thy medicine and medicine be thy food.

-Hippocrates, c 460-370 BCE, ancient Greek physician in the Age of Pericles known as the father of modern medicine

References

8. Blaney D, Diehl H. The optimal diet: the official CHIP cookbook. Hagerstown, MD: Autumn House Publishing; 2009. Jan 1, [ Google Scholar]

9. McDougall JA, McDougall M. The new McDougall cookbook: 300 delicious ultra-low-fat recipes. New York, NY: Plume; 1997. Jan 1, 1997. [ Google Scholar]

26. Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 2010: to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: Agriculture Research Service, US Department of Agriculture, US Department of Health and Human Services; 2010. May, [ Google Scholar]

29. Campbell TC, Campbell TM., II . The China study: the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health. Dallas, TX: BenBella Books; 2006. May 11, [ Google Scholar]

Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente

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Nutritional Update for Physicians: Plant-Based Diets

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The objective of this article is to present to physicians an update on plant-based diets. Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of obesity, diabetes, and ...