Dr Malcolm Mackay | Contributors - Nourish plant-based living

Dr Malcolm Mackay

Malcolm is a General Practitioner with expertise in plant-based nutrition and lifestyle medicine for the prevention, treatment and reversal of chronic disease. Malcolm’s personal and professional interest in plant-based nutrition began in medical school 35 years ago.


Enjoying our inspiring stories? We always love to hear from you with suggestions for the content you want more of. Suggest a topic here.

Sign up to our newsletter and receive our latest editorial and offers directly in your inbox.

Plant performance

Athletes and fitness freaks from all over the world are going plant-based, and for good reason. You can hit peak performance with plants.

More and more leading athletes are adopting a wholefood, plant-based (WFPB) diet for improved sports performance. The release of The Game Changers documentary in 2019 has been a tipping point for interest in WFPB nutrition – a performance-enhancing strategy that is safe, ethical and available to everyone, from leading sportspeople to regular gym users. As an athlete myself, I have a longstanding interest in sports nutrition. Distance  running and a love of snow skiing motivated me to begin my plant-based nutrition journey when I was in medical school, learning about the damage the Western diet was causing to our arteries and other aspects of health. It seemed to work for me, I ran a 2:32 marathon in 1980 and had a couple of first places in my early triathlons. Even now at age 60, I can still run a reasonable half marathon – something I don’t think I would be fit enough to do had I spent decades eating chicken, cheese and oil.

The benefits of WFPB nutrition combined with avoidance of animal  products and processed foods, impact the whole cycle of sports performance – training, competition, and recovery. Carbohydrate-rich whole plant foods not only provide optimal fuel while supporting blood flow to muscles during training and competition but also support the critically important recovery phase. These foods counteract the oxidative stress and inflammation caused by intense exercise, resulting in fewer overuse injuries and a shorter recovery time, giving athletes the capacity to do quality training sessions, more often.

BUT WHAT ABOUT PROTEIN?

The focus on protein, and particularly animal protein, is the most persistent myth in sports nutrition. No one who consumes adequate calories from a variety of whole plant foods is likely to suffer reduced performance due to lack of protein. While the term ‘protein’ is used in common language and some diet guides to describe certain foods, this is misleading. It implies that these foods are composed of protein only and that other foods do not provide any. Dietary guidelines can also add to the confusion by describing a protein group that includes legumes and nuts but not wholegrains, when on a per-calorie basis, wholegrains have the same protein content as nuts. All whole plant foods are a complex ‘package deal’ with varying amounts of protein. Only processed foods like refined oil and sugar contain zero protein. The natural plant protein package also includes an abundance of health-supporting phytonutrients and dietary fibre, which are absent from the animal protein ‘package’. In fact, animal proteins often include health damaging and inflammatory substances.

High protein diets based on animal products are deleterious to health and athletic performance. While some of the effects are due to the other toxic components of the animal protein ‘package’, the quantity and composition of the protein itself has the following adverse effects on health and athletic performance:

  • Acid load (reducing tolerance to lactic acid build-up during intense exercise).
  • Negative calcium balance and bone loss due to acid load.
  • Kidney stress and long-term damage.
  • Dehydration and electrolyte depletion.
  • Insulin resistance (causing reduced muscle glycogen).
  • Adverse shift in gut microbiome profile.
  • Adverse impact on cardiovascular function.

The primary nutrition issue for plant-based athletes is consuming enough calories to support their heavy training loads. Failure to thrive on a plant-based diet is usually the result of not eating enough calories. The carbohydrate-rich foods that provide the ideal fuel for athletes – such as oats, brown rice, wholemeal pasta, potatoes and beans – have only half the calorie density of meat, chicken and fish. This means twice the quantity will be required to get the same number of calories. Eliminating vegetable oils (the most calorie dense and nutrient poor food group) further dilutes the calorie density of meals, so athletes need to adapt to eating larger meals and more snacks.

PLANT POWER!

Plants contain all the essential amino acids and have an amino acid profile that is more health supporting than that of animal proteins. Athletes do not need to choose higher-protein foods to meet their extra protein needs because they consume more calories than the general population, which means more food and more protein. A typical WFPB diet provides about 12 percent protein, which equates to approximately 1.5 grams of protein per kilogram of body weight for a moderately active person, as opposed to an elite athlete. If athletes are (unnecessarily) anxious about getting enough protein on a WFPB diet, this can be increased by consuming more of the higher-protein plants – more legumes, higher-protein grains (e.g. wheat rather than rice), higher-protein tubers (potatoes rather than sweet potatoes) and more protein-rich, low calorie, non-starchy vegetables. Popular sports nutrition emphasises the importance of consuming protein as soon as possible after exercise but much of the evidence supporting this idea is highly reductionist and may not translate to improvements in performance. It’s true that adequate food intake during the recovery period is important, including the protein that is naturally present in the wholefood, plant-based package. However, after a big workout, it may be better to focus on hydration and phytonutrient-rich plant foods that neutralise inflammation and protect damaged tissues.

Protein supplements are unnecessary and can displace calories that might otherwise have come from nutrient-rich whole plant foods. Inadequate protein intake is only likely to occur in the context of inadequate calorie intake (or on diets built on sugar and oil). Most of us easily meet our protein needs and any additional protein is deaminated in the liver (increasing blood urea levels) and then metabolised to sugar and fat, which is used for energy or stored in the body. Adding protein powder to your meal is like adding sugar – calories without any of the fibre, nutrients and phytonutrients.

Nutrients, when removed from their whole food context and concentrated, can also have unanticipated adverse effects. For example, taking more of one mineral can impair the absorption of other minerals. Animal studies performed in the past suggest that increased intakes of plant protein do not promote cancer and ageing in the same way that animal protein does. Whole plant foods contain the right balance of all the nutrients and phytonutrients that we need for optimal health – we don’t need to try and outsmart nature. The exceptions here are vitamin B12 and vitamin D, which we would get from bacteria and sunshine if we lived in nature, but we don’t these days and supplements may be recommended. Iron supplements can also be appropriate for short-term correction of proven deficiencies.

THE PROOF OF PLANT PERFORMANCE

A WFPB diet can improve sports performance in the following ways.

  • The high carbohydrate content maximises glycogen stores, which provides fuel for endurance events and long training sessions.
  • The lower fat content and higher water and fibre content of whole plant foods means they have a lower energy density, making it easier to maintain a lean physique.
  • It supports optimal cardiovascular health. Arteries remain free of plaque and the improved endothelial (artery lining) health allows arteries to dilate fully, improving blood flow to the heart and muscles.
  • The nitrates in leafy green vegetables and beets boost nitric oxide production, improving blood flow to muscles and reducing blood pressure.
  • Blood viscosity and red blood cell stiffness is reduced, boosting capillary blood flow, and delivering more oxygen to where it’s needed.
  • The antioxidant phytonutrients in whole plant foods neutralise the free radicals that are produced as byproducts of our cellular energy metabolism and protect our cells against exercise-induced damage.
  • Many phytonutrients in whole plant foods have powerful anti-inflammatory actions. These dampen down sports related tissue inflammation without the harmful side effects of anti-inflammatory pharmaceuticals.
  • Immune function is improved through the action of whole plant food phytonutrients and the absence of inhibitory effects from animal products and processed food.
  • WFPB nutrition supports improved mood and energy levels, essential for consistent and goal directed training.

Plant-based athletes can easily meet and exceed their protein requirements by eating adequate calories of whole plant foods, which provide protein in a form that our bodies are designed to process. The WFPB diet also comes with a host of benefits that support holistic health and wellbeing. It’s simple – eat peas, not pea protein.


Dr Malcolm Mackay

Malcolm is a General Practitioner with expertise in plant-based nutrition and lifestyle medicine for the prevention, treatment and reversal of chronic disease.

Enjoying our inspiring stories? We always love to hear from you with suggestions for the content you want more of. Suggest a topic here.

Sign up to our newsletter and receive our latest editorial and offers directly in your inbox.

What is WFPB?

A whole food plant-based diet has the ability to prevent and even reverse some chronic diseases. Here we discuss the power of a well-implemented WFPB diet and how to get started.

When we talk about plant-based diets, we really mean plants only, so no meat, chicken, fish, eggs or dairy products. The whole foods part is not so black and white though and needs a little more explanation. When following a whole food, plant-based diet (WFPB), the food groups included are whole grains, legumes, fruits, vegetables and small quantities of nuts and seeds. Processed food is kept to a minimum and adheres to the adage, ‘nothing good removed, nothing bad added’.

A WFPB diet has a strong health ethos – we consider not just whether it’s a whole plant food but also whether it promotes good health. For example, coconut products are avoided because the high saturated fat content is not health promoting. However, unlike other vegan diets, a WFPB diet is defined more by what is included rather than by what is excluded. The key to successfully adopting a WFPB diet is to eat adequate, and even large, portions of ‘complex carbohydrates’ or ‘starches’. You want to get most of your calories from whole grains, legumes and root vegetables, with these making up at least half of your plate. You can load up the rest with salads and vegetables.

Following a WFPB diet is easy to sustain for many because of the improvements in wellbeing that people experience.

These include:

  • Improved mood and energy
  • Better skin tone and resolution of acne
  • Improved sports performance
  • Improved gut health
  • Improved reproductive health

A key benefit of WFPB that can’t be overlooked is personal empowerment. You can take control of your health and protect yourself from numerous lifestyle diseases.

Your best defence against disease

While there are many areas of uncertainty in nutritional science, there is a core of knowledge that is not controversial.

Diets that include significant amounts of processed foods and animal products are a leading cause of modern diseases such as diabetes, heart disease and cancer.

Conversely, a healthy plant-based diet can provide improvements and even reverse these and other lifestyle-related diseases. If we consider all the published data on dietary treatment of disease, the known physiological mechanisms behind these diseases, and the experience of clinicians who treat them, they all point towards a plant-based diet that is low in fat and based on whole foods as a solution. Indeed, this is the only diet that has been proven to reverse coronary heart disease.

The Adventist Health Study 2 demonstrated a reduction in the risk of chronic disease with each step along the dietary spectrum from omnivore through to vegan. However, it should be noted that this and other studies also find some vegans still suffer from hypertension, diabetes and heart disease – conditions shown to be rare in populations with traditional diets that are mostly plant-based. The difference is that these populations ate minimally processed plant products, whereas a modern vegan diet can have more in common with the standard Western diet in terms of low dietary fibre content plus added fat, sugar and salt.

A whole food, plant-based diet has an impact on multiple diseases, whether for prevention, treatment or even reversal of disease. It also has a powerful therapeutic effect: a symphony of nutrients working on a multitude of bodily mechanisms that contribute to good health.

This is particularly powerful when compared to a pharmaceutical drug that inhibits a single chemical reaction. The effects of a WFPB diet is as much due to the inclusion of the many biologically active phytonutrients in whole plant foods as it is to the exclusion of harmful components in animal products and processed foods. Phytonutrients enhance normal physiological function, including:

  • Reducing inflammation and oxidative damage
  • Creating a healthy gut microbiome and gut function
  • Reducing cholesterol and improving circulation
  • Regulating oestrogen and other hormones
  • Enhancing and balancing the immune system
  • Regulating gene expression

A WFPB diet is a personally empowering strategy for staying healthy for as long as possible and has been shown to reverse many chronic diseases. I regularly see evidence of this at the 6-day immersion retreat I run – joint pain resolves, insulin doses plummet and general wellbeing improves in a very short period of time.

“A WFPB diet has a powerful therapeutic effect: a symphony of nutrients working on a multitude of bodily mechanisms that contribute to good health.”

WFPB dos and don’ts

Grains are an important component of a WFPB diet, and gluten free diets are easily accommodated by choosing grains other than wheat, barley and rye. Humans have been eating grains throughout time and research consistently observes better health outcomes for those who consume more whole grains. Intact whole grains such as brown rice, oats, quinoa, are better than flour products for weight loss and reversing insulin resistance. You want to keep any flour products as close to wholemeal as possible.

Avoid refined grains such as white rice, white pasta, processed gluten-free products and non-wholemeal flour. These have had good things removed – dietary fibre, iron and other nutrients, and phytonutrients including antioxidant polyphenols.

Fresh fruit is a health supporting whole food, rich in fibre, nutrients and water and low in calories, so great to include.

Dried fruit is still a whole food, but a lot more concentrated, so good for extra calories if you need them. While smoothies retain nutrients, they provide less satiety and more rapid sugar absorption, so chewing your food is the healthier option. A WFPB diet may include small amounts of partially processed foods, for example plant milks and tofu (which have had some fibre removed).

Sugar, sugary syrups and fruit juices are not whole foods, but if you choose to use them, try to keep this to small amounts.

A big adjustment for many who follow a WFPB diet is that all vegetable oils and margarines are excluded, even olive oil.

Oils are not whole foods and while there is debate as to whether oil can be part of a healthy diet, the consensus among plant-based nutrition experts is that oils are health-damaging foods. This has a lot to do with its composition. Oil has the maximum calorie content of any food and very few nutrients – zero fibre, zero protein, zero iron, zero calcium and so on. And even if oil were somehow healthy, it would displace a lot of food calories that should have provided fibre, nutrients and phytonutrients. Oils are not your friend if you are struggling to maintain your iron levels without supplements or you need more dietary fibre for better gut function. Further, joint pain and other health problems often only resolve when the last bit of oil is removed from the diet. Rest assured, while it may seem like a big change, it’s easy to prepare food without oil and there are plenty of resources to help you do it.

One more thing – plant protein supplements are unnecessary on a WFPB diet and have the same nutrient displacement issue as oil and sugar. Supplementing with isolated and concentrated nutrients is not a good insurance policy because excessive amounts of one nutrient can counteract the action of other nutrients. So, eat peas, not pea protein! (Vitamin B12 supplements are an exception here and are recommended for plant-based diets.)

Calorie density is key

Understanding calorie density is the key to managing weight whether you need to lose weight, maintain weight or bulk up. You do not need to practise portion control when you eat foods that are high in fibre, low in fat and calories, and naturally satiating.

Minimally processed grains, legumes, vegetables and fruits are satiating, resulting in unintended ‘calorie restriction’, which benefits many aspects of metabolic function. The high carbohydrate foods that have been demonised by low-carb ideology – potatoes, beans, brown rice and other whole grains – are moderately low calorie-density foods, with about half the calorie density of meat. You can healthfully eat large serves of phytonutrient-rich plants on a WFPB diet.

Be aware that nuts and seeds are naturally very high in fat and low in water, and consequently have at least five times the calorie density of basic starchy foods.

This makes them appealing to eat, but easy to overeat. Eating a lot of nuts and seeds can give you a very high ratio of omega-6 to omega-3 fats. For a healthier ratio include nuts and seeds that are higher in omega-3 such as flax and chia seeds. There is legitimate debate over how much high-fat whole plant foods to include in a healthy WFPB diet. However, it’s the more starch-based, low-fat end of the spectrum that has the runs on the board in terms of disease reversal studies, effective lifestyle programs and clinical experience.

Of course, part of the personal empowerment is that it’s up to you how plant-based and whole food you eat, but every step you take towards a WFPB diet will improve your health and wellbeing.

WFPB top tips

  • Base your meals on large serves of whole grains, starchy vegetables and legumes
  • Include plenty of vegetables, particularly cruciferous and leafy green vegetables
  • Fresh fruit is not restricted, so eat up!
  • Minimise foods that have had fibre removed and sugar, oil and salt added
  • Learn to prepare food without oil
  • Choose low oil options when eating out
  • Practise moderation when eating nuts and seeds
  • Drink plenty of water

This article is an extract from Nourish plant-based living, Vol 7 No 6 • View magazine
Dr Malcolm Mackay

Malcolm is a General Practitioner with expertise in plant-based nutrition and lifestyle medicine for the prevention, treatment and reversal of chronic disease.

Enjoying our inspiring stories? We always love to hear from you with suggestions for the content you want more of. Suggest a topic here.

Sign up to our newsletter and receive our latest editorial and offers directly in your inbox.

YOUR INPUT