March 2021 Issue
The Flexitarian Diet
By Densie Webb, PhD, RD
Today’s Dietitian
Vol. 23, No. 3, P. 40
Can a focus on this dietary eating pattern improve health and the environment?
Many clients and patients have warmed up to the idea of eating more plant foods, but they’re not sure they’re ready to give up meat completely. A recent survey from the Yale Program on Climate Change Communication and Earth Day Network found that 94% of respondents said they’re willing to eat more plant-based foods.1
Ideally, that means fruits and vegetables would make up one-half the plate. If that describes anyone you counsel, you can suggest a similarly healthful compromise, namely a semivegetarian diet, also known as a flexitarian diet—a flexible diet that focuses on plant foods but doesn’t eschew animal-based foods and products.
While the term “flexitarian” may not be your client’s everyday vocabulary, many do express the desire to eat less meat. “That is what I get mostly from people—that they want to eat more plants and less meat,” says Ginger Hultin, MS, RDN, CSO, a Seattle-based dietitian, owner of Champagne Nutrition, LLC, and a spokesperson for the Academy of Nutrition and Dietetics. That expressed desire can be a good thing, offering dietitians the opportunity to suggest a new-to-them term for healthful eating. Clients often will, on their own, turn to such an eating pattern for a variety of reasons, including health and environmental concerns.
What Is a Flexitarian Diet?
Determining the definition of a flexitarian diet isn’t straightforward, as indicated in a 2017 review of 25 randomized controlled trials and observational studies that examined the health effects of flexitarian-type dietary patterns on health. The studies varied greatly in their definitions of “flexi-semi-vegetarianism.” The definitions ranged from individuals consuming dairy products and/or eggs and eating meat less than once per week to those who eschewed red meat but ate other meats.2
Dawn Jackson Blatner, RDN, CSSD, author of The Flexitarian Diet, says that although she wrote a book with the title and has her own criteria for what makes a diet flexitarian, she doesn’t take credit for the term. “It was voted the most useful word in the English language in 2003 by the American Dialect Society,” she says. “I was so excited when I saw that, because it perfectly described my eating style, and I was the first to create the book on flexitarian eating.” The term was added to the Oxford English Dictionary in 2014, making it official. Blatner also noted that the flexitarian diet has been among the diets ranked as the best by U.S. News & World Report for the last 10 years.
In general, meat consumption varies along a continuum when following a flexitarian dietary pattern. But the diet does call for much less meat than typically is included in a Western dietary pattern. Americans consume, on average, about 10 oz of meat per day (beef, veal, poultry, pork, and lamb).3 The diet offers the option of consciously cutting back on meat, rather than abstaining completely, which is a more palatable compromise for many people.
For individuals who want something more prescriptive, Blatner offers an explanation. In her book, she classifies flexitarians as Beginners, Advanced, and Experts. She defines Beginners as those who eat six to eight meatless meals per week. That amounts to about 26 oz of meat per week. An Advanced flexitarian strives for nine to 14 meatless meals, or about 18 oz of meat, per week. The Expert flexitarian has a goal of 15 or more meatless meals, about 9 oz of meat, per week. Dairy, such as milk, yogurt, and kefir, is another animal protein that can substitute for meat and be included in a flexitarian dietary pattern.
The flexitarian diet often is described as a semivegetarian diet with plenty of fruits and vegetables, whole grains, beans and lentils, and moderate intakes of animal products. “It’s not anti-meat,” Blatner says, “it’s just pro-plant. And that is a good thing. It’s well known that the majority of Americans don’t get enough plant foods in their diets. According to the 2020–2025 Dietary Guidelines for Americans, about three-fourths of the population has an eating pattern that’s low in fruits and vegetables. The recommendation is to include at least two cups of fruit per day and 2 1/2 cups of vegetables per day as part of a healthful eating pattern.4 When meat consumption is decreased, intake of plant foods increases by default.5
As noted in the 2017 review, because the term “flexitarian” connotes flexibility, there’s more than one way to describe a flexitarian diet. For example, the Adventist Health Study 2 defined semivegetarian as someone who eats meat, including fish, at least once a month, but no more than once a week.6
“There’s a large spread of what it can mean to an individual,” Hultin says. “I always ask the individual what it means to them.” Some may consider themselves beginners. Others may already be at the expert level. It’s important to know where clients stand on the continuum.
That flexibility provides health benefits similar to, though no more than that of vegetarians, while allowing for special events, such as birthdays, anniversaries, turkey at Thanksgiving, ham at Easter, and the occasional hot dog at a ballgame, without the accompanying guilt.6 “It offers the mental advantage of being plant-based without having to follow a strict diet,” Blatner says.
Health Benefits
Blatner and Hultin likened a flexitarian diet to the Mediterranean-style eating pattern. The flexitarian diet, like the Mediterranean diet, isn’t 100% vegetarian, and research suggests it may offer much of the same health benefits as the Mediterranean-style of eating.2 A Mediterranean dietary pattern includes a high intake of extra virgin (cold pressed) olive oil, vegetables (leafy greens), fruits, cereals, nuts, and pulses/legumes; twice-weekly servings of fish and seafood; moderate portions of dairy foods and eggs; infrequent servings of meat; and occasional poultry.7 Numerous studies over several decades suggest that following the Mediterranean diet can reduce the risk of CVD and cancer and improve cognitive health.8 This bodes well for the flexitarian dietary pattern.
According to the studies included in the 2017 review, the flexitarian diet provides health benefits related to metabolic health, weight loss, and diabetes prevention.2 One study found that postmenopausal women who followed a semivegetarian diet (which often is considered a flexitarian diet) for more than 20 years had significantly lower glucose, insulin levels, and less insulin resistance compared with non-semivegetarians.9
With regard to weight management, the Adventist Health Study-2 that was included in the 2017 review showed that, of the 97,000 participants, BMI was significantly associated with the degree to which they limited meat intake. The less meat consumed, the lower the BMI.6 Similarly, studies comparing the effects on health of diets across the vegetarian spectrum found that all variants of vegetarian diets (vegan, lacto-ovo vegetarian, pescatarian, and semivegetarian) were associated with substantially lower risk of type 2 diabetes and lower BMI than nonvegetarian diets.10-12 Vegan diets and vegetarian diets were the most beneficial for weight management and diabetes risk in one study, but a flexitarian diet pattern also provided benefits compared with a non-semivegetarian diet.12
A recent systematic review of studies that examined the effects of plant-based diets on weight found that transitioning from an omnivorous diet with no animal food restrictions to a more plant-based diet was associated with weight reduction in a majority of subjects. For the review, the researchers defined plant-based diets as those that exclude meat and fish but acknowledged that people determine them differently and that the term has no specific definition.13
Beyond individual health benefits, the flexitarian diet is a more mindful approach to eating. Those who embrace this way of eating have an eye on its ecological impact on the globe by eating fewer animal products. Research from Johns Hopkins University concluded that if the world adopted a flexitarian dietary pattern (defined as including completely plant-based meals two out of three meals each day) it could result in a potential 41% reduction in food-related emissions.14 Hultin emphasizes that concerns about animal welfare and the environment are among the reasons individuals in her practice cite for choosing a flexitarian-style diet.
Bottom Line
A semivegetarian or flexitarian-style diet can be whatever level of animal food reduction a client seeks. While health often is a primary motivator, concern for the environment is something Chris Vogliano, MS, RD, a global health consultant in New Zealand, and PhD candidate at Massey University of New Zealand, frequently hears from his clients. “While my clients may not have an exact term to describe their aspirations, they’re often interested in reducing their consumption of animal-sourced foods for health, ethical, or environmental related considerations.”
A semivegetarian/flexitarian approach to eating offers the best of both worlds—an increased intake of plant foods, allowing meat and dairy in lesser amounts than what’s typical in an omnivorous diet, and providing some of the health benefits of a vegetarian diet.
— Densie Webb, PhD, RD, is a freelance writer, editor, and industry consultant based in Austin, Texas.
[Sidebars]
Composition of a Flexitarian Diet
Eat More of the Following …
Plant Proteins: Black beans, pinto beans, garbanzo beans, white beans, lentils
Whole Grains and Potatoes: Quinoa, brown rice, oats, white and sweet potatoes
Vegetables: All
Fruits: All
Milk: Cow’s milk and plant-based milk such as soymilk, almond milk, and oat milk
Eggs
Healthful Oils: Olive oil, avocados, fish
Eat Less of the Following …
Animal Protein: Chicken, turkey, red meat, pork
Processed White Grains: White breads, white rice
Animal Fats: Butter, lard
— Source: Dawn Jackson Blatner, RDN, CSSD, author of The Flexitarian Diet
Five-Day Flexitarian Menu
Day 1
Breakfast: Avocado toast with sprouted whole-grain toast, avocado, spinach, egg
Lunch: Kale ranch bowl with chicken or chickpeas, chopped kale/tomatoes, roasted sweet potato cubes, ranch dressing
Dinner: Tacos with seasoned white fish or lentils, corn tortillas, cabbage slaw, guacamole, salsa
Snack: Apple, pecans and/or cucumber, hummus
Day 2
Breakfast: Oatmeal, natural peanut butter, chopped apple
Lunch: Mexican bowl with chicken or black beans, chopped romaine, peppers, brown rice, guacamole, salsa
Dinner: Mediterranean plate with grilled chicken or chickpeas, cucumber/tomato/feta cheese, lemon-dill brown rice
Snack: Grape tomatoes, mozzarella stick and/or clementine, pistachios
Day 3
Breakfast: Green smoothie with 2% plain kefir, rolled oats, banana, spinach
Lunch: Chicken or edamame, coleslaw, quinoa, ginger dressing
Dinner: Beef or bean burger, sweet potato fries, crudités with ranch dressing
Snack: Carrot sticks, almond butter and/or dark chocolate, berries
Day 4
Breakfast: Whole grain cereal, low-fat milk, banana
Lunch: Vegetarian lasagna, side salad
Dinner: Baked chicken breast, roasted root vegetable (parsnips, onion, carrots, rutabagas), wild rice
Snack: Seedless dates stuffed with walnut halves
Day 5
Breakfast: Scrambled eggs, grilled smoked sausage, whole grain bagel
Lunch: Hummus, five-seed crackers, sliced pears
Dinner: Soy-based yogurt, blueberries, ground flax, whole grain toast with peanut butter
Snack: Nondairy frozen dessert
— Source: Dawn Jackson Blatner, RDN, CSSD, author of The Flexitarian Diet
[Recipes]
Honey Gingered Salmon
Ingredients
1/2 cup orange juice
1/3 cup honey
2 1/4 tsp grated ginger, fresh
1 large garlic clove, crushed
4 salmon filets (4 oz each)
Directions
1. Preheat oven to 375˚ F.
2. Line baking pan with parchment paper.
3. In a small pan, over medium heat, combine the orange juice, honey, ginger, and garlic and bring to a boil.
4. Reduce heat to low and simmer for 5 minutes, or until the mixture has thickened to a syrupy consistency.
5. Place salmon on the parchment-lined baking pan.
6. Spread half the glaze on top of the salmon filets.
7. Bake for 8 to 10 minutes.
8. Optional: Use the remaining glaze to serve over the salmon.
Nutrient Analysis per serving (1 filet)
Calories: 192; Total fat: 3 g; Sat fat: 0.5 g; Cholesterol: 45 mg; Sodium: 257 mg; Total carbohydrate: 52 g; Dietary fiber: 0 g; Sugars: 24 g; Protein: 19 g
Mediterranean Stew
Ingredients
2 14-oz cans of fire-roasted, diced tomatoes
3 cups chicken broth
1 cup chopped onion
3/4 cup carrots, cut into coins
4 cloves garlic, minced
3/4 tsp salt
1/2 tsp coarsely ground pepper
1 tsp Ras el Hanout (Middle East spice blend)
1/2 tsp hot paprika
1 15-oz can of chickpeas
8 cups spinach, stemmed and chopped
1 T lemon juice
2 T extra-virgin olive oil
Directions
1. Combine tomatoes, broth, onion, carrots, garlic, salt, pepper, Ras el Hanout, and paprika in a 4-quart slow cooker. Cover and cook on low for 6 hours.
2. Add chickpeas, spinach, and lemon juice to the cooker. Stir, cover, and cook on low until the spinach is tender.
3. Serve the stew into 6 bowls. Drizzle with olive oil.
Nutrient Analysis per serving (1 3/4 cups)
Calories: 191; Total fat: 8 g; Sat fat: 1 g; Cholesterol: 0 mg; Sodium: 416 mg; Total carbohydrate: 23 g; Dietary fiber: 6 g; Sugars: 5 g; Protein: 6 g
— Source: Recipes courtesy of Densie Webb, PhD, RD
References
1. Yale Program on Climate Change Communication; Earth Day Network. Climate change and the American diet. https://climatecommunication.yale.edu/wp-content/uploads/2020/02/climate-change-american-diet.pdf
2. Derbyshire EJ. Flexitarian diets and health: a review of the evidence-based literature. Front Nutr. 2017;3:55.
3. Misachi J. How much meat do Americans eat? WorldAtlas website. https://www.worldatlas.com/articles/meat-consumption-in-america.html. Published September 26, 2018.
4. US Department of Agriculture; US Department of Health and Human Services. Dietary Guidelines for Americans 2020–2025. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf. Published December 2020.
5. Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in state-specific adult fruit and vegetable consumption—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(45):1241-1247.
6. Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014;100 Suppl 1(1):353S-358S.
7. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean diet; a literature review. Nutrients. 2015;7(11):9139-9153.
8. Mediterranean diet. Oldways website. https://oldwayspt.org/traditional-diets/mediterranean-diet
9. Kim MH, Bae YJ. Comparative study of serum leptin and insulin resistance levels between Korean postmenopausal vegetarian and non-vegetarian women. Clin Nutr Res. 2015;4(3):175-181.
10. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23(4):292-299.
11. Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-1980.
12. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791-796.
13. Tran E, Dale HF, Jensen C, Lied GA. Effects of plant-based diets on weight status: a systematic review. Diab Metab Syndr Obes. 2020;13:3433-3448.
14. Center for a Livable Future. Johns Hopkins Center for a Livable Future website. https://clf.jhsph.edu/