Table 2. Key discussion points for patient concerns about plant-based diets.

Concerns	Suggested response	Recommended resources
Worry about nutritional adequacy, such as getting enough protein, B12, vitamin D, iron, calcium or other nutrients.[9]	Reassurance that well-planned plant-based diets are healthy and nutritionally adequate; reframe question to remind patients that the majority of Americans (who are omnivorous) do not get enough vitamin A, vitamin D, vitamin E, folate, vitamin C, calcium, magnesium, potassium, or fiber.[10]	Position paper from Academy of Nutrition and Dietetics on vegetarian diets.[11]
Low self-efficacy due to unfamiliarity or lack of experience in shopping for or preparing plant-based foods.	Provide handouts with recommended cookbooks, recipe websites, and chefs to follow on social media.	Lighter.world StraightUpFood.com ForksOverKnives.com DrMcDougall.com Kaiser Permanente Starter Kit
Reluctance to eat more legumes because of the possibility of increased flatulence.	Increased flatulence may be temporary,[12] and adding more fiber-rich foods gradually, as well as soaking or sprouting legumes may help reduce flatulence;[13] remind patients of benefits of fiber consumption.	Winham & Hutchins comparison of 3 feeding trials to assess flatulence with increased fiber found complaints of flatulence subsided with time.[12]
Concerns about additional expense of buying plant-based foods or economic limitations for grocery shopping which are associated with highly processed foods.[14],[15]	Steer patients away from buying costly and highly processed vegetarian replacement meats and cheeses; suggest inexpensive frozen vegetables, buying items in bulk, such as legumes, brown rice, potatoes, and oatmeal; discuss nutritional value and nutrient-to-cost ratio of legumes as compared to meat.[16]	How to Soak & Sprout Nuts, Seeds, Beans, and Grains blog from Vegetarian Times.
Reluctance to try new foods or consume foods thought to be unpalatable (“I don't like vegetables…” or fruits, legumes, whole grains, etc.)	Explain that taste preferences are learned behaviors as opposed to personality traits, and preferences for high-sugar, high-fat, and high-salt foods often are addictions and will shift after a period of adjustment.[17],[18]	The Pleasure Trap by Alan Goldhamer and Douglas J. Lisle.[19] Breaking the Food Seduction by Neal Barnard.[20]