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A sustainable and healthy diet
REPORT
Putting protein transitions
into perspective
The Dutch food-based dietary guidelines are called the Wheel of Five.
It represents a science-based healthy and more sustainable diet.
At present, the government aims to make the food system even more
sustainable and is therefore targeting a protein transition: less protein
in the diet and more plant proteins overall. However, this may have
implications for public health, particularly for vulnerable populations.
AUTHORS DR. STEPHAN PETERS, JACCO GERRITSEN, JOLANDE VALKENBURG (NZO DUTCH DAIRY ASSOCIATION, THE HAGUE),
DR. CECILE SINGH-POVEL (FRIESLANDCAMPINA, AMERSFOORT), PROFESSOR THOM HUPPERTZ (WAGENINGEN UNIVERSITY RESEARCH,
WAGENINGEN; FRIESLANDCAMPINA, AMERSFOORT)
One of the best-known
recommendations for
a healthier and more
sustainable diet is to eat
more plant-based and
fewer animal-based food
products. This guideline has also been
included in the development of the Wheel
of Five, a representation of the Dutch
food-based dietary guidelines. The Wheel
of Five is developed by the Netherlands
Nutrition Centre. In addition to the Wheel
of Five advice, the Dutch government has
also committed to a protein transition
to encourage people to eat even more
sustainably. However, a protein transition
is not the same as a food transition.
This article discusses the di erences
between a protein transition and a food
transition, and the possible health limita-
tions associated with a transition
based solely on protein.
Food transition
The Dutch food-based dietary guidelines
recommend eating more fruit and vegeta-
bles: i.e., 2 pieces of fruit and 250 grams
of vegetables per day. A diet that follows
Putting protein transitions
into perspective
The Dutch food-based dietary guidelines are called the Wheel of Five.
It represents a science-based healthy and more sustainable diet.
At present, the government aims to make the food system even more
transition, and the possible health limita-
The Dutch food-based dietary guidelines
recommend eating more fruit and vegeta-
1
This article was published in Dutch in Voeding Magazine 1
|
2020
De nieuwe Schijf van Vijf?
REPORTAGE
this fruit and vegetable guideline is con-
sidered healthier and generally more
sustainable, because current average
consumption of fruit and vegetables is
signifi cantly lower. In the Netherlands, we
eat an average of approximately 130
grams of fruit per day (just over 1 piece)1
and 145 grams of vegetables. The Dutch
food-based dietary guidelines also recom-
mend, among other things, eating less
meat, maintaining the current dairy intake
levels, including more legumes in the diet
and eating a handful of nuts every day.
In short, a healthier and more sustainable
diet, according to the Wheel of Five, is
based on foods.
Protein transition
The Dutch government is also tackling the
sustainability of the food system and our
consumption in other ways. The 2018 Bio-
mass and Food Transition Agenda pro-
poses several solutions, including making
agriculture more circular, reducing food
waste, and a protein transition to more
plant proteins or new sources of protein.
The protein transition is viewed from two
perspectives: the production perspective
and the consumption perspective. On the
production side, there is a call for more
innovation and development of plant pro-
teins and new alternative proteins, such as
those from insects. When it comes to the
“plant-based consumption transition”,
two aspects are addressed:
1. Reduction of total protein consumption
by 10-15%.
2. Reversal of the animal-to-plant protein
ratio from 60/40 to 40/60.
In the short term, the Dutch food-based
dietary guidelins are targeting a 50/50
ratio for animal and plant protein. This
already requires considerable behavioral
change for many people. About this shift,
the Netherlands Nutrition Centre says:
“If everyone followed a diet of 50% animal
protein and 50% plant protein, in line with
the Dutch food-based dietary guidelines,
then the environmental impact of our diet
in terms of greenhouse gas emissions
would drop by about 10 to 13%”. For the
Nutrition Centre, going beyond a 50/50
ratio is not yet up for discussion from a
health point of view. According to the
Netherlands Nutrition Centre, this
requires more insight into potential e ects
on our health and the environment. This
article discusses the various health aspects
of a protein transition.
Sustainable versus healthy
The Dutch government’s protein transition
agenda comes mainly from the Ministry of
Agriculture, Nature and Food Quality and
focuses on reducing total protein intake
and on a transition to the intake of more
plant proteins. This vision focuses solely
on protein and is therefore fundamentally
di erent from the vision defi ned in the
Dutch food-based dietary guidelines,
which turns to food products rather than
macronutrients like protein to address
each transition. The Dutch health policy is
based on a comprehensive and holistic
view of nutrition, one that, in turn,
is based on food products, not on its
nutrients. For this reason, the protein tran-
sition agenda should be reviewed by the
Dutch Health Council, the independent
scientifi c advisory board for the Dutch
government. It should look at whether a
policy aimed at reducing protein intake
could pose health risks. In the following
paragraphs, we zoom in on relevant fac-
tors in a protein transition, such as protein
quality and replacement.
Protein quality
The nutritional quality of proteins varies
and depends on the source. Animal pro-
teins often contain more essential amino
acids and in a more benefi cial ratio than
plant proteins. Animal proteins are also
often digested more e ciently. This
should be taken into account when consid-
ering changing a diet to a more plant-
based diet. However, according to the
In 2020, the Dutch government
will present the National Protein
Strategy to increase the production
of plant proteins as well as
how proteins and waste
streams are utilized.
which turns to food products rather than
view of nutrition, one that, in turn,
the Netherlands Nutrition Centre says:
“If everyone followed a diet of 50% animal
protein and 50% plant protein, in line with
the Dutch food-based dietary guidelines,
then the environmental impact of our diet
in terms of greenhouse gas emissions
Strategy to increase the production
A sustainable and healthy diet
REPORT
2
Netherlands Nutrition Centre, if you eat
according to the Wheel of Five and replace
meat, for example, with nuts, legumes,
dairy and eggs, you will get enough pro-
tein. But further moves towards a more
plant-based diet can cause problems. The
most extreme example of such a change is
a vegan diet. According to the Netherlands
Nutrition Centre, vegans need to consume
more protein to meet protein require-
ments, i.e., 20-30% more. And
keep in mind: a vegan diet
requires more points of attention
than just getting enough protein,
like taking dietary supplements.
For more information for Dutch veg-
ans, please refer to the Netherlands
Nutrition Centre’s website. As mentioned
above, to assess protein quality two di er-
ent aspects have to be considered: the
composition of a protein in terms of essen-
tial amino acids, and the digestive e -
ciency. In digestion, proteins from foods
are digested to amino acids. These amino
acids are absorbed into the body where
they can be used for many bodily func-
tions, including muscle/tissue mainte-
nance and growth, the production of pro-
teins and several metabolic functions.
Plant proteins generally contain less essen-
tial amino acids and are, in most cases less
digested, with a lower e ciency. Anyone
who wants to replace animal proteins and
products with plant proteins will have to
take this into account.
Protein substitution
Determining protein quality based on
amino acid composition looks at the limit-
ing essential amino acids in the food. For
a protein with a sub-optimal amino acid
composition, one or more amino acids are
limiting and, consequently, only part of
the protein can be utilized in the body.
As far as essential amino acids are con-
cerned, animal proteins are superior
to plant proteins. It is possible to
improve the amino acid compo-
sition of plant-based products
by mixing di erent protein
sources (see next paragraph).
That mixture, however, must be
consumed in a single meal, because
the amino acids released by the protein
are used within a few hours.
Mixing proteins
The protein quality of plant proteins can
be improved by mixing them. An example
of a plant protein mix is shown in Table 1.
In this example, rice protein is mixed with
lentil protein. A mixture of rice protein
and lentil protein ensures that the limiting
amino acid lysine in rice is compensated
by lentil protein and, conversely, the limit-
ing sulfur-containing amino acids cysteine
and methionine in lentil protein are com-
pensated by rice protein. In the table, the
limiting amino acid is underlined for each
protein. The percentage represents what
the limiting amino acid from 10 grams
of that protein provides compared to the
FAO/WHO recommendations for amino
acids. In rice protein, for example, lysine
is the limiting amino acid. Ten grams of
rice protein provides only 18.1% of the
recommended lysine. The bottom row in
the table shows the protein quality as a
percentage of the limiting amino acid in
the protein or mixture. From this we can
conclude that protein quality is signifi -
cantly improved when lentils and rice are
mixed. However, the quality of the mixture
still does not match that of milk protein.
Furthermore, it should be noted that
values in Table 1 assume 100% digestibil-
ity of the protein sources, whereas studies
have shown that the digestion e ciency
of plant-based proteins is also lower than
that of animal proteins. In short, it is quite
challenging to replace proteins of animal
origin with proteins of equal quality from
plant-based mixtures.
Protein quantity
The average adult in the Netherlands
consumes 78 grams of protein per day
(88 grams for men and 68 grams for
women), 61% of which is from animal
origin. The average intake for the whole
population per kg of body weight is 1.21
grams per day, while the recommendation
is 0.8 grams per kg per day for adults
(Dutch National Food Consumption
Survey, RIVM). Because the average-
protein intake per Dutch person is higher
10 gr milk protein
(279 ml milk or
100 gr quark)
10 gr rice protein
(313 gr cooked rice)
10 gr lentil protein
(130 gr cooked lentils)
5 gr lentil protein and
5 gr rice protein
% of FAO/WHO
recommendation
% of FAO/WHO
recommendation
% of FAO/WHO
recommendation
% of FAO/WHO
recommendation
Histidine 38.6 33.6 42.3 37.9
Isoleucine 37.8 30.9 28.3 29.6
Leucine 37.8 30.3 30.9 30.6
Lysine 41.1 18.1 33.5 25.8
Methionine + cysteine 32.6 41.9 15.8 28.8
Phenylalanine + tyrosine 57.3 49.7 47.0 48.3
Threonine 45.1 34.1 33.3 33.7
Tryptophan 48.7 41.4 30.2 35.8
Valine 33.7 33.5 25.6 29.5
Quality 32.6 18.1 15.8 25.8
Table 1. Contribution of milk, rice and lentils to the FAO/WHO-recommended essential amino acid allowance. The limiting amino acid is underlined. See text
for further explanation.
a vegan diet. According to the Netherlands
Nutrition Centre, vegans need to consume
more protein to meet protein require-
ments, i.e., 20-30% more. And
requires more points of attention
than just getting enough protein,
like taking dietary supplements.
For more information for Dutch veg-
ans, please refer to the Netherlands
Nutrition Centre’s website. As mentioned
the protein can be utilized in the body.
As far as essential amino acids are con-
cerned, animal proteins are superior
to plant proteins. It is possible to
improve the amino acid compo-
sition of plant-based products
by mixing di erent protein
sources (see next paragraph).
That mixture, however, must be
consumed in a single meal, because
the amino acids released by the protein
100 gr quark)
% of FAO/WHO
recommendation
Histidine
3
De nieuwe Schijf van Vijf?
REPORTAGE
than this recommendation, the Dutch
protein transition agenda assumes that the
average protein intake can be reduced by
10-15%. However, no distinction is made
here between di erent population groups
with di erent protein needs, nor between
protein sources. Looking at the recent
Food Consumption Survey, protein intake
in the elderly averages under 1 gram
per kg, and in women aged 31-50 years
0.89 grams per kg per day. It also reveals
that adults consume approximately
60 grams of protein per day on days when
they do not eat meat (approximately
0.8 grams of protein per kg body weight
per day). These fi gures suggest that a sig-
nifi cant proportion of the population has a
relatively low protein intake. It is therefore
important to identify the possible health
e ects of a protein transition agenda
which advocates less protein intake overall
and increased intake of plant-based
proteins in general. This is particularly
important for the older adults, for people
who are ill or immunocompromised, and
for other individuals with a low protein
intake.
Critical nutrients
The transition agenda’s one-sided protein
approach leads to another potential
problem. Our diet not only consists of
proteins, but of foods that also contain
other nutrients. Meat, for example, is an
important source of iron; dairy is an
important source of calcium. The Food
Consumption Survey shows that animal
products (meat, dairy and egg, excluding
fi sh) are responsible for more than 20% of
the intake of:
• Minerals: calcium, phosphorus, iodine,
potassium, magnesium, selenium,
(heme) iron and zinc (fi gure 1a).
Calcium (mg)
Phosphorus (mg)
Iodine (mg)
Potassium (mg)
Copper (mg)
Magnesium (mg)
Sodium (mg)
Selenium (mg)
Iron (mg)
Heme iron (mg)
Zinc (mg)
Eggs Meat Dairy
0 10 20 30 40 50 60 70 80 90 100
Sources of minerals
Food Consumption Survey 2012-2016, ages 1-29
Bronnen van vitamines
VCP 2012-2016, 1-79-jarigen
Retinol activity equivalents (µg)
Retinol (µg)
Vitamin B1 (mg)
Vitamin B2 (mg)
Vitamin B3 (mg)
Vitamin B4 (mg)
Folic acid (µg)
Folate equivalents (µg)
Vitamin B12 (µg)
Vitamin C (mg)
Vitamin D (µg)
Vitamin E (mg)
Vitamin K1 (µg)
Eggs Meat Dairy
Sources of vitamins
Food Consumption Survey 2012-2016, ages 1-29
0 10 20 30 40 50 60 70 80 90 100
Figure 1b. Share of eggs (green), meat (orange) and dairy (blue) in the average Dutch person’s
(ages 1-79) vitamin intake according to the RIVM Food Consumption Survey, 2012-2016.
Figure 1a. Share of eggs (green), meat (orange) and dairy (blue) in the average Dutch person’s
(ages 1-79) mineral intake according to the RIVM Food Consumption Survey, 2012-2016.
Calcium (mg)
Phosphorus (mg)
A sustainable and healthy diet
REPORT
Critical nutrients
The transition agenda’s one-sided protein
approach leads to another potential
problem. Our diet not only consists of
Food Consumption Survey 2012-2016, ages 1-29
Dairy or soy products?
When it comes to dairy substitution, it is important to note that the Health Council of the Netherlands draws a specifi c
connection between the consumption of dairy products and health. It concludes that the consumption of dairy products is
associated with a lower risk of colorectal cancer and that the consumption of yogurt is associated with a lower risk of type
2 diabetes.9 For this reason, the inclusion of dairy products is recommended for the Wheel of Five. The Health Council of
the Netherlands also looked extensively into the health effects of soy (and soy products) and came to the conclusion that
too little research has been done to draw any similar conclusions.
When it comes to dairy substitution, it is important to note that the Health Council of the Netherlands draws a specifi c
connection between the consumption of dairy products and health. It concludes that the consumption of dairy products is
associated with a lower risk of colorectal cancer and that the consumption of yogurt is associated with a lower risk of type
4
• Vitamins: A, B1, B2, B3, B6, B12 and D
(fi gure 1b). It is worth noting that vita-
min B12 does not occur naturally in
plant-based products.
A food transition based solely on proteins
will therefore have major consequences
for food quality. In addition to su cient
protein quality and quantity, the foods in
the alternative diet should also provide
su cient alternative sources of a large
number of vitamins and minerals. The
bioavailability of the nutrients should also
be taken into account. All in all, this is a
major challenge. Moreover, the absorption
e ciency of vitamins and minerals also
depends on which foods they
come from.
Plant-based
alternatives
The Optimeal® program makes
it possible to calculate the conse-
quences on nutrient intake if animal
products are avoided. The RIVM has calcu-
lated example diets in which animal prod-
ucts are avoided and are replaced by alter-
natives to meat and dairy products such as
those o ered in supermarkets. Two sce-
narios were calculated: a 30% and a 100%
replacement of animal products by alter-
native products. In this scenario, meat as
part of the evening meal was replaced
by plant-based alternatives and dairy
products by enriched plant-based drinks.
The RIVM calculated the e ects for adults
and children., The RIVM came to the
following conclusions (fi gure 2):
• A 30% replacement of animal products
leads to a reduction of the CO foot-
print of approximately 14%.
• 100% replacement leads to a 40%
reduction of the CO footprint.
• However, the replacement of animal
products with enriched plant-based
products leads to insu cient intake of
zinc, vitamins A, B1 and B12 and cal-
cium.
This means that in the scenario where
consumers replace all meat and dairy
with plant-based “alternatives”, the
intake of essential nutrients would
still be compromised. Moreover,
from a health point of view,
products o ered on the market
as alternatives to animal products
are not necessarily as healthy as
animal products (see box “Dairy or soy
products?”).
Limits to the protein
transition
For a protein transition that aims to make
food consumption more sustainable, it
cannot simply be assumed that this leads
to a healthy alternative diet. Changing
food consumption with a one-sided
protein-centered approach will lead to a
decrease in the quality of proteins and a
change in the intake of essential nutrients.
In the most optimistic scenario in which
meat and dairy are replaced by alternative
products, risks of nutrient defi ciencies still
remain. The consequences of a two-sided
protein transition in the Netherlands – a
reduction in protein intake and a replace-
ment of animal protein with plant-based
protein – will therefore have to be care-
fully considered. In particular, the conse-
quences for vulnerable groups such as the
older adults and the ill, who with their
current diet may or may not meet the
protein recommendations. For govern-
ment policy, it is better if the protein
transition agenda of the Ministry of Agri-
culture, Nature and Food Quality is har-
monized with the health agenda of the
Ministry of Health, Welfare and Sport.
When it comes to the health impact of a
protein transition, the Health Council of
the Netherlands has an important role
to play.
References
1 www.wateetnederland.nl
2 Transitieteam Biomassa & Voedsel, in: economie, (Ed.)
Transitie-agenda circulaire economie, Transitieteam
Biomassa en Voeding, 2018.
3 RIVM en Voedingscentrum (2019) Brondocument Naar
een meer plantaardig voedingspatroon. 2e herziene
druk.
4 Rutherfurd, S.M. et al. (2015) Protein digestibility-
corrected amino acid scores and digestible
indispensable amino acid scores differentially describe
protein quality in growing male rats. J Nutr 145 (2),
372-9.
5 FAO/WHO/UNU (2007) Joint FAO/WHO/UNU Expert
Consultation on Protein and Amino Acid Requirements
in Human Nutrition (2002 : Geneva, Switzerland), Food
and Agriculture Organization of the United Nations,
World Health Organization & United Nations University.
(2007). Protein and amino acid requirements in human
nutrition : report of a joint FAO/WHO/UNU expert
consultation. World Health Organization.
6 RIVM (2011) Replacement of meat and dairy by more
sustainable protein sources in the Netherlands. RIVM
Letter Report 350123001/2011.
7 Seves, S.M. et al. (2017) Are more environmentally
sustainable diets with less meat and dairy nutritionally
adequate? Public Health Nutr 20 (11), 2050-2062.
8 Temme, E.H., Bakker, H.M.E., Seves, S.M., Verkaik-
Kloosterman, J., Dekkers, A.L., van Raaij, J.M.A., Ocké,
M.C. (2015) How may a shift towards a more
sutainable food consumption pattern affect nutrient
intakes of Dutch children? Public Health Nutr 18 (13),
2468-2478.
9 Gezondheidsraad, Richtlijnen goede voeding, 2015.
30% replacement 100% replacement
% change from reference
-40
-30
-20
-10
0
10
20
30
40
Protein
*
SFA
Fibre
Ca
Fe
Zn
Vitamin A
Thiamin
Vitamin B12
Vitamin D
**
*
*
*
*
*
*
*
*
*
*
Figure 2. Percentage change in nutrient intake following the replacement of 30% and 100% of meat
and dairy with plant-based alternatives. See text for explanation.
% change from reference
30
40
Protein
be taken into account. All in all, this is a
major challenge. Moreover, the absorption
e ciency of vitamins and minerals also
The Optimeal® program makes
it possible to calculate the conse-
quences on nutrient intake if animal
products are avoided. The RIVM has calcu-
This means that in the scenario where
consumers replace all meat and dairy
with plant-based “alternatives”, the
intake of essential nutrients would
still be compromised. Moreover,
from a health point of view,
products o ered on the market
as alternatives to animal products
are not necessarily as healthy as
animal products (see box “Dairy or soy
protein transition, the Health Council of
the Netherlands has an important role
5
