Meat-free diets are regularly encouraged as a health promotion strategy (1–3). Plant foods undoubtedly confer a health benefit, contributing soluble and insoluble fiber, micronutrients, as well as various phytonutrients and bioactive compounds, that are limited in most animal-source foods (4, 5). Similarly, animal-source foods provide certain micronutrients and bioactive compounds, including heme iron, zinc, vitamin B₁₂, creatine and carnosine that are absent or have limited bioavailability in plant-source foods (4–6). For that reason, exclusion or heavy reduction of animal-source foods in favor of a primarily plant-source eating pattern may contribute to or increase the risk for certain nutrient deficiencies (7–9). Contemporary recommendations to reduce animal-source foods usually target red meat (10). The classification of animal flesh as ‘red’ is often misunderstood but is based on the concentration of myoglobin (11). According to the United States Department of Agriculture (USDA), red meat includes beef, veal, pork and lamb (12). Red meat can also encompass ‘alternate red meats’ such as venison and bison (13). Globally, beef and pork are the most consumed types of red meat (14); The concentration as well as bioavailability of some nutrients of concern are lower in non-ruminant meats (e.g., pork) when compared to ruminant meats (e.g., beef) (15–18). For example, about 72% of the iron in ruminant meat is heme iron while just 40% of the iron in non-ruminant meat is heme iron (18).

The routine consumption of red meat is often discouraged for human health, environmental sustainability, or animal welfare reasons (10). However, these are complex issues, which are often over simplified and frequently overlook the nutritional value of red meat as part of a balanced diet (19, 20). Environmental sustainability and animal welfare considerations of red meat production are beyond the scope of the present discussion, which focuses on the nutritional value and health effects of red meat.

Nutritionists are at the forefront of making diet-related recommendations, translating scientific evidence into actionable recommendations, with the goal of promoting optimal health for their clients and patients, which will vary depending upon the individual and their goals as well as the selected population. When evaluating the contribution of red meat to healthy dietary patterns, two things must be considered. First, red meat is an animal-source food. Reducing or eliminating animal-source foods, including red meat, presents challenges in meeting dietary recommendations for protein, indispensable amino acids (IAA), and vitamin B₁₂ (4, 7). With respect to these nutrients, red meat as well as other animal-source foods, such as chicken, can fill the gap. Second, certain micronutrients, such as iron, are more readily available in certain types of red meat, such as beef (4). These two factors together favor the inclusion of red meat as part of a balanced dietary pattern.

The following discussion is comprised of four sections. First, we discuss meatless messaging and initiatives. Then we compare the protein content of animal versus plant-source foods. Next, we examine the role of animal-source foods, particularly red meat, in balanced diets for various population groups. Finally, we evaluate the strength of the evidence in favor of reducing or eliminating red meat due to health concerns.

In recent years, meatless initiatives have gained popularity (21). Several United States schools have initiated campaigns to remove red meat as well as poultry, pork, and seafood from the menu on one or more days of the week as a measure to promote health and environmental stewardship (22–25). There is consensus that meals containing animal-source foods carry a higher carbon footprint than plant-source meals, with red meat being the highest contributor (26–28). While these initiatives do have merit, the possibility that the exclusion of red meat could exacerbate nutrient deficiencies, such as iron or zinc deficiency, among vulnerable children must be acknowledged (29). A recent investigation found that zinc content was significantly lower in vegetarian meals compared to non-vegetarian meals (27). Although iron content was not found to be significantly different, heme iron content was not evaluated (27). The difference between heme iron versus non-heme iron, bioavailability, and iron status is discussed in the micronutrient section.

Meatless initiatives are not confined to schools. Government subsidized programs such as Women, Infants and Children (WIC) offer financial assistance for tofu and eggs, but meat products (except red meat or poultry in single ingredient baby foods) are not eligible (30). Many New York City hospitals encourage vegan meals over meals containing animal-source foods, and this approach is advocated as a best practice for all hospitals (31, 32). In addition, some advocacy groups encourage near elimination of meat (including red meat) or its taxation as a matter of public policy (33, 34). An unintended consequence is that nutritional adequacy could suffer, due to reduced intake of red meat inside of hospitals and upon discharge due to a perception that red meat is unhealthy (35). Notably, filling nutrient gaps created by the exclusion of red meat may not be as simple as supplementation because adherence and bioavailability are variable (36–38).

Plant-source foods are of lower protein quality compared to animal-source foods because plant-source foods are low in one or more IAAs and the bioavailability of these essential nutrients is lower (39, 40). In addition, meat (including lean red meat) provides more protein per weight and relative to total kilocalories than plant-source foods (Table 1). While tofu is considered a high-quality vegan source of protein, the density of certain micronutrients, such as zinc and vitamin B₁₂, is lower than beef (Table 1). The dark meat from turkey is a good source of iron, meaning that it provides at least 10% of the Recommended Dietary Allowance (RDA) (4). When compared to red meat, other non-red meat sources within the category of animal-source foods, such as milk and chicken breast, are lower in bioavailable iron as well as zinc and vitamin B₁₂ (Table 1). Older adults and young children, who may have difficulty consuming large volumes of food (41–44), could benefit from the protein and micronutrient density of red meat, as could individuals focused on weight management.

Protein intake above the current RDA has been shown to preserve lean mass during kilocalorie restriction (45). While recommended protein needs and IAA requirements can be met on a vegan diet, additional kilocalories accompany the increased amount of food needed (7). A vegetarian meal pattern can match the total protein and energy provided by an omnivore diet (7), but other factors, including micronutrient density, may make inclusion of lean red meat the more nutritionally balanced option (Table 1). Consuming sufficient high-quality protein to maintain muscle mass and promote weight loss as well as adequate micronutrients to maintain health requires nutrient dense, kilocalorie-conscious meal patterns. The inclusion of foods that are both protein and micronutrient dense, such as lean red meat, facilitates this approach.

Infants and young children 6–23 months, women of reproductive age, and pregnant women have increased iron requirements per calorie, while older adults have increased zinc and vitamin B₁₂ requirements per calorie (67). Estimates indicate that more than half of children aged under 5 years and two-thirds of women aged 15–49 years have at least one micronutrient deficiency (68), while global data are too scarce to provide estimates for men or older adults. Children consuming an exclusively plant-source diet are at greater risk for micronutrient deficiencies (58). Contrary to the position of the United States based Academy of Nutrition and Dietetics (69), numerous pediatricians and nutritional or pediatric organizations as well as a recent systematic review, discourage vegan diets or both vegan and vegetarian diets for young children and pregnant women because the risk of micronutrient deficiencies, particularly iron, zinc, and vitamin B₁₂ is elevated (70–77). Specific concerns for iron and zinc are considered in the following paragraphs. Vitamin A deficiency is also pervasive in young children globally (78). While certain animal-source foods such as chicken skin and liver are good sources, Vitamin A is not found in muscle meat in sufficient quantities to attenuate deficiency and therefore, is not considered in this perspective (4, 5).

Anti-meat messaging, specifically recommendations to reduce or eliminate red meat, are based on concerns for the environment, animal welfare, and health. Concerns for environmental sustainability and animal welfare are complex and nuanced topics (19, 20) beyond the scope of this perspective, which focuses on potential health consequences of excluding red meat from dietary patterns. Depending upon the cut and type of red meat, approximately 30–50% of the total fat in red meat is saturated (92, 93), and there remains ongoing debate concerning the role that saturated fats play in cardiovascular disease (94–97). However, the United States Dietary Guidelines allow saturated fats to comprise 7–10% of total kilocalories, and red meat can be included in healthy eating patterns while staying within those guidelines (42).

Health-based recommendations to reduce or eliminate meat are largely based on research documenting a relationship between all red meats or processed meats with morbidity and mortality (98–103). However, in-between study heterogeneity is large and the certainty of the evidence implicating red meat in the development of chronic disease is low to very low, whereas, the absolute risks related to elevated consumption are small (104–106). When included as part of a healthy dietary pattern, unprocessed red meat has been associated with lower risk of micronutrient deficiencies (107, 108), improvement of cardiometabolic risk factors (52), and attenuation of sarcopenia in older adults (63). In addition, You et al. reported that red meat consumption correlated with reductions in child mortality and longer life expectancies in all areas studied (covering 90% of the globe), except for Southeast Asia (109). Notably, the EAT-Lancet diet, which recommends large reductions in red meat, does not meet requirements for certain micronutrients including iron, zinc, and vitamin B₁₂ (110). Policy makers, health professionals, and advocates must consider the quality of evidence against red meat as well as the potential unintended consequences that could result from the reduction or exclusion of red meat when developing (or ‘establishing’) policies and dietary recommendations.

Globally, the average person consumes an estimated 51 g (less than 2 ounces) of unprocessed red meat per day (111). In the United States, the estimate is 34 g (just over 1 ounce) (111). The World Cancer Research Fund and the American Institute for Cancer Research guidelines allow up to 2.5 ounces (70.9 g) of unprocessed red meat per day (112), yet consumers are routinely confronted with messages to not only reduce red meat intake below current consumption levels but to eliminate this whole food from their diets (1–3, 22–24, 31–33, 113–115). The present perspective proposes that this messaging could cause more harm than good to public health if implemented in public policy or dietary guidelines. Individuals at risk for undernutrition and obesity may benefit from increased intake of key nutrients by eating animal-source foods, including red meat. Red meat provides highly bioavailable forms of many essential nutrients of concern, such as iron, zinc, and protein. In addition, red meat is a source of these nutrients at a lower energy density and in a smaller serving size than many plant-source options. Messaging to children and other at-risk populations indicating red meat is unhealthy discourages a protein- and micronutrient-dense whole food option. The evidence that red meat is causally associated with chronic disease is mixed. Therefore, additional research is warranted to determine whether noted associations between red meat and chronic disease represent true relationships and in what amounts, or if other diet and lifestyle factors account for the variance in health outcomes. At the macro, as well as individual levels, policy makers and dietitians must weigh the nutritional profile and benefits of red meat consumption against the low certainty of evidence used to discourage red meat intake when making public health and nutrition recommendations. This approach represents a contemporary challenge for nutrition professionals endeavoring to optimize the health of their clients and patients.