Three important reports on food, health and climate

This month we see the release of three important report. The 2026 Global Nutrition Report brings together the evidence on food systems, nutrition and the impact on health, climate and the financial bottom line. It describes the global food system as ‘one of the defining challenges of our time’. I could not agree more.

Our current food system is harming people, the planet and the animals. 2.6 billion people can not afford a healthy diet, with most of this burden concentrated in low- and middle-income countries. We remain way off track to meet Sustainable Development Goals 2 (zero hunger) and 3 (good health and well-being). Obesity and diet-related diseases continue to rise whilst undernutrition still persists in some regions. At the same time, climate breakdown and biodiversity loss threatens our food supply. The report terms this a ‘polycrisis’.

We need a whole system approach to transforming food and farming. The report endorses the need to transition to a plant-based food system and provides recommendations for action across all sectors of society from Governments, policymakers, funders, NGO’s and the private sector. It is going to require us all to transform our food system into one that is healthy, nutritious, accessible, affordable and just. You can find more information about individual countries here.

What I did not like about the report was the promotion of animal grazing systems for the regeneration of soil health. There is no evidence that animals are required for this purpose. Under Conservation Agriculture, the food production system recommended by the Eat-Lancet Commission, animals are not required and in fact studies have shown that animal-free farming has significant advantages for meeting our climate and nature goals.

Closer to home, the flagship annual report from the Food Foundation, the Broken Plate 2026, is a stark reminder of the problems facing individuals and communities in the UK.

Some of the headline findings include:

• Healthier food remains nearly twice as expensive per calorie as less healthy food, and the gap is widening

• Households in the lowest income fifth of the population would need to spend 85% on food to afford the government-recommended healthy diet

• The price gap between healthier and less healthy food is increasing and is now the widest it has been in over a decade

• 40% of food and non-alcoholic drink promotions are on foods high in fat, salt or sugar.

• Fruit and vegetables only account for 3% of traditional advertising food and non-alcoholic drink expenditure, compared to at least 29% for unhealthy foods

The consequences are that diet quality in the UK is at an all-time low, diet-related diseases continue to rise, healthy life expectancy is in decline and our food system continues to be a major driver of climate breakdown and biodiversity loss.

In good news, the BDA (British Dietetic Association) have published their long-awaited report on reducing carbon in NHS patient menus. It is the strongest signalling we have had from the UK dietetic profession on the need to transition to a plant-rich food environment, where plant-based meals are prioritised to meet health and climate goals. There remains an undertone of caution, but the overall message signals to the profession must embrace the evidence and lead on transforming the food service in healthcare settings. I hope this will allow us to accelerate our work through the Plants First Healthcare Coalition.

More evidence supporting plant-rich diets

The consensus on diet quality has remained unchanged for decades. Healthy diets are those that emphasise the consumption of fruit, vegetables, whole grains, legumes, nuts and seeds, whilst minimising/avoiding red and processed meat and foods high in saturated fat, salt and sugar. This way of eating can be adapted to all cultural and traditional diet patterns including Mediterranean, Asian, African, flexitarian, plant-based and more.

With this in mind, a new study examines the Optimal Dietary Patterns for Lower Weight Gain and Risk of Obesity Surrounding Menopause. The study included 38, 283 women from the Nurses’ Health Study II (1989-2019) observed over a 12-year period surrounding the menopause. Diet was assessed every 4 years using validated food frequency questionnaires. The data was analysed with reference to a number of different eating patterns, including Mediterranean, plant-based, Planetary Health Diet, low-carb, high in ultraprocessed foods.

The results showed that in general, eating patterns high in fruits, vegetables, whole grains, legumes, nuts and seeds and low in red and processed meats, sodium, potatoes, and French fries supported better weight management. The two dietary patterns that seems to be most effective were the Planetary Health Diet (>87.7% plant-based) and low-insulinaemic diet. suggesting that high insulin levels may precede the onset of weight gain.

As a sidebar, the empirical dietary index for hyperinsulinemia (EDIH) is comprised of eighteen food groups; thirteen are positively associated with C-peptide - a marker of insulin production - (red meat, high energy drinks, cream soups, margarine, chicken, butter, French fries, fish, low energy drinks, tomatoes, eggs, low fat dairy) and five are inversely associated (red wine, coffee, whole fruit, high fat dairy, green leafy vegetables). I know these are an odd collection of foods and drinks, but they are ones that are associated with insulin levels (high or low) in the blood.

Interestingly, we also have a new study showing that diets higher in whole plant-based foods are associated with a lower risk of sepsis. Sepsis, or bloodstream infection, is not usually a condition thought to be related to diet. Yet, in this study of 180, 442 participants from the UK Biobank, adherence to a healthy plant-based diet was associated with a 16% lower risk of developing sepsis. There was a dose effect, with the more healthy plant foods consumed the lower the risk, and the impact was independent of traditional risk factors (age, alcohol and smoking, presence of chronic conditions). On further analysis the benefit came from having a lower body weight, lower levels of inflammation (lower C-reactive protein) and better metabolic health.

Interestingly, very similar results were found using data from the UK Biobank and analysing the impact of the Planetary Health Diet on risk of sepsis. Greater adherence was associated with a lower risk of sepsis, independent of genetic predisposition, and through the modulation of immune-inflammatory proteins.

Readers will already know that plant-rich diets result in a healthier gut microbiome, which in turn has a positive impact on the immune system. This leads to reduced inflammation, improved insulin sensitivity and metabolic health. These impacts are most likely to explain the reduced risk of sepsis.

Vegan versus Med diet for fibromyalgia

The Mediterranean diet (Med diet) has been extensively investigated over the years with benefits found for all aspects of physical and mental health. However, studies have shown that the health impacts are mostly due to the higher intakes of fruit, vegetables, whole grains, beans, olive oil nuts and seeds and not due to the wine or fish, as often suggested.

So, there should be no reason why a healthy plant-exclusive diet (appropriately supplemented with vitamin B12) should not be just as beneficial. Prior studies have supported this notion, including a randomised study comparing a vegan diet to the Med diet where the vegan diet was better for weight loss, improving insulin sensitivity and blood lipids, but not as good for blood pressure reduction. A lacto-ovo vegetarian diet, as tested in the Cardioveg study, may be better than the Med diet for weight loss and lowering cholesterol but not as good for lowering triglycerides. The vegetarian diet was also better for kidney health.

It is good to read this new randomised study of a Med diet versus a vegan diet for women with fibromyalgia, specifically looking at the impact on cardiometabolic health - the FIBROVEG study. The primary outcome was impact on LDL-cholesterol.

It is a very small and short study - only 11 participants in each study arm and following each diet for 6 weeks. Of note, the vegan diet includes plant-based dairy and meat alternatives and vitamin B12 supplementation.

The results showed that the vegan diet resulted in greater reduction in LDL-cholesterol than the Med diet. For secondary outcomes the vegan diet was also better for lowering triglycerides and for improving fibromyalgia-related pain. It’s worth noting that during the vegan period participants reported lower satisfaction and barriers such as perceived lack of willpower and the cost of foods associated with maintaining the dietary pattern.

This study probably doesn’t tell us anything we didn’t know already. We know a plant-exclusive diet tends to have the greatest impact on cholesterol lowering than other healthy diet patterns. Interesting the lipid lowering occurred in the absence of weight loss, demonstrating that this impact was due to dietary components, most likely fibre.

The impact on pain however is useful given the limited treatment options for fibromyalgia. We have started to recognise that diet has an impact on pain and should be considered a modifiable lifestyle factor when supporting people with pain. In fact a new analysis from the UK Biobank shows that diet patterns higher in plant-based foods, such as the healthy plant-based diet index and the Eat-Lancet Planetary Health Diet, is associated with a lower risk of chronic pain, both musculoskeletal and other types of pain.

Food is medicine

A landmark new study published in Nature Medicine provides some of the strongest, real-world evidence to date that food really can be medicine.

Researchers evaluated a large-scale Medicaid program in Massachusetts that provided medically tailored meals to food-insecure adults living with complex chronic diseases, including cardiovascular disease, diabetes, chronic kidney disease, and mental health conditions. The analysis included 1,866 participants receiving meals and 1,372 matched controls across 11 health systems over a 6-month period.

The dietary plan offerings include five Core Diets: Renal, Diabetic, Cardiac, Maternal Health, General Wellness

The Core Diets were then be combined with ten potential Modifiers to meet personal dietary preferences, additional medical needs, or allergies: Mild flavour with fewer spices, soft foods for individuals with dental issues or swallowing challenges, low fibre, pescatarian, no fish, no red meat, low lactose, vegetarian, high calorie and high protein and no nuts.

The results were remarkable:

• 31% fewer hospitalisations among participants receiving medically tailored meals

• 20% fewer emergency department visits

• US$3,433 lower healthcare costs per person during the intervention period

• Healthcare savings offset 98% of the program costs within a 7-month period

• No reduction in primary care visits, suggesting participants remained engaged with routine healthcare while requiring less acute care

• The greatest benefits were seen among those with the highest disease burden

• Cardiovascular disease: healthcare costs reduced by US$10,450 per person

• Chronic kidney disease: healthcare costs reduced by US$12,312 per person

• Healthcare costs fell by nearly US$9,700 per person amongst the most medical complex patients

This reinforces some key concepts. Addressing the root cause of chronic conditions is not only possible but essential.

Healthy lifestyle habits after a cancer diagnosis.

This important new study from the UK Biobank is the first study to investigate associations between adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations, assessed using an abbreviated version of the 2018 WCRF/AICR score, and all‐cause mortality in people with cancer in the United Kingdom.

Using data from more than 28,500 people who developed cancer during follow-up, the researchers examined adherence to five key recommendations relating to maintaining a healthy weight, being physically active, eating a diet rich in fruits, vegetables and fibre, limiting red and processed meat, and limiting alcohol intake.

Individuals who adhered more closely to these recommendations had a significantly lower risk of death from any cause after a cancer diagnosis. For every one-point increase in the adherence score, equivalent to fully meeting one additional recommendation, the risk of death was reduced by around 8%, after accounting for factors such as age, sex, education and smoking status. Those with the highest adherence scores experienced a 16% lower risk of death compared with those with the lowest scores. Importantly, these associations were consistent regardless of smoking status and whether cancer was diagnosed relatively soon after lifestyle assessment or many years later. The reduction in mortality was apparent for early onset cancers, <50 years old, as well as those occurring in people >50 years old.

When the researchers examined individual cancer types, higher adherence scores were associated with significantly better survival among people diagnosed with prostate, breast, lung, oesophageal and liver cancers. The reduction in mortality risk ranged from around 5% to 14% for every additional point on the lifestyle score. There was also a trend towards improved survival in colorectal cancer, although this did not quite reach statistical significance.

Overall adherence to the recommendations was only low to moderate, with particularly poor adherence to recommendations on limiting red and processed meat and alcohol consumption, especially among men. In contrast, adherence to recommendations on fruit and vegetable intake, physical activity and healthy body weight was generally better. These findings suggest clear opportunities for targeted lifestyle support among people living with and beyond cancer.

Although the study could not account for important clinical factors such as cancer stage and treatment, which may also influence survival, the consistency of the findings across multiple analyses strengthens confidence in the results.

Overall, this research provides compelling support for the WCRF/AICR recommendation that people should continue to follow healthy lifestyle guidance after a cancer diagnosis whenever possible. It reinforces a growing body of evidence showing that lifestyle medicine has an important role not only in cancer prevention but also in improving outcomes for those living with cancer.

We have a useful factsheet for people living with and beyond a cancer diagnosis. Listen to the In a Nutshell podcast episode to hear more about this study

Slovenia’s new dietary guideline and the ensuing controversy

Nutrition professionals in Slovenia have been working on their food-based dietary guidelines for the last 4 years (I have been told the work was conducted free of charge). They have brought together the best available evidence on health and sustainability and devised a brilliant three plate model that allows protein sources to be varied based on preference. Three-quarters of the plate remains constant and composed of fruit, vegetables and whole grains. The remaining one quarter for protein can be akin to the Mediterranean diet, a vegetarian diet or fully plant-based. It is very much in line with the Eat Lancet Planetary Health Diet and was endorsed by its lead author Dr Walter Willet.

The global community celebrated this evidence-based guide, which would be a template for other countries yet to align with the Planetary Health Diet. However, rather alarmingly, two weeks after publication, the new Slovenian government have decided to disassociate themselves from this guidance and removed it from the government website. Instead, they have decided to reevaluate the evidence.

Please support Prof Natasa Fidler as she now navigates this situation and help her to call out what can only be the meat and dairy lobby discrediting evidence-based recommendations.

See you back in July.

Healthy life expectancy in the UK at an all time low

A sobering start to this month’s review. A new report from The Health Foundation finds that healthy life expectancy - the average number of years a person would expect to live in good health - is at an all time low in the UK. Over the last decade it has fallen by 2 years, making it 60.7 years for males and 60.9 years for females.

Even more alarming is that the gap in healthy life expectancy between the most and least deprived deciles in England is now 19.4 years for males and 20.3 years for females. Healthy life expectancy fell more rapidly for females than for males, raising concerns about the worsening trend of women’s health.

Of 21 high-income countries, the UK is one of only five that saw healthy life expectancy fall between 2011 and 2021, and had the second steepest decline. The UK now ranks 20th with only the United States having a lower healthy life expectancy.

This has not been caused by the COVID-19 pandemic as life expectancy has largely remained stable in the UK and other similar countries have seen healthy life expectancy remain stable or improve. Rather, it is a reflection of lifestyle and socioeconomic factors, which are of course inextricably linked.

The authors conclude ‘the UK’s trajectory is not inevitable, but the result of policy choices and underlying conditions that have left the population, particularly among working-age adults, more vulnerable to ill health.’

This should be a wake up call to ensure the UK can offer citizens a minimum standard of living (i.e. housing, education, jobs) and access to healthy behaviours (diet and nutrition, physical activity and avoiding tobacco and alcohol).

New Lancet Commission on liver health

This second Lancet commission on liver health raises awareness of lifestyle factors that are driving liver disease across Europe. Alcohol and unhealthy diets are the key drivers of liver-related mortality (from cirrhosis and liver cancer) and eliminating these risk factors would almost half the burden of liver disease.

The major dietary factors remain excess consumption of saturated fat (mainly from animal-sourced foods), and added or free sugars, such as fructose or sucrose in foods and sugar sweetened beverages. These dietary factors are usually associated with excess calorie intake and overweight/obesity, which in turn causes liver dysfunction.

The commission makes it clear that unhealthy behaviours are primarily related to the environments we live in rather than a failure of individual will power and thus Government and policy makers need to focus on shaping healthy living environments.

Food insecurity is compounding the problem as more people are relying on cheaper, energy-dense, high-fat, high-sugar, low-nutrient foods, leading to an overall decline in dietary quality.

Check out our factsheet on diet and lifestyle for liver health.

Sleep, nutrition and physical activity important for cardiovascular health

This study investigated the combined impact of three healthy behaviours - sleep, nutrition and physical activity - on cardiovascular health. The researchers analysed data on 53,424 participants in the UK Biobank study. Sleep and physical activity information was collected from a wearable, wrist accelerometry data. Dietary intake was assessed once at baselines using a self-reported questionnaire.

Over the 8.0-year follow-up period, 2034 major adverse cardiovascular events (MACE) occurred, comprising 932 myocardial infarctions, 584 strokes, and 518 heart failure events.

The results showed that 8-9.4 hours of sleep per day, 42-104 minutes of moderate to vigorous physical activity per day and a high diet quality score was associated with a 57% lower risk of a MACE. Even small increments towards ideal healthy habits was beneficial with the combination of an additional 10 min/day of sleep, 5 min/day of physical activity and 3 extra points on the diet quality score (equivalent to an extra one-fourth cup of vegetables) associated with a 10% lower risk of MACE.

The authors conclude ‘These findings highlight the need for integrated multi-behaviour lifestyle prevention trials to evaluate the effectiveness of small, achievable lifestyle changes for MACE prevention.’

Read our article on plant-based diets and cardiovascular disease.

Plant-based diets and risk of dementia

Studies on diet and dementia risk are increasingly demonstrating a consistent theme. Diets rich in whole plant foods and lower in animal-sourced and ultra-processed foods are associated with a reduce risk. This is in part because plant-rich diets reduce the risk of hypertension, obesity, type 2 diabetes, dyslipidaemia, condition which increase the risk of dementia.

This new study aimed to investigate the impact of plant-based dietary patterns on the risk of dementia in ethnically diverse population. Data from the Multiethnic Cohort Study, based in Hawaii and California (primarily Los Angeles County), was analysis and includes African American, Japanese American, Latino, Native Hawaiian, and White participants who completed food frequency questionnaires at baseline (1993-1996; age 45-75 years) and at 10-year follow-up (2003-2008). Dietary data were scored according to overall plant-based diet, healthy plant-based diet and unhealthy plant-based diet index. You can read more about the plant-based diet index here.

The results showed that participants most adherent to an overall plant-based diet and a healthy plant-based diet had a 12% and 7% reduced risk of dementia, respectively. Adherence to an unhealthy plant-based diet was associated with a 6% increased risk.

Researchers were also able to assess the impact of dietary change over time. Participants who changed their diet to a more unhealthy plant-based diet over the follow up period had a 25% increased risk of dementia, whereas participants who improved their diet quality over time had a 11% lower risk.

The findings were overall consistent across age groups, race and ethnicity and APOEℇ4 carrier status.

The researchers explored changes in intake of individuals food groups. A large decrease in 4 of the 7 healthy plant food groups (whole grains, vegetable oils, nuts, and tea/coffee) was associated with a higher risk of dementia by 11%–15%. Of the 4 less healthy plant food groups, only increased consumption of added sugars was associated with a 12% higher risk of dementia. Of the 5 animal food groups, a large decrease in egg consumption was associated with a 12% higher risk of ADRD. Increase in consumption of animal fats and meat were associated with an increased risk of dementia.

Overall, the study supports the findings of other similar studies, that increasing the consumption of healthy plant foods, whilst reducing the consumption of animal-sourced foods and limiting unhealthy plant-based foods is helpful for reducing the risk of dementia. The reasons for these finding are multiple, including the presence of nutrients within plant foods such as fibre, vitamins and minerals that help maintain cardiovascular health, normal blood lipid levels and help prevent diabetes.

The finding on eggs is interesting as other studies have also found that egg consumption is associated with a lower risk of dementia, including this new analysis of the Adventist Health Study-2. But, and there is a big BUT. The results from the Adventist Health Study showed that substituting eggs for nuts/seeds or legumes in the diet was associated with a similarly reduced risk of Alzheimer’s disease.

In my view, there is nothing special about eggs. The nutrients that are thought to support better brain health include, omega-3 fats, vitamin B12, choline and lutein and zeaxanthin-carotenoids. All the nutrients in eggs can be adequately sourced from plants, fortified foods or in the case of vitamin B12, from a supplement. Of note, several nutrients in eggs, such as omega-3 fats and vitamin B12 are fed to chickens. It is no different for humans to obtain these nutrients from their original source without having to eat eggs.

Most populations globally are not consuming sufficient legumes and nuts, even if traditionally their diets have been mostly plant-based, like in India. For this reason it is more difficult to assess the impact of legume and nut consumption on brain health or other aspects of health for that matter. If people are not consuming these foods, observational studies can’t assess the impact on health. What we do know from multiple studies is that substituting animal-sourced foods, including eggs, for legumes and nuts, consistently has a positive impact on health, including a reduced risk of premature mortality.

Brain health is dependent on many other factors. Learn more in our article on diet and lifestyle and brain health.

Limiting ultraprocessed foods and optimising fibre intake.

Two new review articles are worth reading. The first is a consensus on ultraprocessed foods and cardiovascular health from the European Society on Cardiology. Diets high in UPFs are associated with negative health outcomes, including cardiovascular diseases. However, not all UPFs are created equal and the classification itself does not tell you about the nutritional value of the foods.

This consensus statement recommends that in clinical practice, we should support patients to remove or greatly limit processed meat, packages snacks and sugar-sweetened beverages in the diet, whilst prioritising fibre-rich plant-based foods. Any shift towards a more plant-based diet is better for health. Encouraging home cooking, considering meal timings and the context in which meals are eaten - earlier in the day, mindfully and slowly - is also important.

The document does not discuss plant-based meat or dairy alternatives which is a shame as these are increasingly included in country-based dietary guidelines and growing numbers of people are actively reducing the consumption of animal-sourced foods for environmental and ethical reasons.

The second is a review on dietary fibre, which remains one of the most under-consuming nutrients in the modern diet.. Despite decades of evidence linking fibre-rich diets with lower rates of cardiovascular disease, type 2 diabetes, obesity and bowel disorders, fibre intake across industrialised nations remains far below recommended levels. In the UK, only 4% of children and adults meet recommended daily intakes.

The authors explore the difference between intrinsic fibre found naturally within whole plant foods and functional fibre added to processed foods or sold as supplements. While both may have physiological effects, the evidence consistently shows that the greatest health benefits come from consuming minimally processed plant foods such as vegetables, fruits, legumes, nuts and whole grains. These foods contain fibre within an intact plant matrix alongside polyphenols, antioxidants and other protective compounds that work together to support health.

A central theme of the paper is the relationship between fibre and the gut microbiome. Different fibres influence microbial composition and metabolism in highly specific ways, particularly through the production of short-chain fatty acids, compounds known to support gut integrity, immune function and metabolic health. However, not all fibres are equal. The physiological effects depend on their structure, fermentability and viscosity, as well as the food matrix in which they are delivered. This may explain why fibre supplements and fortified foods often produce less consistent and less comprehensive benefits than whole plant foods.

The review also highlights the limitations of highly processed diets and cautions against relying solely on isolated fibre ingredients to solve a population-wide fibre deficit. Targeted fibre fortification and supplementation may help in certain contexts, they cannot replicate the broad clinical benefits seen with diets centred on minimally processed plant foods.

The authors emphasise that improving fibre intake requires more than individual behaviour change. Public policy, food reformulation, labelling initiatives and better access to affordable plant foods will all be necessary to create healthier food environments.

Keto diets and LDL-cholesterol

Although low-carbohydrate, animals-based diets, including the ketogenic diet (KD), remain outwith consensus, some clinicians and high profile influencers continue to recommend this way of eating. In the short-term there may be some benefits, but concerns remain about long-term health outcomes. In part, because diets high in saturated fat and low in fibre lead to elevated LDL-cholesterol (LDL-C) and apolipoprotein B levels and thus a higher risk of atherosclerotic cardiovascular disease (ASCVD).

This new review focuses on KD-induced elevation of LDL-C in people with normal body mass index, exploring potential mechanisms underlying this phenotype, and discusses implications for ASCVD risk and management.

The bottom line is that keto diets can result in large elevations in LDL-C. The authors state ‘there is currently no established evidence that individuals with marked LDL-C elevations on KDs are protected from LDL-mediated atherogenesis’ and they suggest that reintroducing carbohydrates is a useful strategy for reducing LDL-C levels. If a person wants to continue a KD despite the dyslipidaemia, then cholesterol lowering medication may need to be instituted.

The authors conclude ‘The absence of long-term outcome data should not be interpreted as evidence of cardiovascular safety in these patients’.

It seems crazy to me that people want to adopt KDs when fibre-rich, plant-based diets have so many benefits for both short and long-term health.

Animal-based versus plant-based protein for muscle protein synthesis

This new systematic review and meta-analysis of 12 studies found that animal-based proteins confer a small but significant advantage in stimulating muscle protein synthesis (MPS) compared to plant-based proteins. Most animal protein data were derived from milk-based sources, while plant proteins were from a variety of different sources.

However, the interpretation is more nuanced. The observed advantage of animal protein was mostly seen in older adults (>65 years), whereas younger individuals showed comparable MPS responses regardless of protein source. MPS responses were observed for young and older adults regardless of resistance exercise or not.

The authors suggest that this age-related difference may be related to the lower leucine content typically found in plant-based proteins. Leucine is a key regulator of MPS and can be rate limiting if not consumed in sufficient amounts. In older adults, anabolic resistance (blunted MPS response to stimuli such as protein and exercise) means that higher per-meal leucine intake is required to effectively stimulate MPS. This could be mitigated by increasing total protein intake or fortifying plant proteins with additional leucine.

Of note, this meta-analysis assessed acute MPS responses rather than long-term changes in muscle mass but overall the data suggests that both plant and animal-based protein can support muscle synthesis providing daily intake is sufficient (approximately 1.6 g/kg). It should also be noted that most of the participants in the included studies were male and so the generalisability to females is uncertain.

Greenwashing by meat & dairy companies and meat industry research funding

Two different but related papers highlight how environmental claims and climate promises by the meat and dairy companies are best classified as ‘greenwashing’ and how meat industry funding of scientific research more often than not finds in favour of eating meat.

The first paper analysed the environmental commitments and claims of 33 of the world’s largest meat and dairy companies. 1233 environmental claims were identified of which 68% (841) were climate-related. 98% of the claims were categorised as Greenwashing i.e. no clear or achievable plan to reach the target.

The second paper included 500 studies investigating the health impacts of meat consumption. 78 (15.6%) reported industry involvement. Studies linked to the meat industry were 16 times more likely to report positive findings about meat consumption with a significant association between meat industry funding and the study conclusion.

These two studies demonstrate the typical industry playbook allowing ‘business as usual’ to continue. It mirrors the tactics of the tobacco and alcohol industry. Fund the scientists and the research; cast doubt and perpetuate misinformation; pretend to care but continue to promote a product that harms; renege on commitments that would improve health and the environment. This has all been eloquently summarised in a fantastic report by Changing Markets - Big Meat and Dairy’s narratives to derail climate action.

Additional papers of interest

Exposure to plastics is of increasing concern as there are associations with negative health impacts. A new intervention study has shown that limiting consumption of highly processed foods, plastic food packaging and canned goods, and minimising plastic touch points during production - from farm to fork - can reduce urinary excretion of phthalates and bisphenols (chemicals associated with plastic exposure). This provides actionable evidence for individuals who are looking to reduce ingestion of plastic.

We know that many chronic conditions are driven by the same undying mechanisms. This is recognised now by the fact that the combination of heart, kidney and metabolic conditions (diabetes and obesity) is known as cardiovascular-kidney-metabolic syndrome, or CKM syndrome. These same chronic condition are known to increase the risk of cancer. A new large retrospective analysis from Japan that includes almost 1.4 million people finds that people with CKM syndrome have an increased risk of multiple cancer types and the risk increases as the stage of CKM worsens. Thus preventing CKM syndrome should also reduce cancer incidence.

Diet and lifestyle practices are essential for cancer prevention but can also have a positive impact even after a cancer diagnosis. This new short report finds that in a large cohort of cancer survivors in the US, adherence to healthy lifestyle practices has not changed much over time. However, people who received counselling on lifestyle factors were more likely to engage in these positive behaviours. This once again highlights the need for lifestyle medicine to be incorporated into all aspects of primary and secondary healthcare.

Processed meat consumption is associated with a number of health harms according to this new umbrella review that summarises existing systematic reviews and meta-analyses. Eating 50g/d was associated with a 72% higher risk of gastric cancer, 17% higher risk of colorectal cancer, 4% higher risk of prostate cancer, and an 8% higher risk of chronic obstructive pulmonary disease. There is no safe limit of consumption and therefore zero is the optimal amount to include in the diet.

Last but not least, our very own research paper published in BMJ Nutrition, Prevention and Health from the team at Plant-Based Health Professionals UK in collaboration with Dr Dagfinn Aune. Consumption of legumes and soya is associated with a reduction in the risk of hypertension. Read more here.

See you back in June!

New lipid guidelines and dietary guidelines to improve cardiovascular health

The new dyslipidaemia guideline from the American College of Cardiology, American Heart Association, and nine other medical associations that replaces the 2018 guide, places renewed emphasis on lifestyle practices as the foundation of cardiovascular disease prevention, while recognising that pharmacotherapy is often required to reach increasingly stringent lipid targets.

A key message is the importance of a life-course approach. Elevated atherogenic lipoproteins over time drive cardiovascular risk, so early intervention, particularly through healthy behaviours, is essential. These include heart-healthy eating, regular physical activity, maintaining a healthy weight, good sleep, stress management, and avoidance of tobacco.

A heart-healthy diet is recommended to reduce cardiovascular events, while dietary supplements are not advised due to limited and inconsistent evidence of benefit. Physical activity is also emphasised, both for modest lipid improvements and broader cardiovascular protection.

The guideline recognises that behaviour change requires support. Referral to dietitians and use of multidisciplinary care are encouraged, particularly in higher-risk individuals such as those with severe hypertriglyceridaemia.

Despite this strong focus on lifestyle practices, drug therapy, especially statins, remains central. Lower LDL-cholesterol targets, particularly in secondary prevention, mean that many patients will require combination therapy alongside lifestyle measures. It also includes lowering the screening and treatment age from 40 to 30.

The American Heart Association (AHA) has also updated its dietary guidance for cardiovascular health and is notably different from the recently released Dietary Guidelines for Americans. The AHA reinforces that overall dietary patterns, rather than individual nutrients, are central to cardiovascular health. Poor diet quality remains a leading contributor to cardiovascular disease, and the guideline emphasises that adopting and sustaining a heart-healthy dietary pattern across the life course is fundamental to prevention.

At its core, the guidance promotes a predominantly plant-based, minimally processed way of eating. This includes a high intake of vegetables and fruits, whole grains, legumes, nuts, and seeds, alongside healthy sources of protein, whilst limiting red and especially processed meat. There is a clear emphasis on replacing saturated fats, found in animal fats and tropical oils, with unsaturated fats from plant oils and whole foods, reflecting strong evidence for improvements in LDL-cholesterol and cardiovascular risk. Healthy protein sources mainly focus on beans and pulses and also include fish.

A major focus is the quality of foods rather than just macronutrient composition. The guideline strongly encourages shifting away from ultraprocessed foods, and towards minimally processed foods that retain their natural structure and nutrient profile. Similarly, it highlights the importance of reducing added sugars, particularly from sugar-sweetened beverages, and lowering sodium intake, both of which have well-established links to cardiovascular risk.

Energy balance is also central, with maintaining a healthy body weight through alignment of diet and physical activity identified as a key determinant of cardiometabolic health. Physical activity is therefore integrated into the dietary framework rather than treated separately.

Importantly, the guidance challenges common misconceptions around supplements and single “superfoods.” Nutritional needs should be met primarily through whole dietary patterns, which provide fibre, micronutrients, and bioactive compounds that work synergistically. In most individuals, a high-quality diet removes the need for supplementation. The exception being a meat-free diet that requires supplementation with vitamin B12 (through fortified foods or supplements).

Alcohol guidance is rightly more cautious than in previous iterations. The statement advises against initiating alcohol consumption for health reasons and recommends limiting intake due to uncertain cardiovascular benefit and clear risks across a range of health outcomes.

A useful article on trending cardiovascular nutritional controversies covers evidence for and against beef tallow, ultraprocessed foods, full-fat dairy, seed oils, medium chain triglyceride (MCT) oils, seafood, and alternative sweeteners. In short, the paper concludes that beef tallow is harmful to health as it raises LDL-cholesterol levels. There is insufficient evidence to choose high-fat over low-fat dairy (remembering that dairy is not required in the diet). Ultraprocessed foods should be limited in the diet, favouring minimally processed, whole foods instead. Seed oils benefit cardiometabolic health and can be part of a heart-healthy diet, but they should not be heated to excessive temperatures or repeatedly heated. MCT oils may have a role in certain rare medical conditions, but the evidence does not support promotion in the general population. It reminds us that coconut oil is not an MCT and is not considered heart healthy. Seafood (or should we say sea animals) are considered a beneficial component of the diet, but there are increasing concerns around environmental contamination of these foods. Articifical sweetners (aspartame, advantame, acesulfame potassium, neotame, saccharin, and sucralose), natural sweeteners (monk fruit extract and stevia) and sugar alcohols (erythritol, mannitol, sorbitol, and xylitol) have an overall negative impact on health, although they may be healthier to consume that sugar-sweetened beverages. The healthiest choices is to stick to consuming water, tea and coffee.

Vegetarian and vegan diets and cancer incidence

This 2026 systematic review and meta-analysis provides a comprehensive assessment of vegetarian and vegan diets in relation to cancer risk, drawing on prospective cohort studies across multiple populations and cancer types.

Overall, vegetarian diets are associated with a modest but consistent reduction in total cancer incidence, with around a 13% lower risk compared to non-vegetarian diets. This reduction extends across several specific cancers, with the strongest associations seen for cancers of the digestive system, particularly stomach and colorectal cancers, as well as pancreatic cancer. There are also smaller but statistically significant reductions in breast cancer, especially postmenopausal breast cancer, alongside bladder cancer, melanoma, and non-Hodgkin lymphoma.

For vegan diets, the evidence base is more limited but broadly consistent in direction. Vegan diets are associated with a larger reduction in total cancer risk, in the range of around 20–25%, and a reduced risk of breast cancer. However, findings for colorectal and prostate cancer are less clear, reflecting the smaller number of studies available.

The authors conclude that the evidence linking vegetarian diets to lower risk of total cancer, colorectal cancer, colon cancer, and breast cancer is “probable,” while for other cancers it is considered suggestive but less certain due to limited data. For vegan diets, the evidence is currently more limited overall.

The paper also explores potential mechanisms. Part of the observed benefit appears to be mediated through lower body weight, as vegetarian and vegan diets are associated with reduced adiposity, an established risk factor for several cancers. However, this explains only part of the effect. Independent dietary factors are likely important, including higher intakes of fibre, whole grains, fruits, and vegetables, and lower consumption of red and processed meat. These dietary differences may influence cancer risk through effects on inflammation, insulin resistance, hormonal pathways, and the gut microbiome.

Overall, the findings support the conclusion that more plant-based dietary patterns, including vegetarian and vegan diets, are associated with a lower risk of several cancers. While further research is needed, particularly in vegan populations and across a wider range of cancers, the evidence adds to the growing case for plant-based diets as a central component of cancer prevention.

Fasting mimicking diet in Crohn’s disease

The fasting-mimicking diet (FMD) is a short, periodic, plant-based dietary intervention designed to reproduce the metabolic effects of prolonged fasting while still providing limited nourishment. Typically followed for five consecutive days each month, it is plant-based, low in calories, protein and sugars, and relatively higher in unsaturated fats. Developed and extensively studied by Dr Valter Longo and colleagues, earlier work has shown that FMD can reduce systemic inflammation, improve metabolic health, and promote cellular repair processes. Preclinical studies have also demonstrated effects on gut microbiota, immune regulation, and intestinal regeneration, providing a strong rationale for testing this approach in inflammatory bowel disease.

This 2026 randomised controlled trial evaluates the effects of FMD in adults with mild-to-moderate Crohn’s disease. Participants were assigned either to continue their usual diet or to undertake three monthly cycles of a 5-day FMD, returning to their habitual diet between cycles. 60-70% of participants were also receiving medications for Crohn’s disease.

The findings are notable. Around 70% of participants in the FMD group achieved a clinical response, compared with approximately 44% in the control group, and nearly two-thirds achieved clinical remission. These improvements were seen early, with benefits emerging after just a single 5-day cycle. Alongside symptomatic improvement, there were reductions in objective markers of inflammation, particularly faecal calprotectin, supporting a genuine anti-inflammatory effect.

The intervention also led to improvements in patient-reported outcomes and quality of life, suggesting that the clinical benefits translated into meaningful day-to-day improvements for patients. Although endoscopic data were limited, early signals pointed towards possible improvements in mucosal healing.

Mechanistically, the study provides insight into how FMD may work. The diet was associated with reductions in pro-inflammatory lipid mediators and downregulation of key inflammatory cytokines, including TNF, IL-1β and IL-18. These findings are consistent with earlier research showing that fasting-like states can suppress inflammatory pathways, enhance autophagy, and promote tissue repair. Additional mechanisms may include beneficial shifts in the gut microbiome and increased production of ketone bodies, which have anti-inflammatory effects.

From a practical perspective, the appeal of FMD lies in its feasibility. Unlike many dietary interventions that require continuous restriction, FMD involves only five days of dietary change per month, allowing individuals to maintain their usual eating pattern for the remainder of the time. Adherence in the study was relatively high, and the intervention was generally well tolerated, with mild symptoms such as fatigue and headache being the most common side effects.

There are, however, important limitations. The study was relatively small and open-label, and most participants had mild disease, which may limit generalisability. The benefits also appeared to diminish after a washout period, suggesting that ongoing cycles may be needed to sustain the effect.

Overall, this trial adds to a growing body of evidence that dietary interventions can have clinically meaningful effects in inflammatory conditions.

Updated guidelines on resistance training for adults

This 2026 American College of Sports Medicine position stand makes a compelling case that resistance training should be considered a fundamental component of health for all adults, not just those interested in fitness or performance. Drawing on a large body of evidence (130 systematic reviews and data from more than 30,000 people), it shows that resistance training improves muscle strength, muscle mass, power, endurance, balance, and overall physical function. These changes translate into meaningful real-world benefits, including improved ability to perform daily activities, maintain independence with ageing, and reduce the risk of falls. Beyond musculoskeletal health, resistance training is also associated with reduced mortality and lower risk of cardiovascular disease, cancer, and type 2 diabetes, alongside benefits for mental health and sleep.

A key message is that resistance training does not need to be complex to be effective. Many different approaches can deliver similar benefits, and the most important factor is consistency over time. The guideline emphasises that programmes should be tailored to the individual to support adherence, taking into account preferences, confidence, and practical barriers. This represents a shift away from rigid, highly structured prescriptions towards a more flexible and inclusive approach.

For most adults, a practical starting point is to engage in resistance training at least twice per week, targeting all major muscle groups. Exercises can be performed using free weights, machines, resistance bands, or body weight, making the approach accessible in a range of settings, including at home. A small number of sets per exercise is sufficient to begin with, and intensity can be progressed gradually as confidence and strength improve. For those aiming to build strength, using relatively heavier loads and focusing on controlled movements through a full range of motion is effective. For improving muscle mass, increasing overall training volume over time is important, while for enhancing power and functional performance, incorporating faster, more dynamic movements with moderate loads can be beneficial.

Importantly, the guideline challenges several common misconceptions. Training to exhaustion is not necessary to achieve results, and no single type of equipment or programme is superior for all individuals. Complex programming strategies offer little additional benefit for most people compared with simpler approaches. Resistance training is also considered safe for healthy adults across the lifespan when introduced progressively, countering the perception that it is inherently risky or only suitable for younger individuals.

Read this short summary, including advice from the lead author.

Physical activity for public health in the 21st century

This 2026 Nature Medicine paper reframes physical activity as a central pillar of public health while challenging the persistent assumption that it is simply a matter of individual choice. It highlights that despite overwhelming evidence of benefit, global levels of physical activity have not meaningfully improved, with a substantial proportion of adults still failing to meet recommended levels. The authors argue that this stagnation reflects not a lack of awareness, but deeper structural and societal barriers.

A key contribution of the paper is its focus on inequality. Patterns of physical activity vary markedly across countries, genders, and socioeconomic groups, with the greatest disparities seen between wealthier men in high-income settings and poorer women in low-income settings. These differences are not incidental; they reflect unequal access to safe environments, time, cultural acceptance, and financial resources. In this context, physical activity is better understood as something shaped by opportunity rather than simply motivation.

The paper also broadens the scope of why physical activity matters. While traditionally emphasised for cardiovascular and metabolic health, it is shown to have wide-ranging effects across physical and mental health, including immune function, mental wellbeing, and cancer outcomes. This reinforces its role as a foundational determinant of overall health, rather than a niche behavioural factor.

One of the most important insights is the distinction between different domains of physical activity, particularly between leisure-time activity and work- or place-based activity. Leisure-time activity, such as walking, cycling, sport, or exercise, is typically performed by choice, in safer environments, and at intensities and durations that are more consistently associated with health benefits. In contrast, work-related or necessity-based activity, such as manual labour, domestic work, or physically demanding jobs, is often repetitive, prolonged, and performed under conditions of low autonomy, limited recovery, and sometimes physical risk. The paper highlights that these forms of activity do not confer the same health benefits and may, in some cases, be associated with adverse outcomes, a phenomenon sometimes referred to as the “physical activity paradox.”

This distinction has important implications. Public health messaging that treats all movement as equivalent risks obscuring the lived realities of those whose physical activity is driven by necessity rather than choice. For individuals in physically demanding occupations, the issue is not insufficient activity but rather the quality, context, and physiological burden of that activity. Conversely, those with sedentary occupations may have the time and resources to engage in beneficial leisure-time activity, reinforcing health inequalities.

In response, the authors propose a shift towards a systems-based model of “physical activity for health and wellbeing.” This approach recognises that activity patterns are shaped by the environments in which people live and work. Factors such as urban design, transport systems, workplace structures, safety, and social norms all influence whether individuals are able to engage in health-promoting activity.

The practical implication is that improving population health will require more than advising individuals to exercise. It will depend on creating conditions that make beneficial forms of physical activity accessible, safe, and integrated into daily life. This includes designing cities that support walking and cycling, ensuring equitable access to green space, addressing gender and socioeconomic barriers, and rethinking workplace environments to reduce harmful physical demands while enabling healthier movement patterns.

A case for lifestyle interventions in Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder characterised by motor symptoms such as tremor, rigidity, and slowed movement, alongside a wide range of non-motor features including cognitive impairment, sleep disturbance, depression, and autonomic dysfunction. While traditionally managed with pharmacological therapies, there is growing recognition that lifestyle factors play a central role in influencing symptoms, quality of life, and potentially disease progression.

This paper presents a comprehensive review of a “wellness prescription” for Parkinson’s disease, advocating a shift from a reactive, medicalised model of care to a proactive, patient-centred approach grounded in lifestyle medicine. It adopts a biopsychosocial framework, placing the individual at the centre and emphasising that everyday behaviours, particularly exercise, diet, sleep, mental health, and social engagement, are integral to outcomes.

Among lifestyle interventions, physical activity has the strongest evidence base. Regular exercise improves core motor symptoms such as mobility, balance, strength, and gait, and also benefits non-motor symptoms including sleep, pain, cognition, anxiety, and depression. There is emerging evidence that it may influence disease progression. Current guidance supports early and sustained engagement in a combination of aerobic, resistance, balance, and flexibility training. Importantly, enjoyment and adherence are key, with activities such as dance, tai chi, and group exercise offering both physical and psychosocial benefits.

Diet is increasingly recognised as an important modifiable factor in both the risk and progression of Parkinson’s disease. Nutritional challenges are common, with a substantial proportion of individuals at risk of malnutrition due to motor difficulties, gastrointestinal dysfunction, reduced appetite, and interactions with medications such as levodopa. Beyond these practical considerations, dietary patterns appear to influence disease biology. Mediterranean-style and plant-rich diets, high in fruits, vegetables, whole grains, legumes, nuts, seeds, and olive oil, are associated with a lower risk of developing Parkinson’s disease, a later age of onset, slower progression, and reduced mortality. Diet may also exert effects through the gut microbiome, with higher-quality diets linked to increased production of anti-inflammatory metabolites. Although randomised trial data remain limited, current evidence supports a predominantly plant-based, Mediterranean-style dietary pattern as the most beneficial approach.

Other aspects of lifestyle are also critical. Sleep disturbance is common and contributes to poorer cognitive and mental health outcomes, with interventions such as sleep hygiene, light exposure, and behavioural therapies offering benefit. Mental health is central to overall wellbeing, with proactive strategies, including exercise, mindfulness, and social engagement, helping to reduce depression and anxiety, which are highly prevalent in Parkinson’s disease. Mind–body approaches such as yoga, meditation, and tai chi show evidence of improving both motor and non-motor symptoms, as well as reducing stress and inflammation.

The paper also highlights the importance of social connection and a sense of purpose. Social isolation is common and associated with worse outcomes, while engagement in meaningful activities and supportive communities can improve quality of life and potentially influence disease trajectory. Broader aspects of wellbeing, including sexual health, general medical care, and self-management skills, are also emphasised as essential components of a holistic approach.

Overall, the review argues that lifestyle interventions should be considered core to the management of Parkinson’s disease rather than optional adjuncts. It calls for a fundamental shift towards integrating exercise, diet, and other lifestyle strategies into routine care from diagnosis, empowering individuals to take an active role in their health and supporting a more holistic approach to living well with Parkinson’s disease.

Half the calories from crops lost in feeding farm animals

The global food system is a major driver of climate change, biodiversity loss, and water use, yet it fails to deliver equitable nutrition. As highlighted in UK government food security reports, rising food insecurity alongside diet-related disease reflects systemic inefficiency rather than a lack of production. This paper examines how effectively global croplands are used to produce food for human consumption.

The central finding is that only around half of the calories grown on croplands are ultimately available to feed people. While global crop production increased significantly between 2010 and 2020, much of this growth was diverted towards feeding farm animals and non-food uses such as biofuels, rather than direct human consumption. As a result, gains in food availability have lagged behind increases in production.

A major source of inefficiency is the conversion of crops into animal products, particularly beef. Large quantities of feed are required to produce relatively small amounts of meat, meaning most of the original calories are lost from the food system. The greatest loss of calories (39.7%) is through production of beef, which only provides 9% of animal-sourced calories (excluding fish).

The scale of this loss is substantial. Croplands produce enough calories to feed far more people than the current global population, yet nearly half of this potential is lost through inefficient use. Shifting towards more plant-based diets or even replacing beef could significantly increase the number of people that could be fed.

Overall, the paper argues that the challenge is not producing more food, but using what we already produce more effectively. We have the ability to ensure every person on this planet has sufficient calories and nutrients to live healthy lives, we just need to ensure there is equitable distribution of food.

Plant-based alternatives to animals foods to improve planetary health

This new paper, Novel Plant and fungi-based Alternatives Support Nutritional Adequacy of Diets and Reduce Their Environmental Impacts, provides important evidence that plant-based meat and dairy alternatives can play a practical and effective role in supporting a shift away from animal-sourced foods, without compromising overall diet quality.

Using a realistic UK “basic basket” that reflects how people actually eat, the authors modelled small, achievable changes, replacing processed meats, milk, or yogurt with plant-based alternatives, and assessed the impact on nutrition, environmental outcomes, and cost.

A key finding is that targeted substitutions with plant-based alternatives can maintain nutritional adequacy across the whole diet. Despite concerns about these foods being ultra-processed, most products assessed were classified as “healthy” using nutrient profiling models, and overall diets continued to meet recommended nutrient intakes in most scenarios . In some cases, nutritional quality even improved, with increases in fibre and reductions in energy intake and saturated fat, particularly when replacing processed meats. While certain micronutrients such as iodine or vitamin B12 may be lower in some products, these differences had minimal impact when considered within the context of the whole diet.

The environmental benefits were consistent and meaningful. Across all substitution scenarios, greenhouse gas emissions, land use, and water use decreased, even with relatively small dietary changes . This reinforces the idea that shifting away from animal products, even partially, can contribute significantly to climate and sustainability goals.

Importantly, the study highlights that plant-based alternatives offer a realistic pathway for change. Unlike whole food plant-based diets, these products are designed to mimic the taste, texture, and convenience of meat and dairy, helping to overcome common behavioural barriers such as familiarity, cooking skills, and social norms. The modelling approach, focusing on single, incremental substitutions, reflects how people actually change their diets, rather than assuming complete dietary overhauls.

Cost remains a key limitation. While plant-based dairy alternatives were often comparable or cheaper, plant-based meat alternatives were consistently more expensive, which may limit accessibility and uptake, particularly among lower-income groups. The authors emphasise that without policy action to improve affordability, the full public health and environmental potential of these foods may not be realised.

Overall, this study makes a strong case that plant-based meat and dairy alternatives can serve as a useful and pragmatic bridge in dietary transition. When carefully selected, they enable reductions in animal food consumption while maintaining nutritional adequacy and delivering environmental benefits, supporting a gradual and achievable move towards more sustainable, plant-forward diets.

Read this article for more information about plant-based meat alternatives.

Updated food-based dietary guidelines from the Netherlands

The new Dutch dietary guidelines are bold, taking both health and planetary sustainability into consideration.

The core of the “Wheel of Five” remains unchanged but there has been an update to quantities of various food groups. The recommendations include:

• Eating Plenty of vegetables, fruit, legumes, and whole grains

• Limiting intake of salt, saturated fat, and sugar

• Increasing legumes intake to 250g per week

• Reducing meat consumption from a maximum of. 500g to 300g/week (with ≤100g red meat). This is less red meat than recommended in the Eat-Lancet Planetary Health Diet.

• Halving cheese intake from 40g to 20g per day

• Whilst still including dairy, encouraging alternating with fortified plant-based alternatives.

These guidelines demonstrate real leadership from the Dutch Government, helping to put scientific evidence into action. We hope the UK Government follow suit.

See you back in May

Healthy lifestyles can improve heart health even when high genetic

Heart disease remains the top killer of men and women globally, yet 90% of cases could be prevented if we addressed modifiable risk factors.

This new study investigated the combined impact of diet and lifestyle on the risk of coronary heart disease. While we know that both genetics and lifestyle influence cardiovascular risk, fewer studies have looked at how these factors interact, particularly in the context of plant-based dietary patterns.

Researchers analysed data from 7,764 participants in the long-running Rotterdam Study, following them prospectively for several decades to track the development of coronary heart disease. The investigators applyed a validated lifestyle score that incorporated a healthy plant-based diet in combination with non-smoking, adequate physical activity and moderate sleep duration, alongside polygenetic risk score.

The results showed that higher adherence to this healthy plant-based lifestyle was associated with a significantly lower risk of developing coronary heart disease. For every increase in the score reflecting healthier behaviours, the risk of coronary heart disease fell. Participants with the highest adherence to the healthy plant-based lifestyle had a 22% lower risk of developing coronary heart disease compared with those with the poorest adherence.

Importantly, adherence to a healthy plant-based lifestyle benefited all genetic risk groups. However, participants with a high genetic risk benefited the most with a 44% reduction in risk compared to participants with a low or intermediate genetic risk who showed a 20% reduction in risk. Once again, these data confirm that genes are not our destiny.

The accompanying editorial highlights an important point. Lifestyle behaviours rarely occur in isolation. People who follow a healthier diet are also more likely to be physically active, avoid smoking and maintain good sleep patterns. Looking at these behaviours together therefore provides a more realistic picture of how lifestyle influences cardiovascular health.

Taken together, these findings reinforce a powerful public health message. A diet rich in whole plant foods, combined with other healthy lifestyle habits, can substantially reduce the risk of coronary heart disease. Even for individuals with an unfavourable genetic profile, lifestyle choices remain a powerful tool for protecting long-term health. This is of particular importance for South Asian. New data from the MASALA study in the US show that South Asians have a significantly higher risk of heart disease and type 2 diabetes, which also occur much earlier in life, compared to all other ethnicities. Thus, tailored and earlier prevention strategies are required with intensive risk factor management.

Do vegan diets increase the risk of colorectal cancer?

One of the largest studies of its kind on diet and cancer saw a hugh amount of media attention. The analysis brings together data from nine different studies, 3 different continents and includes 1,645,555 meat eaters; 57,016 poultry eaters; 42,910 pescatarians; 63,147 vegetarians; and 8,849 vegans. Participants were followed for a median of 16 years.

Although the results support prior literature and shows that vegetarian diets lower the risk of five different cancer type, there are also some surprising results.

Vegetarians in this cohort had a reduced risk of pancreatic, breast, prostate, and kidney cancers, and multiple myeloma. This lower risk was explained, in part, by lower body weight. However, they also had a higher risk of squamous cell oesophageal cancer, which is not easily explained, but could be due to lower intakes of B vitamins. Prior studies have identified B vitamins to be important for preventing oesophageal cancer

For those following a vegan diet, there were just too few numbers of each cancer type to draw firm conclusions. However a surprising finding was that vegans had an increased risk of colorectal cancer.

As the authors themselves point out, this should be interpreted with caution since the results for vegans were based on just 93 cases across all the studies with some studies having fewer than 10 cases. When the first 4 years of follow-up were excluded, the higher risk of colorectal cancer was no longer significant. This suggests that some people already had the early stages of cancer present prior to entry into the study as there is a long lead time prior to cancers becoming clinically apparent. In addition, as pointed out in this excellent video by Mic the Vegan, the models reported adjusted for body mass index (BMI). If you accept that a lower BMI is a result of the vegan diet rather than a confounder then this association with colorectal cancer disappears. In addition, when BMI was not adjusted for, vegans also had a lower risk of prostate and breast cancers.

However, it is worth noting that a very plausible reason for the higher risk of colorectal cancer in vegans is the low calcium intakes across most of the cohorts analysed. Adequate calcium intake has long been known to protect against colorectal cancer.

The lower calcium intake in vegans is likely a reflection of the fact that these studies were from the 1990’s and 2000’s when fortified vegan products were not widely available. Modern day analysis of vegans shows that calcium intakes are now adequate.

Another points to note are that this study did not report on total cancer risk, only site specific risk. Prior analyses, including from the EPIC-Oxford study and Adventist Health Study-2, have clearly shown a reduced risk of total cancer in both vegetarian and vegans, with a greater reduction in vegans. In addition, omnivores in the current analysis had relatively low intakes of meat compared to current typical Western diets. The study did not consider diet quality and vegans were identified based on what they do not eat (animal-sourced foods), rather than what they were eating - which of course is not always healthy.

The take home message remains unchanged. Diets high in fruit, vegetables, whole grains, beans, nuts and seeds are best for cancer prevention. Vegan diets need to be appropriately supplemented with vitamin B12 and certain nutrients need extra focus such as calcium, vitamin D, iodine, selenium and zinc.

Physical activity in cancer survivors

This study examines the impact of physical activity in cancer survival. While there is strong evidence that regular exercise reduces the risk of developing cancer, there has been less research on whether physical activity improves survival after a diagnosis, particularly for cancers other than breast, prostate and colorectal cancer.

Researchers analysed data from six large cohort studies involving more than 17,000 cancer survivors diagnosed with bladder, endometrial, kidney, lung, oral, ovarian or rectal cancer. Participants were followed for an average of almost 11 years after diagnosis, allowing the researchers to examine how levels of leisure-time physical activity related to the risk of dying from cancer.

The findings were striking. Even small amounts of moderate to vigorous physical activity after a cancer diagnosis were associated with a lower risk of cancer mortality for bladder, endometrial and lung cancer. Higher levels of activity, double or triple the recommended amount, were associated with reductions in mortality for oral cancers.

Perhaps the most encouraging finding was that becoming active after diagnosis appeared to be beneficial even for people who had previously been inactive. Lung and rectal cancer survivors who met physical activity guidelines after diagnosis had a lower risk of cancer mortality regardless of their activity levels before diagnosis. This reinforces an important message for patients: it is never too late to start moving.

As with most observational studies, the findings cannot prove cause and effect. People who are able to be physically active may already be healthier than those who are not. However, the results remained broadly consistent even after accounting for factors such as smoking, cancer stage and treatment.

Overall, this research strengthens the case for physical activity as an important component of cancer survivorship care. Alongside good nutrition and other lifestyle measures, regular movement may play a meaningful role in improving long-term outcomes for people living with and beyond cancer.

An opportunity for breast cancer prevention

A major new analysis from the Global Burden of Disease Study provides a stark reminder of the growing global impact of breast cancer and the urgent need to prioritise prevention. The study analysed trends from 1990 to 2023 across 204 countries and territories, making it one of the most comprehensive assessments of breast cancer worldwide.

Breast cancer remains the most commonly diagnosed cancer among women globally and a leading cause of cancer death. Although survival has improved in many high-income countries due to earlier detection and better treatment, the overall number of cases continues to rise as populations grow and age.

What is often overlooked is the extent to which breast cancer is preventable. The study estimates that around 28% of the global burden of breast cancer is attributable to modifiable risk factors. The largest contributors include dietary risks, tobacco exposure, high blood glucose, excess body weight, alcohol consumption and low levels of physical activity.

Looking ahead, the projections are concerning. By 2050, the number of new breast cancer cases each year is expected to increase to around 3.5 million globally, with deaths rising substantially as well. Much of this increase will occur in low- and middle-income countries where access to screening, diagnosis and treatment remains limited.

These findings highlight an uncomfortable truth. While advances in treatment are improving survival, far less attention is given to preventing cancer in the first place. Policies that support healthier diets, increased physical activity and reduced alcohol consumption could prevent a significant proportion of cases.

Diet and brain health

Interest in how diet influences brain health continues to grow, and several new papers this month add to the evidence that what we eat may play an important role in the risk of cognitive decline and dementia.

A systematic review and dose–response meta-analysis examined the relationship between plant-based dietary patterns and the risk of cognitive impairment and dementia across seven prospective studies involving more than 220,000 participants. The overall findings suggested that people who followed plant-based diets more closely tended to have a lower risk of cognitive impairment and dementia. However, the most important message from this analysis was that diet quality matters. Healthy plant-based diets rich in vegetables, fruits, whole grains, legumes and nuts were associated with a lower risk, while plant-based diets high in refined grains, sugary foods and ultra-processed products were associated with a higher risk. In other words, simply eating “more plant foods” does not guarantee protection if those foods are heavily processed.

A second study combined analyses from large prospective cohorts in the United States and the United Kingdom with a broader meta-analysis of cohort studies examining plant-based diets and dementia risk. Once again, the results highlighted the importance of diet quality. Participants with the highest adherence to healthy plant-based diets had a substantially lower risk of developing dementia, while those with diets characterised by less healthy plant foods had a higher risk. Foods most strongly associated with lower dementia risk included vegetables, legumes, nuts and beverages such as tea and coffee. In the pooled analysis, those most closely following a healthy plant-based dietary pattern had around a 21% lower risk of dementia compared with those with the lowest adherence, while unhealthy plant-based diets were associated with a 24% higher risk.

A third paper offered a more cautionary perspective. Using data from cohorts in China, Europe and the United States, researchers reported that more restrictive vegetarian diets in older adults, particularly vegan diets, were associated with a higher risk of cognitive impairment, while pescatarian diets appeared to be associated with lower risk. The authors suggested that nutritional inadequacy could partly explain these findings, particularly with respect to nutrients such as vitamin B12, vitamin D, iron and long-chain omega-3 fats. Importantly, however, the study did not directly measure nutrient status and did not distinguish clearly between healthy and unhealthy plant-based dietary patterns, meaning the findings need to be interpreted carefully.

Taken together, these studies reinforce a key point that is often lost in discussions about plant-based diets. The question is not simply whether a diet is vegetarian, vegan or plant-based in name, but whether it is a high-quality dietary pattern centred on minimally processed plant foods. The strongest evidence continues to suggest that diets rich in vegetables, fruits, legumes, whole grains, nuts and other whole plant foods are associated with better cardiometabolic health and, increasingly, with better brain health as well. At the same time, the more cautionary findings remind us that plant-based diets need to be well planned, particularly in older adults, to ensure adequate intake of key nutrients such as vitamin B12.

Parkinson’s disease and dairy - is there a link?

A new systematic review and meta-analysis has examined whether dairy consumption is associated with the risk of Parkinson’s disease. Parkinson’s disease is a progressive neurodegenerative condition affecting almost 12 million people worldwide, and the number is expected to more than double by 2050. Identifying modifiable lifestyle factors that influence risk is therefore an important public health priority.

This review analysed nine observational studies from the United States, Europe and Asia, including more than 630,000 participants and over 4,000 cases of Parkinson’s disease. The researchers found that people with the highest intake of dairy had a 21% higher risk of developing Parkinson’s disease compared with those consuming the least dairy. When milk alone was examined, the association remained significant, with a 13% higher risk among those with higher milk consumption. Interestingly, the relationship appeared stronger in men than in women.

Not all dairy products were associated with risk. The analysis did not find a significant link between Parkinson’s disease and fermented dairy products such as yoghurt, or with cheese, butter or ice cream. This suggests that the type of dairy consumed may be important, with the strongest signal seen for plain milk.

The reasons for this association are not yet fully understood, but several explanations have been proposed. One possibility relates to the gut–brain axis. Changes in the gut microbiome may influence the misfolding and spread of alpha-synuclein, a protein that accumulates in the brains of people with Parkinson’s disease. Another theory is that milk may lower levels of uric acid in the blood. Uric acid acts as a natural antioxidant, and lower levels have been linked to greater vulnerability to neurodegeneration. Environmental contaminants such as pesticide residues in dairy products have also been suggested as a possible contributor.

It is important to interpret these findings cautiously. The evidence comes from observational studies, which means the research can identify associations but cannot prove cause and effect. Dietary intake was also typically measured only once and relied on self-reported food questionnaires, which can introduce error. Nevertheless, the consistency of the findings across multiple large studies means the potential link between milk intake and Parkinson’s disease warrants further investigation. It is worth noting that prior studies using Mendelian randomisation and the lactase gene variant to predict for intakes of dairy have found that higher intakes are associated with an increased risk of Parkinson’s disease. This suggests that a causal relationship is indeed possible.

Taken together, this research adds to a growing body of evidence suggesting that dietary patterns may influence the risk of neurodegenerative disease. While more research is needed to clarify mechanisms and causality, it highlights the importance of considering diet as part of a broader strategy to reduce the burden of chronic disease.

When it comes to dairy, we know it is not required in the diet, 75% of the worlds population is lactose intolerant (the natural state in humans), dairy may increase the risk of prostate cancer and of course its production is terrible for the environment and the animals. If we apply the precautionary principle we should be moving away from consuming dairy, especially when we have healthier alternatives in the form of plant drinks.

European diets and sustainability

A new paper examined how closely European diets align with the planetary health diet, a framework designed to support both human health and environmental sustainability. The researchers analysed dietary data from nine European countries, comparing current eating patterns with the dietary targets proposed by the EAT–Lancet Commission.

The study included 16,083 adults with sample sizes ranging from 519 in the UK to 3703 in Portugal. Across all countries studied, the findings showed a clear gap between current diets and what would be considered both healthy and environmentally sustainable. In general, people consumed far more red and processed meat, dairy and added sugars than recommended, while intake of whole grains, legumes, nuts, fruits and vegetables fell well below suggested levels. These patterns were consistent across much of Europe, highlighting how deeply entrenched animal-based and ultra-processed food consumption remains in modern diets.

More specific quantification of food groups showed average intakes of 189.6 ± 24.6 g/d for vegetables and 177.1 ± 47.7 g/d for fruits, followed by 66.2 ± 13.6 g/d for tubers, 31.5 ± 19.5 g/d for whole grains, 27.5 ± 12.8 g/d for legumes, 5.2 ± 3.2 g/d for nuts, and 14.0 ± 7.4 g/d for unsaturated oils. For animal-based foods, mean intakes were 263.8 ± 85.6 g/d for dairy, 82.5 ± 10.5 g/d for total red meat (40.4 g/d from beef and lamb and 42.0 g/d from pork), 49.9 ± 17.8 g/d for poultry, 22.8 ± 7.0 g/d for eggs, 38.6 ± 17.4 g/d for fish and seafood, and 28.2 ± 9.3 g/d for saturated fats. The mean intake of added sugars was 54.6 ± 9.5 g/d.

The UK data reflected this broader pattern and showed some of the lowest scores for adherence to the planetary health diet. Compared with the planetary health diet targets, UK diets were characterised by excessive intake of red and processed meat, poultry, eggs, sugar and saturated fat and insufficient consumption of plant foods such as legumes, nuts and whole grains. Fruit and vegetable intake also remained below optimal levels.

The overall message from the study is clear: achieving diets that are both healthy and environmentally sustainable will require substantial shifts in food consumption across Europe. This requires joined up policy and regulation across farming, healthcare, retail and public sector catering. We are still hopefully that the National Food Strategy for the UK, likely due for publication in the summer, will address these key issues. Read our collaborative Ten Point Plan recommendations for the National Food Strategy team.

Micronutrient adequacy of plant-based meat alternatives

Concerns are often raised about the nutritional adequacy of plant-based diets, particularly with respect to micronutrients such as iron, zinc, vitamin B12 and iodine. At the same time, plant-based meat alternatives have attracted criticism because they are often classified as ultra-processed foods. Critics argue that replacing animal products with these alternatives could worsen diet quality or increase the risk of nutrient deficiencies. A new randomised controlled trial helps address some of these concerns by directly comparing micronutrient intake and status in people consuming plant-based meat alternatives with those eating animal-based meats.

In this eight-week trial, 89 adults were randomly assigned to consume either plant-based meat analogues or animal-based meat as their primary protein source while otherwise maintaining their usual diet. Researchers assessed both dietary intake and blood markers of micronutrient status before and after the intervention. Overall, the study found that replacing animal meat with plant-based meat alternatives did not lead to clinically meaningful declines in micronutrient status. Key nutrients often highlighted as potential concerns in plant-based diets, including iron and zinc, remained within normal ranges, and there were no significant differences between the groups at the end of the study. Some nutrients, including dietary fibre, were higher in the plant-based meat group, reflecting the plant ingredients used in these products.

A remaining concern about plant-based meat alternatives is the higher sodium content. Of course, when people eat meat they tend to add salt when cooking for added flavour, so the differences may not be as wide as expected. Interestingly, the SWAP-Meat study comparing beef with Beyond meat products did not find a detrimental effect on blood pressure from the potential higher sodium intake, at least in the short term.

While the current study was relatively short and cannot address long-term health effects, it provides useful evidence that plant-based meat alternatives, if used as part of a varied diet, may offer a practical way for people to reduce their intake of animal products without increasing the risk of nutrient deficiencies. Read our article on plant-based meat alternatives.

See you back in April!

American College of Lifestyle Medicine Updated Dietary Position

The ACLM have updated their dietary position statement. The term now given to the recommended dietary pattern is whole food plant-predominant. The intention is to strengthen the message that whole plant foods should be the focus of the diet i.e. fruit, vegetables, whole grains, beans, nuts and seeds. Red and processed meat, sugar-sweetened beverages, refined grains and ultra-processed foods should be avoided or minimised, as should the consumption of excess sodium, sugar and saturated fat.

This way of eating can of course be adapted to different traditional and cultural ways of eating and the ACLM have an enormous amount of resources to support people to adopt healthier eating habits. This includes their complimentary culinary medicine programme.

These guidelines align closely with the Eat-Lancet Planetary Health Diet, relaunched in October 2025. Not only is this way of eating good for our health it will help to support our global food system remain within planetary boundaries. This is also a of key importance to those practicing lifestyle medicine, as there are no healthy people on an unhealthy planet. Lifestyle medicine approaches have the potential to reduce the burden of chronic ill health on healthcare services and hence support greater sustainability.

Updated WHO healthy diet factsheet

The updated WHO dietary recommendations are fairly similar, but where they digress from the ACLM and Eat-Lancet is in their protein recommendations. They state that protein can come from a mix of animal and plant sources, which seems to give them equal weight. However, we know that obtaining the majority if not all of our protein from plant-based sources has the potential to dramatically improve individual and population health outcomes. This is sort of acknowledged by the WHO in this statement; ‘In some contexts, switching to more plant-based sources of protein may be preferable to decrease risk of diet-related noncommunicable diseases in adults’. I would have preferred there to be at least some recommended proportions, such as at least half of your protein requirements obtained from plant-based sources and limits on red/processed meat.

It goes on to say ‘In other contexts, consumption of animal source foods is still important to favour nutrient intakes, particularly in children and pregnant/lactating women.’ I do not believe this to be factually accurate given that fully plant-based diets can be adopted at all life stages without a detriment to health (cf the study below discussed on vegan children).

The WHO does acknowledge that healthy diets can vary in macronutrient percentage with carbohydrates ranging from 45-75% of energy intake and in some situations increasing protein intake above 15% of energy. A recent study highlights once again how diet quality matters more than macronutrient intakes, with reduced cardiovascular and all-cause mortality in people obtaining protein and fats from plant-based sources, regardless of the whether the diet is low-carb or low-fat.

Vegan infants grow just fine

A very timely, large and reassuring retrospective study assessing the growth of infants based on the family dietary pattern. Of the 1,198 818 children included, 1.2% (914 790) were raised in vegetarian families and 0.3% (3338) in vegan families. Infants born at 32 weeks or later were included and growth reported in the first 60 days and at 24 months.

The results showed that infants born to vegan mothers had a slightly higher incidence of low birth weight but lower incidence of high birth weight. On average, infants in vegan households were less than 0.5 cm shorter and approximately 100g lighter at birth compared with their counterparts from omnivorous households. These are not clinically meaningful differences. In the first 60 days, there was a slightly higher risk of vegan infants being underweight but no difference in risk of stunting. By 2 years of age, there were no statistically significant differences in growth between the different diet groups. Interestingly, women in the vegan and vegetarian breastfed for a longer duration than omnivorous women. Of note, the study did not provide information on dietary composition of the women during pregnancy.

Overall, these results are very reassuring and suggest that a vegan diet can support healthy growth in infants. The authors suggest that there should be adequate counselling available for parents during pregnancy and infancy to ensure diets are well-planned and I would suggest this important regardless of the chosen diet pattern.

Dietary factors and flares in inflammatory bowel disease

The PRognostic effect of Environmental factors in Crohn’s and Colitis (PREdiCCt) prospective cohort study is the largest to follow patients with inflammatory bowel disease (IBD) to investigate environmental, dietary and lifestyle factors associated with flares of the disease.

This report from the study cohort included 2629 participants from 47 UK centres. Dietary information was collected at baseline and participants followed for a median of 4.7 years. The results showed that higher meat intake, both red and white, in people with ulcerative colitis (UC) was associated with a 95% increase in risk of flares, independent of demographic, clinical and biochemical factors. This association was not present in people with Crohn’s disease. No consistent associations were seen for ultraprocessed foods, fibre or polyunsaturated fatty acid intake.

Interestingly, this is not the first study to suggest such an association. Results of the IBD Partner study also showed an increased risk of flares in people with UC, but not Crohn’s, with higher intakes of red meat. The lack of association for people with Crohn’s disease is interesting to note and may reflect the differences in disease pathogenesis. Other aspects of the diet may be more important. For example, a randomised study from King’s College London has shown that reducing/eliminating emulsifiers in the diet is also beneficial in the treatment of Crohn’s disease.

Nonetheless, accumulating evidence suggest that not only are low and meat-free diets, when composed of healthy plant-based foods, associated with a lower risk of IBD but may also be associated with better outcomes for people living with IBD.

Intermittent fasting for adults with overweight or obesity

There are different ways to achieve weight loss but all require a sustained reduction in calorie intake. Intermittent fasting (IF) has gained popularity for both weight loss and purported additional benefits for reducing inflammation and supporting insulin sensitivity.

This updated Cochrane analysis brings together 22 studies, including 1995 participants. The studies were randomised controlled trials (RCTs) and cluster‐RCTs that compared IF (including time‐restricted feeding, periodic fasting, alternate‐day fasting, and modified alternate‐day fasting) with regular dietary advice, no intervention or waiting list in men and women with overweight or obesity, with or without associated comorbid conditions. The minimum duration of the intervention was four weeks, and the minimum duration of follow‐up was six months.

Overall, the results suggest that IF has no clinically meaningful impact on weight loss compared to no intervention, waiting list or usual dietary advice. This does not mean of course that at an individual level a person won’t experience benefits, but within the context of clinical trials, taking all the currently available data, there do not appear to be any specific advantages for IF in achieving weight loss.

It’s useful to remember that lifestyle medicine approaches play an important role in supporting a healthy body weight. However, to achieve clinically meaningful and sustained weight loss, intensive lifestyle interventions are usually needed. Diet and lifestyle interventions in general achieve around 5% reduction in body weight, which is often not sustained in the long-term. This review highlights the role of lifestyle medicine in the era of highly effective anti-obesity treatment (medication and surgery).

National Cancer Plan for England

This month we saw the publication of the new cancer plan for England. It is bold and ambitious. At first look I did not hold out much hope. I was expecting it to focus on pharmaceutical and technological solutions for our poor cancer outcomes. However, I was pleasantly surprised to find a clear focus on cancer prevention. The report suggests that 30% of cancers are preventable although it’s worth noting that global data suggest that figure is closer to 45% if behavioural and metabolic risk factors are considered. Nonetheless, a focus on prevention is hugely welcome.

In an opinion piece in the BMJ, Adam and colleagues argue that cancer should be recognised and managed as a chronic disease within primary care systems, rather than remaining largely confined to specialist follow-up. Although cancer remains a leading cause of death, improvements in treatment mean that millions of people are now living for years or decades after diagnosis. In the UK alone, 3.5 million people are cancer survivors, a figure projected to rise substantially, with one in four adults over 65 expected to have had a cancer diagnosis by 2040

Despite this growing population, survivorship care remains fragmented and inconsistently delivered. Cancer survivors frequently experience persistent physical symptoms such as pain, fatigue, neuropathy, and late cardiovascular effects, alongside psychological distress, fear of recurrence, financial toxicity, and the practical burden of coordinating complex care. Many report a sense of “abandonment” when discharged from oncology services, and primary care involvement is often reactive rather than structured. The authors suggest that cancer meets established definitions of chronic disease, sharing long duration, ongoing management needs, and common behavioural and environmental risk factors with other long-term conditions.

Since up to two thirds of people with cancer have at least one other chronic condition, and around half live with multimorbidity, integrating cancer into existing chronic disease reviews in primary care is both logical and potentially beneficial. Core elements of survivorship care, including medication review, symptom monitoring, prevention and health promotion, cardiovascular risk assessment, screening for recurrence or new cancers, and coordinated care, closely align with established chronic disease management frameworks. However, significant barriers remain, including limited primary care capacity, lack of dedicated funding, inadequate communication between oncology and general practice, insufficient GP training in survivorship care, and the enduring cultural perception of cancer as an acute or exceptional illness rather than a chronic condition. The authors call for pragmatic trials with economic evaluation, improved digital systems, standardised treatment summaries, risk stratification, and stronger collaboration between primary care, oncology, and third sector organisations. High quality integrated care for people living with and beyond cancer could improve outcomes and quality of life, but will require strategic policy commitment and investment to become routine practice.

Impact of coffee and tea consumption on brain health

This is good news for those of you who enjoy drinking tea and coffee. There is accumulating evidence that these drinks can be part of a healthy diet, assuming they are not consumed with loads of sugar or cream!

This study specifically examined the impact of caffeinated and decaffeinated coffee and tea on brain health. The study included 131, 821 participants from the Nurses’ Health Study and the Health Professionals Follow-up Study, followed for up to 43 years. The results showed that higher caffeinated coffee intake was significantly associated with lower dementia risk (18% reduction) and lower prevalence of subjective cognitive decline (15% reduction). Higher intake of tea showed similar associations with these cognitive outcomes, whereas decaffeinated coffee intake was not associated with lower dementia risk or better cognitive performance. The benefits were observed with intake of approximately 2 to 3 cups per day of caffeinated coffee or 1 to 2 cups per day of tea, with additional intakes not showing further benefits. These impact were independent of genetic risk for dementia and other major risk factors. The results also suggest that caffeine is the reason for the protective effect, given that decaffeinated coffee did not show benefits.

This is not the first study to show a benefit of coffee consumption with a prior umbrella review of meta-analyses finding a 10% reduction in people who drink coffee.

Global biodiversity loss and ecosystem collapse

There has been a lot of talk about this much delayed report from the UK Government. The state of the planet and its continued destruction is now a direct threat to national security and prosperity. Unless action is taken, it is likely that we in the UK will not be able to maintain food security.

Taken directly from the report ‘The UK does not have enough land to feed its population and rear livestock: a wholesale change in consumer diets would be required. It would also require greater investment in the agri-food sector so that it is capable of innovating in sustainable food production.’ Yet we know if health and agricultural policies were aligned such that our land was used to produce food that promotes health (all the healthy plant foods), our farmers were supported to transition to producing horticultural products and land was managed appropriately i.e. stopped being used graze animals and grow crops to feed animals, we could certainly be self reliant in food production. In fact a transition to a plant-based food system would not only feed the entire population but at the same time release a land mass the size of Scotland that could be returned to nature to recover our biodiversity and also to sequester carbon.

Yet, in the UK, misinformation from the meat and dairy industry remains pervasive. A new report about dairy, from Agricultural and Horticultural Development Board (AHDB) tries to persuade us that dairy is not only important for health but sustainable for our planet. This could not be further from the truth and we have shared an article countering some of the claims made and including a call to action.

The Eat-Lancet planetary health diet provides a global framework by which the food system and diets can feed a global population of 10 billion equitably whilst also keeping within planetary boundaries. It feels like now or never. Read our article on food systems and planetary health.

See you back in March!

The year kicked off with the highly anticipated release of the Dietary Guidelines for Americans (DGA). These were always going to be controversial since it was known that the recommendations of the Dietary Guidelines Advisory Committee had been thrown out and replaced by a rather non-transparent process. I have written a separate in-depth review. Needless to say, ideology and industry influence has replaced evidence-based recommendations.

At the same time, the US New and World Report has published their annual analysis of the best diets for various health conditions, as recommended by a panel of experts. In contrast to the DGAs, all recommended diets have a focus on nutrient-dense, fibre-rich plant-based foods.

Going forwards, it is going to be difficult to assess the impact of dietary guidelines on health outcomes with so many people using GLP1 agonists for weight loss and their potential positive impacts for other chronic conditions. However, diet and lifestyle support will remain fundamental for the success of these therapies as demonstrated by the next two papers.

Nutritional and lifestyle supportive care recommendations for management of obesity with GLP-1 - based therapies

This expert consensus statement addresses a rapidly evolving area of obesity care: how best to support people using GLP-1–based therapies such as liraglutide, semaglutide and tirzepatide with appropriate nutrition and lifestyle interventions. Recognising that these drugs can produce substantial weight loss but are frequently accompanied by gastrointestinal side effects, nutritional inadequacy and high discontinuation rates, the authors convened an international, multidisciplinary panel to develop practical recommendations using a modified Delphi process.

Drawing on a broad scoping review of the literature published since the introduction of semaglutide for weight management, alongside established obesity and nutrition guidelines and extensive clinical experience, the panel agreed on 52 consensus statements covering the full patient journey. These span preparation before starting therapy, management during the active weight-loss phase, longer-term weight maintenance, and strategies to mitigate harm if treatment is discontinued. Central to the guidance is the recognition that GLP-1–based therapies should not be viewed as stand-alone solutions, but as part of a comprehensive, individualised approach that prioritises nutritional adequacy, physical activity, preservation of lean body mass and long-term behavioural support.

The statement emphasises that people living with obesity are often at baseline risk of micronutrient deficiencies due to poor diet quality, and that the profound appetite suppression induced by GLP-1 therapies may exacerbate these risks. Ensuring adequate protein intake, sufficient dietary fibre, hydration and micronutrient sufficiency is therefore presented as fundamental, not optional. The authors stress the importance of regular monitoring to avoid excessive or overly rapid weight loss, which may compromise muscle mass, bone health and overall nutritional status, particularly in older adults or those with sarcopenic obesity.

Physical activity is positioned as a critical co-therapy, with a strong consensus around combining aerobic exercise with resistance training to support cardiometabolic health and mitigate loss of lean mass during weight loss. The guidance also provides pragmatic advice on managing common gastrointestinal side effects through dose adjustment, meal timing, food choices and hydration, reinforcing that these symptoms are usually transient and manageable without undermining weight-loss efficacy.

Importantly, the paper highlights the reality that many people discontinue GLP-1–based therapies within a year, often due to cost or access rather than clinical choice. In this context, the authors underscore the high risk of weight regain after cessation and the need for structured nutritional and lifestyle support to reduce rebound weight gain. Throughout, there is a consistent call for care that is non-judgemental, stigma-free and grounded in shared decision-making, ideally involving registered dietitians and multidisciplinary teams.

Overall, this consensus statement does not claim to be underpinned by a strong body of direct trial evidence, and the authors are transparent about this limitation. Instead, it offers a thoughtful, clinically grounded framework to help healthcare professionals integrate nutrition and lifestyle medicine into the use of powerful new pharmacological tools, while clearly signalling the urgent need for better evidence on optimal dietary patterns, long-term nutritional consequences and strategies to sustain health gains beyond medication use

Weight regain after cessation of medication for weight management

This systematic review and meta-analysis pooled data from 37 studies involving more than 9,000 adults treated with weight-management medications, including modern incretin-based therapies such as semaglutide and tirzepatide, as well as older pharmacological agents. The authors sought to quantify what happens to body weight after these medications are stopped, a question of growing importance as incretin therapies become widely used for obesity treatment.

The central finding is that weight loss achieved during active pharmacotherapy is typically followed by substantial weight regain once medication is discontinued. On average, people regained weight at a rate of approximately 0.4 kg per month after stopping treatment, and modelling from the combined studies projected that most individuals returned to their pre-treatment weight within about 1.7 years of cessation. The pattern was similar for both newer GLP-1 receptor agonists and older weight-loss drugs, although the absolute amount of weight regained tended to reflect the amount lost during therapy .

Importantly, the analysis also found that cardiometabolic markers such as blood glucose and blood pressure tended to revert toward baseline alongside body weight, with projected return to pre-treatment levels within about 1.4 years after stopping medication. This suggests that the physiological benefits accrued during drug use are not sustained in the absence of ongoing treatment or concurrent lifestyle support .

When compared with traditional behavioural weight-management programmes involving diet and physical activity, the rate of weight regain after stopping pharmacotherapy was almost four times faster, even though behavioural programmes typically produce smaller initial weight losses. This highlights that the phenomenon of weight regain is not unique to drugs, it reflects the fundamental biology of energy balance, but that medications do not intrinsically alter the body’s homeostatic responses in a lasting way once they are withdrawn .

The authors and subsequent commentators emphasise that these findings do not undermine the value of weight-loss medications for appropriate patients, but they do caution against viewing them as a standalone long-term solution. Instead, the data underscore the chronic, relapsing nature of obesity and the need for integrated, ongoing strategies, including attention to nutrition, physical activity, behavioural support and metabolic adaptation, to support durable health outcomes beyond the period of pharmacotherapy

Which foods support a healthy body weight?

This comprehensive umbrella review synthesises the highest level of available evidence on how different food groups relate to the risk of developing overweight and obesity, drawing together data from 13 systematic reviews and meta-analyses, most of them based on large prospective cohort studies

By focusing on food groups rather than individual nutrients, the authors provide a clear and policy-relevant picture of which foods are consistently associated with long-term weight gain and which appear protective.

Across the evidence base, foods most consistently associated with a lower risk of overweight and obesity are whole grains, legumes, nuts and fruits. Higher intakes of these foods were associated with reduced risk both in high-versus-low comparisons and, for several groups, in dose-response analyses. Whole grains and fruits in particular showed a largely linear relationship, with progressively higher intakes associated with lower risk across the observed range. Legumes, although supported by fewer studies, also showed a protective association, aligning with their role as fibre-rich, low-energy-density staple foods. Nut consumption was associated with lower risk of overweight and obesity despite their energy density, with the strongest associations seen at moderate intakes, suggesting that satiety effects and displacement of less healthy foods may be more important than calorie content alone.

Vegetables showed a more nuanced relationship. While many individual studies suggested benefit, the pooled results did not reach statistical significance in all analyses, and non-linear dose-response curves suggested that moderate intakes were associated with the lowest risk. This likely reflects methodological limitations, including measurement error and limited variability in vegetable intake within many populations, rather than an absence of biological effect.

In contrast, foods most clearly associated with weight gain and higher risk of overweight and obesity were sugar-sweetened beverages and red meat. Sugar-sweetened beverages showed one of the most consistent and robust associations in the review, with higher consumption linked to increased risk in both high-versus-low and per-serving analyses. This strengthens the causal inference that liquid sugars contribute to excess energy intake and weight gain. Red meat consumption was also associated with increased risk, particularly in high-versus-low comparisons, likely reflecting its energy density, saturated fat content and the broader dietary patterns in which it is typically consumed.

Refined grains and processed meats showed trends towards increased risk, but the associations were weaker and in some cases did not reach statistical significance, partly due to higher heterogeneity and lower quality of the underlying evidence. Total dairy intake was not consistently associated with either weight gain or protection, with mixed findings depending on dose and product type, highlighting the limitations of grouping diverse foods under a single category.

Taken together, the findings reinforce a pattern that is now familiar across nutrition research: diets built around minimally processed plant foods are associated with better weight outcomes over time, while diets characterised by sugary drinks and higher intakes of red and processed meats are associated with weight gain. Importantly, these associations emerge from long-term observational data rather than short-term weight-loss trials, providing support to their relevance for prevention. In the context of current debates about obesity management, including the rapid uptake of pharmacological therapies, this review serves as a reminder that food patterns remain central to population weight trajectories, and that the foods associated with healthier body weight are, by and large, the same foods associated with lower risk of chronic disease and lower environmental impact.

Minimal and optimal lifestyle habits for improving all-cause mortality

This large prospective analysis from the UK Biobank offers a timely and important reminder that health behaviours do not operate in isolation, and that it is their interaction which matters most. Drawing on wearable-derived data for sleep and physical activity alongside a diet quality score derived from dietary questionnaires, researchers examined how combined variations in sleep, physical activity and nutrition relate to all-cause mortality over a median follow-up of just over eight years. What distinguishes this study is not simply its scale, but its explicit attempt to quantify the minimum combined changes across these behaviours associated with meaningful reductions in mortality risk, rather than focusing only on ideal or often unrealistic targets

The findings are striking in their practicality. While optimal combinations of moderate sleep duration, higher levels of moderate-to-vigorous physical activity and better diet quality were associated with substantially lower mortality risk, the most clinically relevant message lies elsewhere. Very small, concurrent improvements across all three behaviours were associated with measurable benefits. An additional fifteen minutes of sleep per day, 1.6 minutes more of moderate-to-vigorous physical activity, and a modest improvement in diet quality ( 1/3 cup of cooked vegetables and 1.5 servings of fruit extra per day) were together associated with a 10% reduction in all-cause mortality. None of these changes, when considered in isolation, achieved the same effect. Diet quality in particular showed limited association with mortality unless accompanied by more favourable sleep and activity patterns, reinforcing the idea that nutrition cannot be meaningfully disentangled from the wider context of daily living.

Larger combined shifts were associated with progressively greater reductions in mortality risk. A pattern characterised by roughly an extra hour of sleep per day, around 12 minutes more physical activity, and more substantial improvements in diet quality was associated with a 50% lower risk of death during follow-up. At the upper end of the spectrum, the most favourable combination of sleep, physical activity and diet quality in this study was associated with a 64% per cent lower mortality risk compared with the least favourable pattern.

On a similar theme, it seems even small amounts of physical activity alone can reduce mortality. A large analysis published in the Lancet has shown that even a 5 minute increase in moderate to vigorous physical activity per day could reduce the risk of death by up to 10%, whilst reducing sedentary time by 30 minutes a day would provide additional benefits. Of course, more is better, and this new analysis in the BMJ shows that higher levels of physicial activity are associated with larger reductions in mortality with a greater variety of activities having independent additional benefits to just the total amount of activity.

Lifestyle interventions in pregnancy on gestational diabetes

This study shifts the focus earlier in the life course and into a period where prevention has implications not just for one individual, but for two generations. In this large individual participant data and network meta-analysis, the authors examined the effects of lifestyle interventions during pregnancy on the risk of gestational diabetes, drawing together data from multiple randomised trials to compare different approaches more robustly than has previously been possible .

What emerges clearly is that lifestyle interventions in pregnancy can reduce the risk of gestational diabetes, but that not all interventions are equally effective, and timing matters. Physical activity interventions appeared to be the most effective single intervention and so were interventions delivered in a group format.

The dietary components of effective interventions tended to emphasise overall diet quality rather than rigid macronutrient targets, aligning with broader evidence that dietary patterns matter more than individual nutrients. Prior studies have shown that plant-based dietary patterns are associated with a lower risk of gestational diabetes.

From a lifestyle medicine perspective, the findings reinforce the idea that pregnancy represents a window of opportunity for meaningful, supported behaviour change, but also a moment of vulnerability. Interventions that were supportive, structured and integrated into routine antenatal care were more likely to succeed than those that relied on individual motivation or compliance. The study also highlights a recurring challenge: while lifestyle interventions can reduce gestational diabetes risk, their implementation remains uneven, and access is often poorest for those who would benefit most.

The wider implications extend well beyond pregnancy itself. Gestational diabetes is a strong predictor of future type 2 diabetes and cardiometabolic disease for the mother, and of metabolic risk for the child. Reducing its incidence through achievable, non-stigmatising lifestyle interventions therefore represents a form of intergenerational prevention. Taken together with the broader lifestyle literature, this analysis strengthens the case for embedding nutrition and lifestyle medicine into standard antenatal care, not as an optional add-on, but as a core component of preventive health across the life course.

Dietary interventions and gut microbiota

This systematic review brings much-needed clarity to an area that has generated enormous interest but is often discussed in overly simplistic terms. Drawing together evidence from 80 controlled clinical trials, the authors examined how different dietary patterns influence the gut microbiota, allowing for a direct comparison between plant-based diets (including vegetarian and vegan) and a range of other commonly studied dietary interventions .

Across the body of evidence, plant-based dietary patterns consistently emerged as the most favourable for gut microbial diversity and function. Diets characterised by higher intakes of whole plant foods were associated with increased microbial richness, higher abundance of butyrate and anti-inflammatory bacteria. These changes are widely regarded as markers of a healthier gut ecosystem and are mechanistically linked to improved metabolic, immune and inflammatory outcomes. Additionally, a plant-based diet was associated with reduced triglycerides, total cholesterol, LDL cholesterol, and both fasting and postprandial glucose levels, along with reduced HbA1c levels indicative of improved blood glucose control

Western-style, high fat and ketogenic diets stood out for their contrasting effects. Although some trials reported short-term changes in specific microbial taxa, these patterns were frequently accompanied by reductions in overall diversity and marked decreases in fibre-associated bacteria and short-chain fatty acid production. In addition, they showed adverse impacts on blood lipids, markers of inflammation and glucose regulation.

From a clinical and public health perspective, these findings strengthen the biological plausibility underpinning plant-based nutrition recommendations. They also help explain why plant-predominant dietary patterns are repeatedly associated with lower risk of cardiometabolic disease, certain cancers and all-cause mortality. The microbiome emerges not as a separate or fashionable add-on, but as a central mediator linking what we eat to long-term health. For lifestyle medicine, this reinforces a familiar but still under-appreciated message: diets built around a wide variety of whole plant foods support not only human physiology, but also the complex microbial ecosystems on which our health depends.

Lifestyle interventions for major depressive disorders - a consensus statement

This expert consensus statement from the American College of Lifestyle Medicine represents one of the most comprehensive attempts to date to formally integrate lifestyle medicine into the prevention and management of major depressive disorder. Using a rigorous modified Delphi process, a multidisciplinary panel of experts reviewed the existing evidence base and reached consensus on 71 statements covering assessment, diagnosis, and the six core pillars of lifestyle medicine: nutrition, physical activity, sleep, stress management, social connectedness, and avoidance of harmful substances.

At its core, the statement challenges the continued marginalisation of lifestyle interventions in mental health care. While acknowledging that pharmacological and psychological therapies remain important, the panel reached strong consensus that lifestyle interventions are foundational to the management of major depressive disorder, rather than optional adjuncts. Physical activity emerged as the intervention with the most robust and consistent evidence, with consensus that it can be used as a primary therapy for adults with mild depression and as an effective adjunct for moderate to severe disease. Notably, the strength of evidence for physical activity compares favourably with antidepressant medication, with substantially lower numbers needed to treat to achieve clinical benefit.

Nutrition and gut health feature prominently, reflecting a growing recognition of the diet–brain–microbiome axis. The panel reached consensus that whole-food, plant-predominant dietary patterns, including Mediterranean-style eating, are associated with lower risk of depression and improved outcomes in people with established disease. Diets high in fibre, polyphenols and minimally processed plant foods were consistently viewed as beneficial, while dietary patterns high in ultra-processed foods, saturated fat, refined carbohydrates and salt were associated with increased risk of major depressive disorder. Importantly, the statement explicitly notes insufficient evidence to support ketogenic or very low-carbohydrate diets for depression management, while highlighting well-documented adverse cardiovascular and metabolic effects associated with these patterns.

Sleep was identified as another critical pillar, with strong consensus that sleep quality, quantity and regularity directly influence depressive symptoms and long-term mental health outcomes. The panel emphasised the importance of assessing sleep routinely in people with depression, including screening for obstructive sleep apnoea, which is highly prevalent in this population. Cognitive behavioural therapy for insomnia, delivered either in person or digitally, was endorsed as an effective intervention that can improve both sleep and depressive symptoms.

The consensus statement also places considerable emphasis on stress, social connection and the wider environment. Loneliness, lack of social connectedness and chronic unregulated stress were all identified as significant risk factors for the development and persistence of depression. Social interventions, including peer support, group activities and community engagement, were viewed as effective components of care, while the panel clearly distinguished meaningful social connection from passive social media use, which does not confer the same mental health benefits. Substance use, including alcohol and cannabis, was consistently associated with higher prevalence of depression, anxiety and suicidal ideation, reinforcing the need to address these factors as part of comprehensive care.

Across all domains, the statement highlights that effective lifestyle intervention depends not only on what is recommended, but on how it is implemented. There was strong agreement that assessment of baseline lifestyle habits should be routine, that care should be trauma-informed and equity-focused, and that sustained behaviour change is more likely when interventions are integrated into daily life, supported by social networks and delivered through coordinated, multidisciplinary care. The authors are careful to position this work as a consensus statement rather than a formal clinical guideline, reflecting ongoing gaps in the evidence, but the message is nonetheless clear: lifestyle medicine offers powerful, evidence-based tools for improving mental health outcomes that remain underused in clinical practice.

There’s no such thing as climate-friendly beef

Food system transformation is urgently needed to meet our global nature and climate targets. Yet the meat and dairy industry continue to suggest that changes in farming practices can reduce the environmental harms associated with the production of animal-sourced foods.

This new analysis from the World Resources Institute makes it clear that claims of “low-emissions” or “net-zero” beef are, at present, more marketing than reality. When greenhouse gas emissions are counted across the full lifecycle, including methane from cows, feed production, land use change and deforestation, even the best available production methods reduce beef’s climate impact by only modest amounts. Even with improved practices, beef continues to emit far more greenhouse gases per unit of protein than most plant-based foods, and labels that tout sustainability often rely on questionable offsets rather than transparent, verifiable reductions in emissions. In practical terms, the only scalable way to reduce the climate burden associated with beef is through lower consumption and a shift toward more plant-predominant dietary patterns that are both healthier for people and markedly lower in carbon emissions.

See you back in February!

The newly published Dietary Guidelines for Americans has dampened the start to the year. These guidelines tend to have a global influence and, although well known to be heavily influenced by the food industry, they have always broadly followed the scientific consensus on nutrition and health. More importantly, the work of the Dietary Guidelines Advisory Committee (DGAC), who volunteer thousands of hours over the preceding two year period to publicly review the evidence and formulate recommendations, provides the global community with an incredibly useful report.

The Scientific Report of the 2025 Dietary Guidelines Advisory Committee did not disappoint and left us hopeful that plant-rich dietary patterns would be at the forefront of the update. Their recommendations included prioritising plant sources of protein, encouraging people to eat less red and processed meat and recommended legumes to be placed within the protein section (where they should have always been!)

Then came the Trump administration and Robert F.Kennedy Jr appointed as the Secretary of Human Health and Services and sadly nutrition guidance has veered off course ever since. One reason cited for dismissing the recommendations of the then DGAC was because of the emphasis on health equity. Since when is this a bad; to consider all people, including different ethnicities and indigenous people? The Eat Lancet Commission has now centred justice at it’s core.

Sidebar: The guidance is accompanied by a 90 page scientific report and a 418 page Appendix. But we have to confess to not having read these documents fully. We just could not face it. When we saw that Ty Beal, PhD, a well known prominent of meat and dairy consumption had reviewed the evidence on vegan diets and written that ‘Most plant sources of protein do not contain all essential amino acids in high enough quantities to meet requirements without being combined with complementary plant proteins or animal-source foods.’ Big eye roll! In addition, processed meats and processed meat alternatives have been considered together as if they represent one entity. Neither are considered to cause health harms. How can that be when processed meat is classified as a group 1 carcinogen by the WHO?

For us, a healthy diet should be nutritious and healthy, sustainable for the producer, society and the planet, affordable and accessible, culturally adaptable and in our view kind and compassionate to all beings. The latest iteration is far removed from meeting these basic objectives.

The good aspects (or less bad!)

We certainly agree with one key recommendation, which is to focus on ‘real food’ and ‘whole nutrient-dense foods’, whilst limiting or avoiding added sugars and refined grains. This includes an emphasis on consuming fruits and vegetables, shown at the top of the flipped pyramid. This contrasts with the typical American diet where more than 50% of energy comes from ultra-processed foods and is therefore lacking in fibre and other health-promoting nutrients found in whole plant foods.

But from there on the guidelines moves away from the scientific consensus.

The bad (and a lot of it!)

The flipped pyramid

The US dietary guidelines have not used a pyramid shape since 2011. Instead, like many countries, it had moved to a picture of a plate (MyPlate), which provides a better depiction of the proportions of certain food groups to consume regularly/daily opposed to providing a hierarchy whereby one might assume eating foods at the top were sufficient.

A misplaced focus on protein whilst failing to emphasise fibre

We don’t have a major issue with the recommendation to consume 1.2 to 1.6g/protein per day rather than the usual global reference of 0.8g/kg, as there is some debate on this topic. However, most Americans are already meeting and exceeding this level of protein intake and thus emphasising it further risks citizens wrongly focusing on this nutrient. The further concern is the emphasis on animal sources of protein such as red meat, dairy and eggs rather than plant sources. Just the sheer size of the images depicting red meat, chicken, whole milk and egg (seemingly a fried egg!) gives the impression that these are preferred sources of protein. This is at a time when Americans are one of the highest consumers of meat globally, with an average daily intake of almost 400g per day. High meat diets, especially if high in red meat, are associated with a higher risk of chronic conditions and premature mortality, in part because it displaces other potentially healthier foods.

The nutrient that should have been emphasised first and foremost is fibre, since it is lacking in the diets of most Americans. Only 5% of Americans currently meet fibre recommendations, with the average intake only half of what is considered necessary for good health. Found only in plant foods, fibre consumption promotes both physical and mental health and wellbeing and is associated with a significant reduction in rates of chronic conditions.

As pointed out by Prof Christopher Gardner, one of the original 2025 Dietary Guidelines Advisory Committee members, the portions of fruit and vegetables have been changed from cups to servings (1 serving = half a cup), which means that less is being recommended compared to prior versions.

Where have the beans and nuts gone?

We can’t see beans depicted in the pyramid (can you?) and nuts are shown in ridiculously small proportions. These two foods are the healthiest sources of protein, and also serve as a source of fibre and numerous vitamins and minerals.

Without reviewing all the evidence again, beans, lentils, soya foods, nuts and seeds are a cornerstone of every evidence-based dietary recommendation, associated with lower risks of chronic conditions and reduced risk of premature mortality. In the UK, we have an amazing campaign to double the consumption of beans by 2028 for just these reasons. Additionally, a 30g portion of nuts per day is also standard global advice given the association with better health outcomes.

Confusing and conflicting advice

Whilst the guidance to limit saturated fat consumption to less than 10% of energy intake is welcome, if citizens follow the advice to consume more meat, dairy and eggs, there is no way this can be achieved. All the foods that are being emphasised in the guideline are also high in saturated fat content.

The advice to cook with butter and beef tallow also adds further saturated fat to the diet. Although olive oil is also included, other plant-based oils, high in essential polyunsaturated fats are excluded. This is not a surprise as RFK is well known for spreading misinformation about seed oils but his views do not reflect the scientific consensus.

It is unclear why there is an emphasis on whole dairy specifically without consideration of alternative sources of nutrients found within dairy foods. Not only is it higher in saturated fat, it is unsuitable for people with lactose intolerance, especially prevalent in non-White populations. In the UK, the Scientific Advisory Committee on Nutrition has clearly stated that milk from a cow is not necessary in the diet of children or adults. Health Canada removed dairy as a food group in their industry-free 2019 dietary guideline. This was based on the fact that dairy is not necessary in the diet, represents a more inclusive recommendation and because its production is terrible for the planet. So why do US officials consider dairy essential?

The guidance rightly emphasises the need to limit salt in the diet but then goes on to suggest flavouring foods with added salt!

The importance of the health of the gut microbiome is rightly acknowledged, but again, an emphasis on consuming the foods that promote gut health i.e. plants, is lacking.

Lack of nuance around processed foods

The guideline reads as if all food processing is bad. This is incorrect. It is well known that not all processed foods are created equal and that the degree of processing does not necessarily reflect its nutritional profile or impacts on health. The health harms associated with ultraprocessed foods consumption are almost exclusively due to the consumption of processed meats, sugar-sweetened beverages and foods high in salt, sugar and saturated fat. Certain processed foods, such as whole grain breads and cereals, fortified plant milks and certain meat alternatives, have not been shown to negatively impact health and can even be beneficial.

A nod to low-carb diets

The guidance endorses a low-carbohydrate dietary pattern. This may not be an issue in and of itself, since a range of macronutrient ratios can make up a healthy diet pattern.

However, people do not shop for macros, they shop for food. The guidance infers that animal-sourced foods should be consumed in favour of carbohydrate-rich foods (i.e. plant-based foods). This way of eating is known to increase the risk of chronic conditions such as cardiovascular disease, type 2 diabetes, cancer and premature mortality.

Woeful guidance on vegetarian and vegan diets

Although great to see the inclusion of vegetarian and vegan diets, the guidance is insufficient to support the adoption of a healthy plant-based diet. Overly cautious, it assumes that vegetarians and vegans will merely remove eggs and dairy and then by default be deficient in a range of nutrients. Plant-based eaters don’t just remove foods, they replace and add in plant-based foods that on the whole can provide all the nutrients we need, bar vitamin B12 and vitamin D (when exposure to sunshine is limited). Since when do vegans have to worry about potassium consumption! One of the major benefits of a plant-based diet is the high potassium intake which is associated with a lower risk of high blood pressure.

Luckily, we had updated guidance in 2025 on vegetarian and vegan diets from the Academy of Nutrition and Dietetics, which confirms that these plant-based diets can meet nutritional requirements and can be associated with improved health outcomes.

Failure to provide exact limits on alcohol consumption

Although the guidelines do state limiting alcohol consumption, quantities have been removed from the previous set upper limits in favour of this vague guidance, for no clear reason (apart from industry influence...). Less alcohol means different things to different people. The scientific consensus has moved on from the past medical position that low intakes of alcohol can be healthy. Instead, current consensus is that there is no safe amount of alcohol to consume and zero is the optimal amount.

Failure to consider planetary health

Most recently, updated country-based dietary guidelines have considered the impact of the food system on planetary health and guidance has been tailored to ensure that the dietary recommendation can also support environmental health. Afterall, there are no healthy people on an unhealthy planet and the climate crisis is considered the greatest threat to human health. Without food system transformation, it is not possible to meet global climate and nature targets.

This does not seem to have been considered important in this new guideline. We know that the production of animal-sourced foods, especially red meat and dairy, have the most damaging effect on all indicators of planetary health and hence the scientific consensus, as outlined in the 2025 update of the Eat Lancet Planetary Health Diet, is the need for an urgent global transition to a plant-based food system and dietary pattern.

Clear influence of the meat and dairy industry

The usual transparent and open guideline development was thrown out for a closed door approach whereby the advisory committee for this new guideline was only revealed on the day of release. There is no doubt that the meat and dairy industry have had an oversized influence. At least seven of the nine subject matter experts involved have strong relationships with the meat and dairy industry, including links to the Global Dairy Platform, National Cattlemen’s Beef Association, National Pork Board, and the California Dairy Research Foundation.

They have certainly failed on this stated aim ‘“The American public deserves dietary guidance grounded in the best available science—free from ideological bias, institutional conflicts, or predetermined conclusions.”

Failure to consider the welfare of farm animals

The misguided emphasis on eating animals will encourage people to consume more animals, most of whom (99% in the US) are being raised in industrial farming operations. These ‘factory farms’ are hideous places where animals and the people who work in them suffer immeasurable harm. Since we know all animals are sentient, feel pain, have individual personalities, form loving bonds and want to live, surely we should be aiming to minimise the harm we cause to our animal kin?

Knowing that a 100% plant-based diet can meet our nutritional needs at all stages and ages of life whilst also having the lowest impact on the environment, this should be the default approach wherever possible.

Our concern for long-term health

The major concern we have as a community of healthcare professionals is that these dietary recommendations will lead to worse long-term health outcomes. Meat and dairy heavy diets will lead to increased consumption of saturated fat, higher blood cholesterol levels, and higher blood pressure, all of which increase the risk of cardiovascular diseases. High meat diets increase the risk of overweight and obesity and also increase the risk of type 2 diabetes. Meat-based diets are associated with higher rates of cancer.

This seems to be a dangerous population experiment.

The silver-lining

It may be a blessing that most citizens do not follow their country-based dietary guidelines. People who focus on eating fibre-rich whole foods are not suddenly going to stop. Eating more plants has been popularised through widespread coverage of the health benefits of eating 30 different plant types per week, the latest trend of fibremaxxing and mainstream interest in improving gut health.

We hope that US citizens will take notice of the critiques being published by highly regarded, qualified and trusted health professionals and researchers. We are also pleased our friends at PCRM have launched a federal legal challenge.

Recommended reading

Dr David Katz

Part 1: on the deficiencies in THESE dietary guidelines

Part 2: on the historical deficiencies in the dietary guidelines process

Stanford medicine

Dr Kevin Klatt

The Center for Biological Diversity and the Center for Science in the Public Interest in the US have released a healthy re-write of the new US dietary guidelines, based on the evidence. View them here:

Uncompromised Dietary Guidelines for Americans

Available at: cspi.org/sites/default/files/2026-01/20260107_CSPI_uncompromisedDGA_report_4_FINAL.pdf

A Model for Healthy and Sustainable Dietary Guidelines for Americans

Available at:

biologicaldiversity.org/programs/population_and_sustainability/pdfs/2025-sustainable-dga.pdf

Recommended watching:

I was Wrong about RFK Jr´s New Dietary Guidelines – Nutrition Made Simple

It is always enjoyable compiling my annual review, which summarises my learning on diet and health. This is year is no different to many before. We continue to face challenges in our quest to improve individual and population health, support planetary health and ensure equitable healthcare delivery. But the scientific research continues to support plant-rich diets as a key part of the solution.

Our health is worsening and we know why

Lifestyle expectancy stalls in Europe, including in the UK. The slowdown is attributed to a lack of progress in reducing deaths from cardiovascular diseases and cancers, mostly due to our failure to sufficiently tackle modifiable risk factors. These risk factors include high blood pressure, dietary risks, high LDL-cholesterol, high body mass index (BMI), and tobacco use.

Globally, these same risk factors are driving the widening gap between healthspan and lifespan. This gap reflects the years lived in poor health. Women have a larger healthspan-lifespan gap than men, averaging an additional 2.4 year. The largest gaps are observed in high-income countries such as the United States (12.4 years), Australia (12.1 years), New Zealand (11.8 years), the UK (11.3 years) and Norway (11.2 years).

An updated analysis from the Global Burden of Disease (GBD) collates an enormous mount of data on 375 diseases and injuries and 88 modifiable risk factors across 204 countries. Nearly half of all years lost in ill health in 2023 was attributable to modifiable risk factors and the leading causes of death were cardiovascular diseases, respiratory conditions, Alzheimer’s disease, diabetes and cancer. The top risk factors globally were high systolic blood pressure, particulate matter air pollution, smoking, high fasting plasma glucose, and low birthweight/short gestation. High blood pressure alone accounted for an estimated 8.4% of years lost.

Dietary risks remain a major, modifiable driver of premature death and disability worldwide. The main risks relate to low intakes of fruits, vegetables, legumes, whole grains, and nuts and seeds; high sodium intake; high intakes of red and processed meat and sugar-sweetened beverages; and industrial trans fats. Many diet–disease pathways are mediated through metabolic factors such as blood pressure, blood lipids and glucose.

These data support the urgent need for health systems to shift focus from merely increasing lifespan to improving healthspan by prioritising preventive care with a key focus on diet and nutrition. A new state of the art review on diet and prevention of cardiovascular disease and cancer concludes that the evidence supports the implementation of a whole food plant-based diet for primary and secondary prevention.

In the UK, diet quality has continued to deteriorate with updated results of the National Diet and Nutrition Survey showing that <1 in 10 children and <1 in 5 adults meeting recommendations to eat five portions of fruit and vegetables a day and only 4% of the population meeting recommendations for fibre intake (30g/day). The 10 year health plan published this year by NHS England does prioritise prevention as one of its key aims, albeit with an oversized emphasise on pharmaceutical and technological solutions and very little detail on addressing dietary risk factors. Read my thoughts on the 10-year health plan and a vision for a health service that prioritises prevention.

Plant-based diets are nutritionally adequate and offer health benefits

This year saw the publication of the long awaited update of the position statement from the Academy of Nutrition and Dietetics on vegetarian dietary patterns. Of note, this relates to adults, 18 years and older (non-pregnant/non-lactating).

The statement reaffirms that plant-based diets (vegetarian and vegan) are nutritionally adequate and can have health benefits, although it correctly emphasises the importance of diet quality. It highlights the need for vitamin B12 supplementation and additional potential deficiencies in micronutrients including, iodine, iron, calcium and choline. These can all be easily addressed through food sources and for iodine, either iodised salt, seaweed or supplementation. Fortified plant-based drinks, even if classified as ultra-processed, are acknowledged as a useful source of nutrients such as calcium and it is noted that there are no data to suggest these drinks are harmful. The statement recommends incorporating sources of alpha-linolenic acid (ALA) such as flaxseeds, chia and hemp seeds, but does not find that an algae-derived DHA/EPA is necessary for everyone. In addition, the statement acknowledges there may be benefits of a vegetarian and vegan diet for preventing and managing cardiometabolic conditions such as overweight/obesity, glucose dysregulation/diabetes, high blood lipids and blood pressure. There is also acknowledgment of the association between vegan diets and lower bone mineral density and potential increased risk of fracture. Thus ensuring sufficent intake of calcium and vitamin D and paying attention to diet quality to mitigate against these potential issues is important.

The document is aimed at dietetic, nutrition and health professionals who should have sufficient knowledge to support clients in both the outpatient, inpatient and community settings to adopt a nutrient-dense, vegetarian or vegan diet if that is their wish and that these dietary patterns can be used to manage chronic conditions. We know from our own research survey that dietitians in the UK and Ireland do not feel confident in supporting clients to adopt a plant-based diet, in part because the dietetic curricula do not sufficiently cover the topic and there is a lack of resources for use in clinical practice.

Plant-based diets lower the risk of cancer

The global burden of cancer continues to rise, in part due to an ageing population and population growth. Worryingly there is also a rising incidence of cancer in young people, less than age 50 years. Yet, 40-50% of cases could be prevented by addressing modifiable risk factors. Dietary risk factors are also a key driver and we have known for a while that meat-free diets can reduce the risk of cancer.

An updated analysis from the Adventist Health Study-2 aimed to assess the impact of vegetarian and vegan diets on a broader range of cancer types, including so called ‘medium frequency’ cancers (melanoma, endometrial, renal, urothelial, thyroid, ovarian, central nervous system, lung, rectal, pancreatic, primary liver, stomach, oesophageal, mouth-pharyngeal-laryngeal, lymphoma, lymphoid and myeloid leukemias). The study included 79,468 adults in North America, including 20,662 black participants, who were cancer-free at recruitment and followed for an average of 8 years.

Compared to omnivores, lacto-ovo vegetarians (LOV) had a 9% reduction and vegans a 24% reduction in overall cancer risk. For medium frequency cancers, LOV had a 18% reduction and vegans a 23% reduction in risk. Younger (at age 65 years) but not older vegans (at age 85 years) had a lower risk of prostate (43% reduction) and breast cancer (31% reduction). At age 85 years, vegans had a significantly lower risk of lymphoma (56% reduction). LOVs also had a lower risk of lymphoproliferative disorders in general. Pescovegetarians showed a reduced risk of total and medium frequency cancer, although to a lesser degree. They did however show a reduced rate of colorectal cancer (39% reduction) and breast cancer at an older age (43% reduction). Lower rates of carcinoma of the stomach were seen among all vegetarians combined, and also in LOVs.

Of particular interest was the further analysis around dairy consumption. Given the lower rates of breast and prostate cancer in vegans, the authors evaluated the link between dairy milk and the risk of these cancers. They found a strong positive correlation between dairy milk consumption and these cancers.

Overall the results strengthen the association between meat-free diets and cancer, with greater benefits for those on a 100% plant-based or vegan diet, including for less common cancers. There are a number of reasons why this may be the case. In general, meat free diets result in lower exposure to dietary carcinogens such as those associated with processed meat and cooking meat at high temperatures. Vegetarians and vegans have been shown to have lower levels of inflammation and a healthier gut microbiome, due to higher intakes of fibre. The lower rates of various co-morbidities, such as cardiovascular diseases and type 2 diabetes may also have a positive impact for cancer.

The authors conclude that in vegetarians the ‘decreased risk of all cancers, and medium frequency cancers as a group, in this North American cohort, were strong and persuasive. The public health significance is clear, with the risk of adverse effects being very small or non-existent (for vegetarian dietary patterns), and that some benefits are likely real, although an observational study cannot establish causality with certainty’.

Hot off the press, plant-based supplements may be beneficial in slowing the progression of prostate cancer. We already know that plant-rich diets and intensive lifestyle interventions can improve outcomes for people with a diagnosis of prostate cancer. A new randomised study from the UK has demonstrated that a whole food supplement containing a variety of plant-derived nutrients along with a plant-based probiotics can slow progression of prostate cancer, improve symptoms, reduce inflammation and improve general health. Read a summary of the study.

Plant-based eaters have the best gut health

This study from the team at Zoe investigated the relationship between self-reported diet patterns and gut microbiome composition, analysing data from a large global cohort of 21,561 individuals. The three diet patterns examined, vegan, vegetarian and omnivore, significantly influenced gut microbial composition. In total, stool sample analysis from 656 vegans, 1,088 vegetarians and 19,817 omnivores was included.

The microbiome signature in omnivores was consistent with eating meat and included bacterial species such as A. putredinis, B. wadsworthia and R. torques, that have previously been implicated in inflammatory diseases such as inflammatory bowel disease, colorectal cancer, and are more likely to be associated with negative cardiometabolic health outcomes. Omnivores consumed fewer plant-based foods on average compared to vegetarians and vegans, resulting in lower abundance of fibre-degrading and short chain fatty acid (SFCA)-producing microbes. The lack of plant diversity contributed to reduced gut microbial richness and functionality compared to plant-based diets. Microbial functions in omnivores focused on protein and amino acid metabolism, reflecting the animal-product-heavy diet. Metabolic pathways for processing red meat and dairy products, such as the production of TMAO (trimethylamine N-oxide), were prominent in omnivorous microbiomes and are linked to inflammation and cardiovascular risk.

Vegetarians exhibited gut microbiomes enriched with microbes associated with moderate plant-based diets, such as Streptococcus thermophilus and Lactobacillus acidophilus, common in dairy products. The microbial signatures of vegetarians were linked to better cardiometabolic health outcomes than those of omnivores but not as favourable as vegans. While vegetarians consumed more plant-based foods than omnivores, their diets included fewer diverse plant sources compared to vegans, reflected in their microbial composition.

Vegans exhibited unique gut microbial compositions dominated by fibre-degrading bacteria such as Lachnospiraceae, Roseburia hominis, and Butyricicoccus sp. These microbes are linked to the production of SCFAs, which support gut health and reduce inflammation. Vegan-associated microbes showed a stronger correlation with favourable cardiometabolic health outcomes compared to omnivores and vegetarians. Signature microbes in vegans are linked to lower risks of inflammatory diseases, such as cardiovascular diseases and type 2 diabetes. Vegan diets, rich in diverse plant-based foods, resulted in higher health-promoting gut microbial diversity. Specific microbial functions enriched in vegans included fermentation of dietary fibers and biosynthesis of vitamins like vitamin B7 (inositol). Vegan gut microbiomes showed significant overlap with soil and plant microbiomes, including microbes like Enterobacter hormaechei and Klebsiella pneumoniae, which are often involved in plant growth and nitrogen fixation. These findings suggest dietary sources, particularly fruits and vegetables, contribute directly to gut microbial diversity in vegans.

Overall, the results confirm prior data that dietary patterns impact gut microbiome composition. Plant-based diets, especially vegan diets, are associated with greater gut microbial diversity and characterised by bacterial species that are associated with improved gut health, lower levels of inflammation and better cardiometabolic health. Increasing plant diversity in all diet patterns, including omnivorous diets, can foster beneficial microbial profiles. The finding that vegans have gut microbiomes that are found in plants and soil is intriguing and is an area that requires more research. You can read the study summary from the research team here.

The same research team has just published another study demonstrating that a fibre-rich, whole food dietary intervention can improve the health of the gut microbiome and shift the gut bacterial community to one that is associated with better health outcome, such as butyrate-producing bacteria.

As much as I don’t rate the commercial aspects of the company Zoe, they have continued to provide us with evidence that plant-rich diets support better gut and overall health. I just don’t think we all need their microbiome testing and supplements to achieve our best health.

Red meat consumption, health outcomes and industry influence

Online influencers and the meat industry want us to believe that red meat is a ‘nutrient dense food containing essential nutrients that support better health’. It is true that red meat is a source of certain essential nutrients, including protein, iron and zinc. Yet its consumption is associated with an increased risk of several chronic conditions, including type 2 diabetes, cardiovascular disease, and certain cancers.

An analysis of over 200,000 participants across three major U.S. cohorts, followed for 28 years, found that higher intakes of both processed and unprocessed red meat were consistently linked to an increased risk of type 2 diabetes, even among those following an otherwise high-quality diet (as assessed using the Alternative Healthy Eating Index). The higher risk persisted even after adjusting for BMI, waist circumference, and weight change, suggesting the harms of red meat are independent of body weight. The study also demonstrated that substituting red meat with healthier foods, such as plant-based proteins, whole grains, or seafood, was associated with lower diabetes risk. The benefit of lowering red meat consumption was greater in participants with a higher diet quality.

This study helps to counter the narrative that the negative health impacts of red meat consumption are due to the fact that consumption is associated with an overall unhealthy diet. In fact, there was a greater risk associated with red meat in those who ate a healthier diet. In addition, it has been suggested that it is the food that red meat is consumed with that is responsible for harm. But this study also addressed this and showed that even in people with the lowest french fries consumption there was still a greater risk of developing type 2 diabetes. Substitution analysis showed that replacing red meat for refined grains was also beneficial, so we can’t even blame the bun!

Processed meats, in particular, raise significant concerns given their classification as carcinogenic by the World Health Organization. A report from the Food Foundations called Meat Facts finds that in the UK, nearly one-third of meat consumed is processed, with especially high intakes seen among children and younger men. The UK is consuming twice as much meat as the global average and 42% of meat consumed is chicken, despite the concerns around antibiotic resistance, pandemic risk, use of soya feed from areas of deforestation. Sadly, chicken consumption is likely to only increase especially with KFC investing 1.5 billion into the UK. There is an urgent need for public health messaging and government policies to support the reduction of meat consumption whilst increasing consumption of healthy plant-based foods.

Meat industry influence affects scientific rigour

The scientific literature on red meat is further complicated by issues related to industry influence. A 2025 systematic review revealed that studies with financial ties to the red meat industry were far more likely to report neutral or favourable health outcomes related to unprocessed red meat consumption. In contrast, all studies without industry ties reported either neutral or unfavorable outcomes. This pattern mirrors what has been observed in other areas of public health research, including studies on tobacco and sugar-sweetened beverages, raising serious concerns about the role of industry sponsorship in shaping scientific narratives.

Importantly, the health effects of reducing red meat depend significantly on what replaces it in the diet. Research has shown that substituting red meat with refined carbohydrates or other animal proteins such as white meat or fish may not lead to significant health improvements, and in some cases may even be detrimental. This is a study design ‘trick’ used by industry players to minimise the effect size of any potential harm attributed to red meat consumption. However, replacing red meat with high-quality plant-based foods like legumes, nuts, and whole grains consistently yields better outcomes for cardiovascular and metabolic health. This highlights the importance of specificity in dietary recommendations, general advice to reduce red meat intake is insufficient without guidance on appropriate substitutions.

Despite mounting evidence, UK dietary guidelines offer only broad recommendations to reduce red and processed meat with relatively high upper limit of 70g per day of red meat.. In contrast, international frameworks, such as the EAT-Lancet Planetary Health Diet, advocate for more precise limits, recommending no more than 14 grams of red meat per day for both health and environmental sustainability. It’s worth noting that men in general consume more meat than women as shown in the Meat Facts report and corroborated by this study from France. These habits are formed early in life according to this study from Sweden, in which diets of 4-years olds failed to meet sustainability goals with boys more likely to be consuming higher quantities of environmentally damaging foods such as meat.

Misinformation from the meat and dairy industry in the UK

The AHDB (Agriculture and Horticulture Development Board), a farmer levy board supported by Defra, continues to try and persuade us that red meat is a necessary component of a ‘healthy, balanced diet’. Their 2025 report ‘Balancing health and sustainability: the role of red meat in the UK diet’ is counter to all the available evidence. The seventh carbon budget from the UK’s Climate Change Committee make it clear that the UK needs to reduce the number of farmed cows and sheep and significantly reduce the consumption of red meat and dairy to meet climate and nature goals. The target set is to reduce red meat consumption by 40% by 2050. There is no role for red meat consumption in a healthy, sustainable future.

We don’t need meat for iron

A key argument remains the fact that red meat is a source of readily bioavailable iron and diets low or absent in red meat will increase the risk of iron deficiency. Interestingly, new research challenges this assumption. A controlled trial titled Dietary Adaptation of Non-Heme Iron Absorption in Vegans found that long-term adherence to a vegan diet is associated with physiological adaptations that enhance non-haem iron absorption. The study, which compared iron absorption between omnivores and vegans, demonstrated that despite the absence of haem iron in the vegan diet, overall iron status remained within normal ranges. Vegans exhibited increased fractional absorption of plant-based (non-haem) iron, suggesting that the human body may up-regulate absorption mechanisms in response to lower dietary iron bioavailability. These findings call into question the prevailing narrative that red meat is indispensable for maintaining adequate iron status and support the feasibility of plant-based diets in meeting nutritional needs when appropriately planned. Of course longer more in depth studies are required, but available evidence does not find an increased risk of iron deficiency anaemia in people following meat-free diets.

Plant-rich diets support better health for people and the planet

The updated EAT–Lancet Commission on Healthy, Sustainable, and Just Food Systems, published in 2025, marks a significant evolution in our understanding of how food connects health, the environment, and social justice. Since the first report in 2019, the world has faced multiple converging crises including, geopolitical instability, the COVID-19 pandemic, escalating climate impacts, and deepening inequalities. Yet despite these challenges, the message is more urgent and unequivocal than ever: our global food system remains the single largest driver of environmental degradation and a fundamental determinant of human health and wellbeing.

At the heart of this new analysis lies the Planetary Health Diet (PHD), a pattern of eating that is predominantly plant-based, rich in whole grains, fruits, vegetables, legumes, nuts, and seeds, and complemented by modest amounts of animal-sourced foods. These dietary recommendations first and foremost reflect our knowledge of diet and health. The PHD obtains 87.7% of energy from plant-based foods and meat, dairy and eggs are not considered essential. Authors clearly state that a 100% plant-based or vegan diet is compatible with the PHD recommendations.

The evidence supporting this way of eating for health has only strengthened over the past six years. Adopting a largely plant-based diet could prevent up to 15 million (27%) premature deaths annually, while substantially reducing the risk of cardiovascular disease, type 2 diabetes, respiratory conditions, cancer, dementia, and unhealthy ageing. The diet remains flexible and culturally adaptable, providing a framework within which regional food traditions can thrive. It supports adequate nutrition at all stages of life, including pregnancy and childhood (age 2 and above), noting that careful attention to key nutrients such as vitamin B12, iron, calcium, and iodine is required.

Perhaps the most profound shift in this Commission is the explicit integration of justice alongside health and sustainability. The 2025 report recognises that our food systems are not only environmentally unsustainable but also socially inequitable. Nearly half of the world’s population lives below the social foundations required to meet basic human rights such as access to food, clean environments, and decent work. Meanwhile, the diets of the wealthiest 30 percent of people are responsible for more than 70 percent of the environmental impact of global food production. The Commission calls for a transformation that is both nutritious and fair, ensuring that the benefits and burdens of food systems are shared equitably and that those most affected by injustice, smallholder farmers, women, and marginalised communities, have a voice in shaping the solutions.

Scientifically, the updated Commission represents a step change. For the first time, researchers have quantified food’s contribution to all nine planetary boundaries, those thresholds that define the safe operating space for humanity. The findings are sobering: food systems are the dominant cause of transgressing five of these boundaries, including land use, biodiversity loss, greenhouse gas emissions, freshwater depletion, and nitrogen and phosphorus pollution. Even with ambitious interventions, healthier diets, more efficient agriculture, and a 50% reduction in food waste, the world only just manages to return to safe limits for climate and freshwater use.

Sustainable food production does not require animal inputs

I am delighted to see that Conservation Agriculture, pioneered by my father Dr Amir Kassam, is endorsed (panel 5) as the sustainable, ecological and just solution to food production intensification, enabling food systems to operate within planetary boundaries. Conservation Agriculture does not require any inputs from farmed animals as the healthy soil and its components are self-sustaining without the need for animal grazing and manure. Biomass is incorporated directly into soils by soil biodiversity, particularly earthworms and further processed by soil bacteria and fungi. Conservation Agriculture also requires much reduced inputs of chemicals and fossil fuel than tillage-based agriculture and it is entirely possible to practice within organic farming systems. You can read more about our vision for a sustainable plant-based farming system here.

The transformation envisioned by the Commission will reshape how and what we eat. It implies a 33 percent reduction in ruminant meat production, alongside a 63 percent increase in the cultivation of fruits, vegetables, and nuts. This shift would create a food system that is less resource-intensive, less polluting, and better aligned with human health. Crucially, the authors stress that food must also be delicious, desirable, and culturally meaningful if such dietary changes are to be sustained.

Can the global population continue to eat fish?

Where I think health and planetary priorities digress are with the continued recommendations for fish consumption. This would require increased fish production by up to 46% globally, when current levels of production have been shown to be unsustainable and hugely unethical. I look forward to learning how the authors propose this will be achieved.

Country-based dietary guidelines are rapidly updating to reflect the Eat-Lancet recommendations. In 2025 I am aware of updated guidelines from Switzerland, Sweden, Belgium and the Netherlands, which also take environmental sustainability into consideration. Swiss guidelines recommend consuming meat, including poultry and processed meat, a maximum of twice to three times per week. Sweden has advised lowering red meat intake from a maximum of 500g to 350g per week, promoted the consumption of legumes, included plant-based dairy alternatives and acknowledged the benefits of plant-based meat alternatives. Belgium guidelines advise limiting unprocessed red meat to a maximum of 300g per week, dairy and fish recommendations are in line with the PHD, consumption of legumes, including tofu and tempeh, are promoted but plant-based milk and meat alternatives have not been included. The updated Dutch guidance relates to protein source, recommending eating more plant sources of protein and less animal-sourced foods. Specific recommendations include limiting red meat consumption to 200g per week and increasing legume consumption to 250g per week. The French National Agency for Health and Food have published, in 2025, a risk/benefit analysis of vegetarian and vegan diets. They reported a lower risk of a number of chronic conditions, including type 2 diabetes, ischaemic heart disease and certain cancers, whilst highlighting nutrients that require particular attention when consuming a meat-free or animal-free diet.

Plant-based meat alternatives are better for health than eating meat

The Eat-Lancet report acknowledges the potential role of plant-based meat alternatives (PBMA) in panel 11. Although the more newer, ultra-processed, meat mimics are not required in the diet, they may make it easier for people to move away from eating animals.

Most of the published studies on health suggest PBMAs, even if categorised as ultra-processed, are better for health when compared to their unprocessed, animal-based counterpart. Benefits are predominantly noted for cardiometabolic risk factors, such as body weight and LDL-cholesterol, without negative impacts on blood pressure despite the high sodium content (probably because people add salt to their meat too!).

Of course we would all recommend a minimally processed plant-based diet rather than relying on PBMA’s, but even if we did, studies show that these PBMAs have a favourable nutrient profile when compared to meat, including being a source of fibre, lower in saturated fat and if fortified, a source of nutrients such as vitamin B12 and iron. If we were to replace all meat consumption with PBMA’s (which no-one is!) protein intake would remain adequate for the majority of people. The Scientific Advisory Committee on Nutrition (SACN) in the UK did not find any adverse health impact of PBMAs in their statement on processed food and health.

In fact, researchers at PCRM have shown in a number of secondary analyses of their randomised studies that a fully plant-based or vegan diet, even if consuming processed plant-based foods, is more effective for weight loss than a healthy omnivorous or Mediterranean diet, including for people with type 1 diabetes.

Read our article on PBMAs.

What about plant-based dairy alternatives?

SACN in the UK have provided an assessment of plant-based drinks (i.e. dairy alternatives/plant milks), comparing the benefits and risks to health as a replacement for cow’s milk. Their findings are sensible albeit a little cautious, but includes the sensible statement that ‘Cows’ milk is not an essential component of young children’s diets (or the diets of other age groups). But if it is not part of their diet, other foods and drinks are needed to replace the nutrients that it provides.’

Plant-based drinks are also not required in the diet and perhaps should not be considered as an equivalent replacement for cow’s dairy as they differ in nutritional profile. However, plant-based drink or dairy alternatives can play a useful role, being a vehicle for nutrients for those consuming a fully plant-based or vegan diet.

Fortified soya milk is the closest to cows milk in terms of nutritional profile. So it is useful to remember that last year a large meta-analysis of randomised studies found that replacing cow’s milk with soya milk improves markers of cardiometabolic health, regardless of the sugar content.

No wonder the meat and diary industry is lobbying to ban meat-like terms such as burger, sausage and milk for plant-based alternatives. They seem to forget that terms such as peanut butter and coconut milk are already in widespread use!

If we know plant-based diets are good, how do we shift behaviour?

This is not only about individual change but system change, i.e a food environment that priorities and normalises plant-based meals as the default option. At the moment, animal-based meals are the default in most settings. The UK policy priorities on climate and health clearly state the need to shift food service in the public sector to reflect the recommendations of the EAT-Lancet commission - less or no meat and many many more plants.

The evidence suggests that the best strategy to shift dietary norms and uptake of plant-based meals is to provide plant-based meals as the default option (without restricting choice) and incentivising their update. Provision of information or labelling on its own does not work and initiatives that appear to strict choice can sometimes backfire.

This is why our approach at Plant-Based Health Professionals UK is to champion plant-based defaults in healthcare settings, both hospitals and at health-related events and conferences through our initiative Plants First Healthcare. Check out our ‘how-to-guide’ for medical institutions, in collaboration with the UK Health Alliance on Climate Change.

The worst media headlines of 2025

Vegan’s can’t build muscle, even though the study cited did not measure muscle growth or strength! This is despite more and more evidence showing that plant-based diet can adequately support muscle strength, being equivalent to meat-based diets. There is also no evidence to suggest a detriment to physical performance as evidenced by this randomised study in semi-professional soccer players. Plant-based diets can support muscle growth in older adults as shown in a randomised, controlled, cross-over study of 34 community-dwelling adults with a median age of 72 years. A vegan diet for 10 days did not compromise muscle protein synthesis compared to an omnivorous diet. Of note, the participants were physically active, achieving 12,460 +/-4512 steps/day.

Vegan children are skinnier and shorter. This was in fact true but what was excluded from the headlines was that the study in question found that the growth of vegan children was in fact considered normal and the lower body mass index is an advantage (in contrast to risk of being overweight!), with additional benefits found for cardiometabolic health given lower levels of LDL-cholesterol. The study was useful given its large size but did not reveal any new information. It reconfirms that a vegan diet can be nutritional adequate and support good health, whilst reminding us that certain nutrients such as iron, calcium, iodine, zinc, vitamins B12 and D need particular attention, through the use of fortified foods and supplements.

And finally, don’t forget that alcohol is a dietary component and a macronutrient. There is no safe limit of alcohol, no safe limit for cancer prevention, heart health or brain health.

Wishing you all a very happy new year and see you back in 2026!

Updated Lifestyle Medicine Core Competencies

The 2025 update to the Lifestyle Medicine Core Competencies marks an important step in the evolution of the field. It reflects a growing recognition that health is determined not only by individual behaviours, but also by social, environmental and structural factors that shape people’s daily lives. Building on the substantial 2022 revision, this latest update introduces one new competency and refines two others, bringing the total to 89 competencies guiding lifestyle medicine education, certification and practice worldwide.

The most notable addition is a new competency on applying lifestyle medicine within the context of the social determinants of health. Factors such as income, housing, education, access to healthy food and neighbourhood environment drive a large proportion of health outcomes, yet remain under-recognised in routine care. This new competency asks clinicians to integrate an understanding of these determinants into assessment, intervention and follow-up, pairing lifestyle prescriptions with culturally relevant strategies, community partnerships and support in navigating systems and resources. The direction of travel is clear: lifestyle medicine must be not only evidence-based but equity-focused, working to remove the structural barriers that prevent people from making healthy choices.

The planetary health competency has been strengthened to emphasise more clearly the bidirectional relationship between human health and the health of the planet. The update highlights mounting evidence that climate change, air pollution, biodiversity loss and environmental degradation are driving rising rates of chronic disease, respiratory and cardiovascular pathology, allergies and the health consequences of extreme weather. At the same time, it underlines that our food system, especially the high consumption of animal-based foods, is a major driver of greenhouse gas emissions, whereas predominantly plant-based dietary patterns support both human and planetary wellbeing. Planetary health is therefore positioned not as an optional extra, but as a core concern for preventive and therapeutic care.

The competency on food processing has also been updated to reflect rapidly expanding evidence linking ultra-processed foods to poor health outcomes. Rather than focusing solely on classification systems, clinicians are asked to understand how different types and degrees of processing affect physiology and disease risk. Ultra-processed foods are now strongly associated with obesity, metabolic disease, cardiovascular disease, kidney disease, adverse perinatal outcomes, mental health problems, systemic inflammation and higher all-cause mortality. At the same time, the revised competency acknowledges that not all processing is harmful; freezing fruit and vegetables or milling whole grains, for example, can preserve nutrients and improve access. This nuance is essential for patient-centred advice that goes beyond simplistic “processed versus unprocessed” messages. Relevant to this is a new review paper on ultra-processed plant foods such as meat and dairy alternatives. The review concludes that although whole plant foods are healthier, ultra-processed plant foods result in improved cardiometabolic outcomes when compared to unprocessed animal-based products. Therefore, plant-based meat and dairy alternatives provide useful options to support people to transition away from animal-sourced foods.

Overall, the 2025 update reflects an increasingly interconnected view of health: the social and economic conditions that shape choice, the planetary systems that sustain life and the industrial food environment that drives risk. For clinicians, it signals a shift towards a more holistic, justice-oriented and environmentally aware practice that places whole food plant-based nutrition, equitable access and supportive environments at the centre of chronic disease prevention and care.

2025 Lancet Countdown: Diet, Food Systems and Modifiable Risk Factors

The 2025 Lancet Countdown report makes it painfully clear that our food systems and dietary patterns are now among the most important modifiable drivers of both climate breakdown and premature mortality. Agricultural greenhouse gas emissions have risen by 36% since 2000, reaching their highest level to date, with red meat and dairy alone responsible for more than half of these emissions. Despite improvements in efficiency, growth in the production and consumption of animal-source foods has more than offset any gains. Per capita agricultural emissions in very high HDI (human development index) countries are now nearly three-quarters higher than in low HDI settings, illustrating the disproportionate contribution of affluent populations.

The health consequences of this food system are stark. Diet-related mortality increased to an estimated 11.8 million preventable deaths, including 1.9 million attributable specifically to excessive red meat and dairy intake. Diet-related deaths are rising fastest in high HDI countries, where high intakes of meat and refined grains remain dominant risk factors for non-communicable disease. The report underlines that diet is now one of the most powerful levers we have for improving global health, and that the window for action is narrowing.

Climate change is already undermining food security. Heatwaves and drought, now more frequent due to human-driven warming, were associated with an additional 123.7 million people experiencing moderate or severe food insecurity across 124 countries in 2023. Warming oceans, acidification and declining marine productivity threaten nutrition for communities dependent on fisheries, often those who have contributed least to the crisis. Almost one-third of the world’s population cannot afford a healthy diet, and hundreds of millions remain undernourished. Climate impacts are compounding existing inequities in food access, nutrition and health.

Dietary choices therefore represent a rare domain where individual, clinical and policy actions can deliver simultaneous benefits for people and planet. Yet the report stresses that the potential health co-benefits of adopting predominantly plant-based, low-carbon diets remain largely unrealised. Mortality linked to high-carbon diets continues to rise, reflecting political inaction, industry influence and the absence of coherent food and agricultural policy reform. The Countdown identifies a shift towards plant-rich diets, reduced red and processed meat, and resilient, sustainable food systems as essential to reducing mortality, closing health inequities, stabilising the climate and protecting future generations.

The report also links food systems to air pollution. Agricultural emissions, notably ammonia from intensive livestock production, contributed to almost one-fifth of all anthropogenic PM₂.₅-related deaths in 2022, driving cardiovascular and respiratory disease. Land degradation, deforestation and rising wildfire risk, much of it linked to the expansion of livestock and feed crops, intensify respiratory health threats and increase the risk of zoonotic spillover. Taken together, the findings show that high-income countries and wealthy populations remain disproportionately responsible for both food-system emissions and diet-related disease, while low-income populations bear the greatest burden of climate-amplified food insecurity and malnutrition.

The overarching message is that transforming our food system is no longer an optional add-on to climate policy; it is a central public health intervention. A shift towards predominantly or exclusively plant-based diets, embedded within broader policies that support sustainable agriculture and equitable access to healthy foods, is one of the most effective actions we can take to protect health and the climate simultaneously. The Eat Lancet commission, covered in my October review, provides us with the knowledge on how this can be achieved.

Physical Activity: Steps, Cancer Risk and Brain Health

A series of new studies provide further clarity on the health benefits of everyday movement, especially simple walking.

A comprehensive systematic review and meta-analysis of 57 prospective studies, including more than 160,000 adults with device-measured steps, has provided the clearest picture yet of how daily steps relate to long-term health. Risk reductions were seen across a range of outcomes, including cardiovascular disease, type 2 diabetes, cancer mortality, dementia, depression and all-cause mortality, as people moved from very low step counts upwards. The largest proportional gains occurred when individuals increased their steps from sedentary levels to around 7000 per day. At this level, the risk of early death fell by nearly half compared with 2000 steps, with substantial reductions in major cardiovascular events and cancer deaths. Although benefits continued to accrue at higher step counts, the curve flattened for several outcomes beyond 7000 steps. The authors conclude that around 7000 steps per day is a realistic and clinically meaningful target, particularly for those who find traditional “minutes of moderate-to-vigorous activity” targets off-putting. The message is simple: every additional step counts, and modest increases in walking can deliver substantial physical and mental health benefits.

A large US cohort analysis, following over 230,000 adults for more than three decades, examined how long-term adherence to physical activity recommendations affects the risk of digestive system cancers. Those who consistently met the recommended activity threshold, roughly 17 MET-hours per week, equivalent to about five hours of brisk walking, had substantially lower risks of both developing and dying from cancers of the bowel, pancreas, liver and gallbladder. Notably, doing far more than this, up to 40 MET-hours per week, did not further reduce risk, suggesting that long-term consistency matters more than high intensity or volume. This reinforces the importance of embedding manageable levels of movement into daily life rather than relying on intermittent bursts of exercise.

A third study, in individuals with biomarker evidence of preclinical Alzheimer’s disease, provides further insight into the neuroprotective effects of physical activity. Among participants with amyloid pathology but no cognitive symptoms, higher habitual activity was associated with slower accumulation of tau pathology and better preservation of brain network integrity in regions vulnerable to early Alzheimer’s changes. The levels of activity associated with these benefits were modest and comparable to those observed in the step-count meta-analysis - 5000-7500 steps per day. This reinforces a consistent theme: moderate, achievable increases in movement support both physical and cognitive health, even before disease is clinically apparent. For clinicians, it strengthens the case for framing physical activity as a core component of dementia prevention as well as cardiometabolic and cancer risk reduction.

Lifestyle Interventions and Cognitive Decline

A large network meta-analysis of 109 randomised controlled trials involving over 23,000 cognitively unimpaired older adults has clarified which lifestyle interventions most reliably preserve cognitive function. The authors compared a range of single-domain interventions, that is, physical exercise, dietary changes, cognitive training, social activity, with increasingly complex multidomain programmes combining several of these elements. Outcomes focused on global cognition, using tools such as the MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment).

Two approaches stood out consistently. Structured cognitive training alone and physical exercise alone each produced meaningful improvements in global cognition compared with health education, no intervention or active control conditions. When combined, cognitive training plus regular physical exercise produced the largest effect on cognitive outcomes. Multidomain programmes that added diet, social activity and health education did show benefits, but these were modest and did not exceed the gains from the simpler exercise-plus-cognitive-training combination. The analysis suggests that “more” is not always “better”; highly complex programmes may dilute adherence and intensity without delivering additional benefit.

Subgroup analyses suggested that cognitive training, alone or with exercise, was particularly effective in adults younger than 70 years, whereas multidomain interventions including health education appeared more beneficial in those aged 70 and older, albeit with wider confidence intervals due to smaller numbers. Interventions lasting longer than three months tended to produce more stable benefits, particularly when exercise and cognitive training were combined.

Although the effect sizes were generally small to moderate, they are clinically meaningful in a context where pharmacological options remain limited and pathological changes begin decades before symptoms. The findings are broadly consistent with landmark trials such as the FINGER trial, but refine the message: the most reproducible cognitive benefits come from targeted interventions that directly stimulate neuroplasticity and build cognitive reserve, namely physical activity and cognitive training.

Nutrient Adequacy and Environmental Footprint of Vegan vs Other Menus

A detailed modelling study comparing Mediterranean omnivorous, pesco-vegetarian, ovo-lacto-vegetarian and vegan menus under strictly isocaloric conditions provides robust evidence that a well-planned vegan diet is both nutritionally adequate and environmentally superior. The authors constructed seven-day menus for each pattern, all providing 2000 kcal per day and consistent with national dietary guidelines, allowing a like-for-like assessment of nutrient density and environmental impact.

Across all four dietary patterns, protein requirements were fully met, including in the vegan menu, dispelling the persistent myth that plant-based diets are inherently protein deficient. The vegan pattern delivered the highest fibre intake, the lowest saturated fat and the lowest dietary cholesterol. It also provided the greatest coverage of several key micronutrients, including folate, vitamin C, vitamin E, magnesium, potassium and iron, reflecting the nutrient richness of whole plant foods.

Nutrient shortfalls in the vegan menu were limited to a small, predictable set. Vitamin B12 intake was very low in the absence of fortified foods or supplements, reaffirming standard guidance that supplementation or regular consumption of B12-fortified foods is essential for vegans. Vitamin D intake was inadequate across all four dietary patterns, a reminder that diet alone is rarely sufficient to meet vitamin D needs in the UK and many other countries. Iodine intake fell short of recommendations in all diets except the pescatarian pattern, though iodised salt, commonly used in real-world settings, was not included and would likely correct much of this deficit. Long-chain omega-3 fatty acids (EPA and DHA) were below recommended levels in the vegan and vegetarian menus, though alpha-linolenic acid (ALA) intake was high. The authors therefore suggest considering algal DHA supplementation for those not consuming fish, a simple step that preserves the benefits of a fully plant-based diet.

Overall micronutrient adequacy was excellent in all four models, with the vegan pattern performing particularly well aside from the small group of nutrients that are already routinely flagged for attention in plant-based practice: vitamin B₁₂, vitamin D, iodine and long-chain omega-3 fats. When those are addressed through fortified foods or supplements, the vegan diet emerges as nutritionally complete.

The environmental analysis was equally striking. Greenhouse gas emissions decreased progressively as animal products were reduced, reaching their lowest levels in the vegan menus, which cut emissions by nearly half compared with the Mediterranean omnivorous diet. Measures of land use and ecosystem impact showed the same pattern. Even a healthful omnivorous diet emphasising fruit, vegetables and whole grains carried a substantially higher environmental burden than the vegan dietary pattern. The conclusion is clear: a well-planned vegan diet can deliver high nutritional adequacy without compromising health, while simultaneously offering the greatest benefits for planetary health.

From Hamburgers to Holidays: The Impact of Reduced Meat Intake

A UK-focused modelling study from Imperial College London complements these findings by showing how powerful even modest reductions in meat intake can be when scaled across populations. Using global food system emissions data combined with UK consumer survey responses, the authors estimated that reducing meat consumption to three portions per week, especially by limiting ruminant meat, could almost halve production-related greenhouse gas emissions from food in high- and middle-income settings.

Crucially, the study frames changes in terms that feel concrete and achievable for the public. For an individual consumer, the emissions saved by cutting down to three weekly meat servings (92 kcal per day) were equivalent to avoiding six short-haul return flights per year. While the study did not model fully vegan diets, it reinforces a consistent message that shifts towards plant-rich, and ideally fully plant-based, eating patterns deliver large and rapid climate benefits, whilst preserving nutritional adequacy. They also align with public preferences for simple, meaningful climate actions, offering people something positive and practical they can do every day.

Nudging Meat Off the Plate: Real-World Behaviour Change

A large systematic review and meta-analysis of real-world “nudge” interventions in food-service settings offers practical insight into how institutions can help people choose more plant-based meals. Drawing on 33 field experiments and 78 effect sizes, the analysis found that not all nudges are equal. The most effective strategies were those that changed the choice architecture itself rather than simply providing more information.

In particular, making vegetarian or vegan dishes the default option, while still allowing people to choose meat if they wished, reduced meat selection by an average of 54%. This represents one of the strongest behaviour-change effects documented in nutrition research. By contrast, simpler informational approaches such as labels, health messages or environmental signage had little measurable impact and, in about a third of poorly designed interventions, even backfired.

For hospitals, schools, workplaces and other large caterers, these findings are highly relevant. When plant-based options are made the easy, convenient and attractive default, people tend to choose them without feeling coerced. Coupled with evidence that well-planned vegan and planetary health diets are nutritionally adequate and environmentally beneficial, this behavioural science offers a powerful lever for institutions to reduce emissions and improve public health at scale. This reinforces the evidence supporting our own approach in the UK through our Plants First Healthcare initiative.

Nutritional Adequacy of the EAT-Lancet Planetary Health Diet: UK Evidence

Debate around the EAT-Lancet Planetary Health Diet (PHD) has often centred on a perceived risk of nutritional inadequacy, particularly when animal-source foods are reduced. A new analysis from the MRC Epidemiology Unit in Cambridge provides robust, UK-specific evidence to address these concerns.

Using 11 years of data from the nationally representative UK National Diet and Nutrition Survey, the researchers analysed detailed 4-day food diaries from nearly 10,000 individuals aged 15 and over, alongside biomarker data from over 4,600 participants. They assessed alignment with the PHD using a 14-component score and examined both nutrient intakes and objective nutritional status.

Higher adherence to the PHD was consistently associated with better, not worse, nutritional adequacy for most vitamins and minerals. Individuals with higher PHD scores were more likely to meet reference intakes for folate, vitamin C, magnesium, potassium, fibre, iron and many other nutrients. Importantly, there was no evidence that closer adherence increased the risk of inadequacy for any nutrient.

The study paid particular attention to nutrients often cited as problematic in more plant-based patterns, such as iron, zinc, calcium, vitamin D and vitamin B12. In the general diet, iron adequacy was low among women of reproductive age and adolescents. However, within these groups, those whose diets were more closely aligned with the PHD were more likely to achieve adequate iron intake. Ferritin levels did not differ by PHD alignment, suggesting no adverse effect on iron stores. Zinc and calcium adequacy likewise improved with higher PHD scores, supporting the capacity of plant-rich diets, built on whole grains, legumes, nuts, seeds, fruits and vegetables, to cover these key minerals.

Vitamin D intake was inadequate across the board, both in the average UK diet and in diets more consistent with the PHD, which is unsurprising given limited food sources and UK latitude. This reinforces existing guidance that supplementation is generally required at the population level, regardless of dietary pattern. Vitamin B12 intake did not rise with greater PHD adherence, as expected, but there were no differences in B₁₂ status measured by serum B₁₂ or holotranscobalamin. This likely reflects the use of fortified foods and supplements among those with the highest PHD scores, and underscores the point that B12 is a nutrient requiring explicit attention in plant-based diets, but one that is easily and safely managed.

A direct comparison with a Mediterranean diet score showed similar improvements in nutritional adequacy for iron, zinc, calcium and vitamin D with higher adherence to either dietary pattern. This places the PHD on equal footing with the Mediterranean diet in terms of nutrient adequacy, while offering greater potential environmental benefits.

The key message is reassuring: for the UK population, greater adherence to the Planetary Health Diet does not compromise nutritional adequacy. On the contrary, it is associated with better intake and status for many nutrients of concern. For policymakers, clinicians and the public, this study strengthens the case that shifting towards sustainable dietary patterns is entirely compatible with, and indeed supportive of, nutrition security.

Coffee and Arrhythmias: The DECAF Trial

A small but highly practical update on a question many patients ask: does coffee worsen atrial fibrillation? The DECAF randomised clinical trial provides reassuring evidence that, for most people living with atrial fibrillation, moderate coffee consumption is not harmful and may even be beneficial.

In this six-month study of 200 regular coffee drinkers undergoing cardioversion for persistent atrial fibrillation, participants were randomised either to continue drinking at least one cup of caffeinated coffee per day or to abstain completely. Recurrence of atrial fibrillation or flutter occurred in 47% of those continuing coffee, compared with 64% in the abstinence group, corresponding to a 39% lower hazard of recurrence in the coffee arm. There was no signal of increased adverse events.

These findings challenge the long-standing dogma of advising patients with atrial fibrillation to avoid caffeine altogether and are consistent with observational studies suggesting neutral or even protective associations between coffee and cardiovascular outcomes. For individuals who enjoy coffee, this trial offers welcome reassurance within the context of a healthy lifestyle. Moderate caffeinated coffee intake appears safe and may confer a small additional benefit for rhythm stability.

See you back in December !

The Big Picture: What’s Driving Ill-Health — And What We Can Change (GBD 2023)

This updated analysis from the Global Burden of Disease (GBD) synthesises an enormous evidence base of 375 diseases and injuries and 88 modifiable risk factors across 204 countries using updated methods and >35,000 new data sources. Nearly half of all health loss in 2023 (about 46% of total disability adjusted life years - DALYS) was attributable to modifiable risks, reaffirming prevention as our biggest lever for improving healthy life expectancy. The leading causes of death were cardiovascular diseases, respiratory conditions, Alzheimer’s disease, diabetes and cancer. The top risk factors globally were high systolic blood pressure, particulate matter air pollution, smoking, high fasting plasma glucose, and low birthweight/short gestation. High blood pressure alone accounted for an estimated 8.4% of total DALYs. While communicable, maternal, neonatal and nutritional conditions continue to decline, the burden from non-communicable diseases has risen, driven by ageing populations and increasing metabolic risks.

Crucially for clinical practice, the analysis shows divergent trends: age-standardised burdens attributable to many behavioural and environmental risks are falling, but metabolic risks are not. From 2010 to 2023, ill health attributable to high body mass index (BMI) rose by ~10%, and those due to high fasting plasma glucose increased slightly, in contrast to substantial declines for risks like smoking and unsafe water/sanitation.

Dietary risks remain a major, modifiable driver of premature death and disability worldwide. The risk cluster includes low intakes of fruits, vegetables, legumes, whole grains, and nuts and seeds; high sodium; high intakes of red and processed meat and sugar-sweetened beverages; and industrial trans fats. Many diet–disease pathways are mediated through metabolic factors such as blood pressure, blood lipids and glucose. Methodologically, GBD 2023 tightened mediation modelling and, notably, revised the theoretical minimum risk exposure level for trans fatty acids, reflecting the consensus that even very low exposures carry harm. It’s worth noting that meat and dairy are a source of trans fatty acids.

Geography matters. Particulate matter pollution dominates in South Asia and parts of sub-Saharan Africa; smoking remains a leading risk in Western Europe and high-income Asia Pacific; and high BMI or high fasting glucose top the list in several regions of the Americas and Australasia. For clinicians and policymakers, this argues for integrated strategies: clean air and tobacco control plus aggressive management of blood pressure and glucose and a focus on improving diet quality at a population scale.

You can read the summary of the report here and search for country profiles here.

The EAT–Lancet Commission 2025: Health, Sustainability, and Justice

The updated EAT–Lancet Commission on Healthy, Sustainable, and Just Food Systems, published in 2025, marks a significant evolution in our understanding of how food connects health, the environment, and social justice. Since the first report in 2019, the world has faced multiple converging crises including, geopolitical instability, the COVID-19 pandemic, escalating climate impacts, and deepening inequalities. Yet despite these challenges, the message is more urgent and unequivocal than ever: our global food system remains the single largest driver of environmental degradation and a fundamental determinant of human health and wellbeing.

At the heart of this new analysis lies the Planetary Health Diet (PHD), a pattern of eating that is predominantly plant-based, rich in whole grains, fruits, vegetables, legumes, nuts, and seeds, and complemented by modest amounts of animal-sourced foods. The PHD obtains 87.7% of energy from plant-based foods and meat, dairy and eggs are not considered essential. Thus, a 100% plant-based or vegan diet is compatible with the PHD.

The evidence supporting this way of eating has only strengthened over the past six years. Adopting a largely plant-based diet could prevent up to 15 million (27%) premature deaths annually, while substantially reducing the risk of cardiovascular disease, type 2 diabetes, cancer, dementia, and unhealthy ageing. The diet remains flexible and culturally adaptable, providing a framework within which regional food traditions can thrive. It supports adequate nutrition at all stages of life, including pregnancy and childhood (age 2 and above), with careful attention to key nutrients such as vitamin B12, iron, calcium, and iodine.

Perhaps the most profound shift in this Commission is the explicit integration of justice alongside health and sustainability. The 2025 report recognises that our food systems are not only environmentally unsustainable but also socially inequitable. Nearly half of the world’s population lives below the social foundations required to meet basic human rights such as access to food, clean environments, and decent work. Meanwhile, the diets of the wealthiest 30 percent of people are responsible for more than 70 percent of the environmental impact of global food production. The Commission calls for a transformation that is both nutritious and fair, ensuring that the benefits and burdens of food systems are shared equitably and that those most affected by injustice, smallholder farmers, women, and marginalised communities, have a voice in shaping the solutions.

Scientifically, the updated Commission represents a step change. For the first time, researchers have quantified food’s contribution to all nine planetary boundaries, those thresholds that define the safe operating space for humanity. The findings are sobering: food systems are the dominant cause of transgressing five of these boundaries, including land use, biodiversity loss, greenhouse gas emissions, freshwater depletion, and nitrogen and phosphorus pollution. Even with ambitious interventions, healthier diets, more efficient agriculture, and a 50% reduction in food waste, the world only just manages to return to safe limits for climate and freshwater use. The report also highlights the need for sustainable and ecological intensification, farming practices that restore soil health, enhance biodiversity, sequester carbon, and reduce dependence on synthetic fertilisers and pesticides.

I am delighted to see that Conservation Agriculture, pioneered by my father Dr Amir Kassam, is endorsed (panel 5) as the sustainable, ecological and just solution to food production intensification, enabling food systems to operate within planetary boundaries. Conservation Agriculture does not require any inputs from farmed animals as the healthy soil and its components are self-sustaining without the need for animal grazing and manure. Biomass is incorporated directly into soils by soil biodiversity, particularly earthworms and further processed by soil bacteria and fungi. Conservation Agriculture also requires much reduced inputs of chemicals and fossil fuel than tillage-based agriculture and it is entirely possible to practice within organic farming systems. You can read more about our vision for a sustainable plant-based farming system here.

The transformation envisioned by the Commission will reshape how and what we eat. It implies a 33 percent reduction in ruminant meat production, alongside a 63 percent increase in the cultivation of fruits, vegetables, and nuts. This shift would create a food system that is less resource-intensive, less polluting, and better aligned with human health. Crucially, the authors stress that food must also be delicious, desirable, and culturally meaningful if such dietary changes are to be sustained.

Where I think health and planetary priorities digress are with the continued recommendations for fish consumption. This would require increased fish production by up to 46% globally, when current levels of production have been shown to be unsustainable and hugely unethical. I look forward to learning how the authors propose this will be achieved.

Overall, this report strengthens the scientific and ethical case for plant-forward, minimally processed diets as the cornerstone of human and planetary health. It reminds us that our plates are powerful tools, not only for preventing disease and mitigating climate change but also for advancing equity and compassion in a world that urgently needs both.

Plant-Based Meat and Dairy Alternatives: Modelled Impacts on Health and Nutrient Adequacy

This new study published in the American Journal of Clinical Nutrition offers an important complement to the EAT–Lancet Commission by examining how the replacement of meat and dairy with plant-based substitutes affects health and nutrient adequacy in practice. Using national dietary data from over 2,000 French adults, the researchers simulated diets in which all meat, milk, and dairy desserts were replaced with plant-based alternatives. They then modelled the impacts on nutrient deficiency and chronic disease–related mortality.

The results are reassuring. On average, replacing animal products with plant-based substitutes did not increase the overall risk of nutrient deficiency. While the likelihood of vitamin B12 and riboflavin deficiency rose slightly (unsurprising given their predominance in animal foods) this was offset by improved intakes of fibre, unsaturated fats, and folate. The benefits were most pronounced when meat was replaced, leading to marked reductions in premature deaths from cardiovascular disease, type 2 diabetes, and cancer. These gains were mainly attributed to the sharp fall in red and processed meat consumption and improvements in the quality of dietary fats. However, the high sodium content of some meat substitutes modestly reduced these advantages, highlighting the importance of product formulation.

Across all substitution scenarios, the models projected that between 3,700 and 6,700 premature deaths from chronic diseases could be averted each year in France, depending on the nutritional quality of the substitutes. The most nutritionally robust plant-based products, those fortified with key vitamins and minerals and lower in sodium, offered the greatest benefit.

The study also reinforces that not all plant-based substitutes are equal. Their health impacts vary substantially depending on how they are formulated. Poor-quality substitutes, often more energy-dense and highly processed, increased the proportion of ultra-processed foods in the diet, whereas higher-quality products kept this rise minimal. Fortification, particularly with vitamin B12 and calcium, made a measurable difference to nutrient adequacy.

This research therefore provides critical nuance to the EAT–Lancet Commission’s broader message. While the Commission rightly centres plant-based diets in its vision for planetary and human health, it pays limited attention to the rapidly growing market of meat and dairy alternatives that are now helping consumers make the transition away from animal products. This study demonstrates that, when well designed and appropriately fortified, such products can facilitate healthier diets and significantly reduce chronic disease burden without compromising nutrient adequacy.

The findings also underscore the responsibility of industry and policymakers to ensure that plant-based alternatives support, rather than undermine, public health goals. Reformulation to lower sodium, mandatory fortification standards, and clear front-of-pack labelling could help consumers choose products that align with both health and sustainability.

In summary, this study provides robust evidence that replacing animal products with high-quality plant-based alternatives is a safe and effective strategy for improving population health and reducing premature mortality. It highlights the potential of innovation in the plant-based food sector to accelerate dietary change, if guided by nutritional science and supported by effective policy.

The MyPlanetDiet Randomised Controlled Trial: Sustainable Diets and Micronutrient Adequacy

Following the encouraging evidence on the potential of plant-based meat and dairy alternatives to improve health outcomes, the MyPlanetDiet randomized controlled trial provides a much-needed real-world test of whether sustainable dietary patterns can also meet micronutrient requirements.

This 12-week trial, conducted in Ireland and Northern Ireland, enrolled over 350 healthy adults and compared two diets: one based on conventional healthy eating guidelines and another explicitly designed around environmental sustainability principles. The sustainable diet emphasised fruits, vegetables, legumes, nuts, and wholegrains, while reducing red and processed meat and limiting dairy and fish to modest amounts.

As expected, the sustainable diet significantly lowered dietary greenhouse gas emissions, by almost one-third, demonstrating that personal dietary change can meaningfully reduce environmental impact. However, the study’s findings also highlight important nutritional considerations that must accompany such transitions.

Participants following the sustainable diet experienced measurable reductions in the intake of several key micronutrients, including vitamin B12, riboflavin, calcium, iodine, and zinc. The prevalence of inadequate intakes rose most notably for vitamin B12, calcium, and zinc, even though participants were still consuming some animal foods.

Interestingly, despite these lower intakes, blood biomarkers of nutrient status remained largely unchanged over the 12-week period. This likely reflects both the short study duration and the body’s ability to draw on existing nutrient stores. Yet the results underscore the need for careful planning, fortification, and monitoring as populations move toward more plant-forward eating patterns.

The control group, who followed national healthy eating guidelines, also reduced their dietary emissions, by around 14 percent, but without any loss of nutrient adequacy. This finding is encouraging: even modest shifts toward healthier food choices can have measurable benefits for planetary health.

The trial exposes a familiar but resolvable tension: diets that are good for the planet can fall short in certain micronutrients unless we pay deliberate attention to sources of vitamin B12, iodine, calcium, and zinc. The inclusion of fortified plant-based milks, nutritional yeast, or supplements where appropriate can close these gaps without reverting to resource-intensive animal agriculture.

Taken together with the earlier study on plant-based substitutes, the MyPlanetDiet results suggest that the success of sustainable diets will depend not only on reducing meat and dairy but also on ensuring nutritionally adequate, accessible, and appealing plant-based alternatives. High-quality, fortified products and public-health strategies that promote nutrient literacy are essential if sustainable eating is to benefit both people and the planet..

The Global Burden of Cancer: A Growing but Preventable Crisis

The Global Burden of Disease 2023 Cancer Study offers the most comprehensive assessment to date of the worldwide cancer landscape. In 2023 there were an estimated 18.5 million new cancer cases and 10.4 million deaths, making cancer the second leading cause of death globally after cardiovascular disease. The burden continues to rise, with forecasts predicting 30 million new cases and nearly 19 million deaths annually by 2050, a 75% increase driven largely by ageing populations and population growth.

Yet within these numbers lies an urgent message of opportunity. More than 40 percent of all cancer deaths in 2023 were attributable to modifiable risk factors, meaning that millions of cases are preventable. The most significant drivers remain tobacco use, unhealthy diets, alcohol consumption, obesity, physical inactivity, and air pollution. Dietary risks alone contribute to a substantial fraction of global cancer deaths, particularly those from colorectal, breast, prostate, lung, oesophageal, and stomach cancers.

The study highlights the inequity of cancer’s toll. Nearly two-thirds of new cases and deaths now occur in low- and middle-income countries, where prevention, early detection, and treatment services remain under-resourced. Without decisive action, these regions will bear the brunt of the projected increase.

Encouragingly, age-standardised mortality rates have declined modestly over the past three decades, reflecting progress in tobacco control, screening, and treatment. But the decline is far too slow to meet the UN Sustainable Development Goal of reducing premature non-communicable disease mortality by one-third by 2030.

The evidence is clear: cancer is not inevitable. Tackling its modifiable causes through population-level policies, reducing tobacco and alcohol use, promoting whole-food plant-based diets, increasing physical activity, and addressing environmental pollutants, could save millions of lives each year. The study calls for a shift from treatment-dominated strategies to prevention-centred, equitable cancer control, supported by universal health coverage and stronger public-health infrastructure.

Food as Medicine in Gastrointestinal Cancer Therapy

A companion Nature Reviews Gastroenterology & Hepatology commentary deepens this message by exploring how nutrition can be used therapeutically in the prevention and management of gastrointestinal cancers.

Rates of colorectal and liver cancer are rising sharply, especially among younger adults, with clear links to diet and lifestyle. High intakes of red and processed meat, alcohol, and energy-dense, pro-inflammatory foods increase risk, while diets rich in wholegrains, fibre, legumes, fruit, and vegetables are consistently protective.

Beyond prevention, diet also influences treatment response, recurrence, and survival. In people with colorectal cancer, a higher adherence to a healthy plant-based diet ( as defined by the plant-based diet index) was associated with significantly longer survival and lower recurrence, even in metastatic disease. Conversely, diets that promote insulin resistance, high in refined carbohydrates and saturated fats, are linked to higher cancer-specific mortality.

Emerging research is revealing biological mechanisms behind these effects. Red meat intake can induce mutational signatures in colorectal tumours, contributing to DNA damage and worse outcomes. In contrast, fibre-rich plant foods lower insulin and IGF-1 levels, reduce inflammation, and foster a more diverse gut microbiome. The metabolites produced by these healthier microbiota, notably short-chain fatty acids, appear to enhance immune function and suppress tumour progression.

Early intervention trials are beginning to confirm that personalised nutrition can improve outcomes. Randomised studies in colorectal cancer survivors show that targeted dietary counselling enhances nutritional status, physical functioning, quality of life, and even survival. The field now calls for larger, integrated studies that combine clinical outcomes with biomarker, microbiome, and metabolomic data to guide precision nutrition in oncology.

Health Inequalities and Social Prescribing: Framing and Findings

A new government analysis, Health Trends and Variation in England (September 2025), starkly documents widening inequalities in life expectancy and, more importantly, healthy life expectancy, with stratification by geography, deprivation, ethnicity and gender. These gaps are not inevitable; they reflect the social and environmental conditions in which people are born, live, work and age. Reversing them requires a shift from reactive, biomedical care to proactive, preventive, and socially informed practice.

One of the most promising ways to address the social and lifestyle determinants of health within clinical settings is through social prescribing, connecting patients to community-based activities and support that nurture wellbeing beyond what medical care alone can achieve. This landmark Lancet Public Health study provides the first national analysis of England’s social prescribing scheme since its formal integration into NHS primary care in 2019.

Social prescribing encompasses a diverse range of non-clinical services designed to meet social, emotional, and practical needs. These include exercise and walking groups, volunteering opportunities, arts and cultural programmes, gardening projects, befriending services, mental health and counselling support, skills training, employment and housing advice, and financial guidance. In England, the predominant model is the GP–link worker system, in which a patient referred by their GP is supported by a trained link worker who co-designs a personalised care plan and connects them to relevant community resources.

Using data from more than 1.2 million patients across 1,736 GP practices, the study tracked how this system has developed over time. The findings reveal remarkable growth: between 2019 and 2023, there were over 9.4 million GP consultations involving social prescribing, with 5.5 million resulting in formal referrals, far exceeding the NHS Long Term Plan target of 900,000 referrals by 2023–24. In 2023 alone, 1.3 million people were referred to social prescribing link workers, confirming that this approach is now embedded in the fabric of primary care.

Equity of access has also improved. The proportion of patients referred from the most deprived communities nearly doubled, from 23% in 2017 to 42% in 2023, demonstrating progress in reaching those most affected by social and health inequalities. Participation among ethnic minority patients rose to around 22%, surpassing their representation in the wider population. These data counter early concerns that social prescribing might benefit mainly the more advantaged; instead, it appears to be strengthening inclusion.

Encouragingly, service refusal rates fell sharply, from 22% in 2019 to just 11% in 2023. Women and people from minority ethnic backgrounds were more likely to accept referrals, while younger adults increasingly engaged in social prescribing activities. Together, these findings reflect a growing trust in the model and a recognition among patients and clinicians that health is shaped as much by connection, purpose, and community as by medicine.

Beyond patient wellbeing, social prescribing also offers systemic benefits. Around one in five GP consultations involves social or emotional needs that do not require medical treatment. By linking people to community support, social prescribing helps reduce the strain on primary care, while promoting physical activity, mental health, and social cohesion.

In summary, this nationwide analysis presents social prescribing as a major public health success. It demonstrates that when health systems move beyond a purely biomedical model, by investing in the social foundations of health, they can deliver care that is preventive and equitable.

Prediabetes Remission Without Weight Loss: Rethinking the Target

This analysis in Nature Medicine turns a familiar narrative on its head: people with pre-diabetes can return to normal glucose regulation without losing weight, and they are then far less likely to develop type 2 diabetes. Drawing on the German PLIS (Prediabetes Lifestyle Intervention Study) trial with up to 10 years’ follow-up and replicated in the U.S. Diabetes Prevention Program, the study shows that remission in the absence of weight loss cut future diabetes risk by roughly 70%, a protection comparable to weight-loss–driven remission.

What changes, if not the number on the scales? The answer is fat distribution and metabolic health. Among participants who did not lose weight, those who achieved remission avoided the usual increase in visceral adipose tissue (the metabolically hazardous fat around abdominal organs) and instead stored any additional fat in subcutaneous depots. Their subcutaneous-to-visceral fat ratio rose, and this shift was associated with better insulin sensitivity, improved β-cell function, stronger GLP-1–mediated insulin responses, and greater suppression of glucagon after glucose, an ensemble of changes that normalised glycaemia despite stable or even higher body weight. Circulating adiponectin, a hormone linked to insulin sensitivity, was higher after the intervention in those who with remission, consistent with the healthier fat distribution.

Diet quality appears central to this redistribution story. In PLIS, the lifestyle targets were classic quality metrics, fat less than 30% of energy, saturated fat less than 10%, and fibre greater than 15 g per 1,000 kcal, rather than a prescribed weight-loss quota. The authors point to convergent evidence that dietary quality dictates where fat is stored. Diets higher in polyunsaturated fats and lower in saturated fats are less likely to promote visceral fat gain, even during periods of weight stability or weight gain. Higher fibre intake improves insulin sensitivity, dampens post-meal glycaemic excursions, and supports a gut microbiome favourable to metabolic health.

In practical terms, this means prioritising whole plant foods, legumes, whole grains, vegetables, fruit, nuts and seeds, and replacing sources of saturated fat with foods naturally higher in unsaturated fats, while keeping highly refined carbohydrates to a minimum.

These results remind me of one of the original diabetes remission studies, in which participants were asked to consume a high fibre, high carbohydrate diet without losing weight. This led to a number of patients reducing or eliminating the need for medications, emphasising that diet quality matters most.

Alcohol Use and Brain Health: No Safe Limit

This multi-cohort analysis is one of the largest and most rigorous examinations of alcohol and brain health to date, combining prospective data from more than half a million adults in the UK Biobank and US Million Veteran Program with genetic (Mendelian randomisation) evidence drawn from approximately 2.4 million participants across 45 cohorts. The authors integrate traditional observational associations with both linear and non-linear genetic analyses to ask a simple but important question: is there any level of alcohol intake that is safe for the brain?

In conventional cohort analyses, the familiar U-shaped curve appears, higher dementia risk in non-drinkers and heavy drinkers, with the lowest risk among light drinkers. However, when drinking patterns over time are assessed, the researchers find that people who go on to develop dementia tend to reduce their alcohol intake in the years before diagnosis. This reverse causation helps explain the illusion of benefit in light or moderate drinkers.

The genetic analyses cut through this bias. Using Mendelian randomisation, which approximates lifelong exposure and eliminates issues relating to confounding, the study shows a dose-related increase in dementia risk as alcohol consumption rises, with no evidence of a protective effect at any level.

The policy implications are clear. Reducing or eliminating alcohol use could lower population dementia incidence. The authors state ‘Halving the population prevalence of alcohol use disorder may reduce dementia cases by up to 16%’. For clinicians and the public, the message is straightforward. If people choose to drink, less is safer, and for brain health there is no threshold below which alcohol can be considered risk-free.

Read more about the impact of alcohol on health outcomes in my article here.

Plant-Based Diet Quality and Dementia Risk in Cardiometabolic Disease

This new UK Biobank analysis strengthens the case that diet quality, specifically a healthy plant-based diet pattern, is a powerful lever for dementia prevention, even among people already living with cardiometabolic disease. In more than 71,000 adults aged 55 years and older, baseline heart disease, stroke or type 2 diabetes nearly doubled subsequent dementia risk. Yet that excess risk was markedly modified by what people ate. Those with cardiometabolic disease who most closely adhered to a healthful plant-based diet (higher intake of whole grains, vegetables, legumes, fruit, nuts and minimal refined or ultra-processed foods) had a 61% lower risk of dementia. Conversely, an unhealthful plant-based diet, more refined grains, sugary drinks, sweets and ultra-processed plant foods, was associated with over a threefold higher risk among those with cardiometabolic disease. These associations persisted after adjusting for age, sex, education, deprivation, BMI, smoking, physical activity, alcohol, hypertension and APOE4 status. Mediation analyses suggested that better glycaemic control (lower HbA1c) may be one pathway by which a healthful plant-based diet supports brain health.

Lifestyle beyond diet still matters, but the impact of diet was dominant. Among people with cardiometabolic disease who were not following a healthful plant-based pattern, being physically active, avoiding smoking and not drinking attenuated risk. However, in those already eating a high-quality plant-based diet, adding these behaviours produced only a small, non-significant further reduction, underscoring diet quality as a central pillar of risk modification in this high-risk group.

Conclusions

Taken together, these studies move us beyond abstract ideals and toward actionable evidence. Diet and lifestyle approaches not only support disease prevention but can improve treatment outcomes, address health inequalities and support planetary health. A whole food plant-based diet is an essential part of a healthy, sustainable and just lifestyle. For policy-makers, putting this into action requires making the healthiest choice the easiest and most affordable one, particularly for those currently furthest from good health.

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See you back in November!

Plant-Based Diets and Diabetes

We have known for a while that high quality plant-based diets, including vegetarian and vegan, are associated with a lower risk of developing type 2 diabetes. This is in part, although not entirely, due to the fact the plant-based diets are associated with a healthier body weight. This new analysis from the UK-based EPIC-Norfolk prospective cohort assessed the impact of the Planetary Health Diet (>85% of energy is derived from plant-based foods) on the incidence of type 2 diabetes. With 23,722 participants and a median follow-up of 19.4 years, the results confirmed that people who are most adherent to this plant-based and sustainable way of eating had a 32% reduced risk of developing type 2 diabetes. This was after adjusting for confounders such as energy intake and adiposity.

A new analysis from the UK Biobank followed nearly 5,000 people with established type 2 diabetes for more than 11 years to see how adherence to different types of plant-based dietary patterns affected survival. The researchers found that people with the highest adherence to an overall plant-based diet had a significantly lower risk of death compared with those with the lowest adherence. The benefit was clearest when the diet emphasised whole plant foods such as vegetables, fruits, legumes, whole grains, and nuts. In contrast, people whose plant-based diets were dominated by refined grains, sugary drinks, and desserts actually faced a higher risk of mortality.

The protective association was particularly marked among those with more advanced or poorly controlled diabetes i.e people with higher HbA1c levels, larger waist circumferences, younger age at diagnosis, or longer disease duration. This suggests that a shift towards a healthy plant-based diet may be most impactful in higher-risk groups. Interestingly, the findings were stronger than those reported in studies of the general population, probably reflecting the greater potential for dietary change to offset the elevated risk carried by people with diabetes.

The study adds weight to existing evidence that quality matters: not all plant-based diets confer benefit. Diets rich in whole, minimally processed plants appear to extend survival, while unhealthy versions have the opposite effect. Most national and international guidelines recommend fibre-rich, plant-predominant diets for prevention, management and remission of type 2 diabetes, alongside other healthy lifestyle habits, including the American College of Lifestyle Medicine

Plant-Based Diets and Multimorbidity

This large prospective analysis pooled 407,618 adults from the EPIC (European Prospective Investigation into Cancer and Nutrition) and UK Biobank studies to test whether the quality of plant-based eating influences the path from being disease-free to developing two or more of cancer, cardiovascular disease (CVD), and type 2 diabetes. Diet quality was scored with a healthful plant-based diet index favouring whole grains, legumes, fruit, vegetables and nuts, and an unhealthful index emphasising refined grains, sweets and sugary drinks. Over roughly 11 years, 6,604 people developed multimorbidity (2 or more chronic diseases in the same person). Each 10-point higher healthful score was linked to a lower risk of becoming multimorbid - 11% reduction in EPIC and 19% reduction in UK Biobank - and this protective association also showed up consistently for first events of cancer, CVD and type 2 diabetes. By contrast, higher unhealthful scores tracked with more multimorbidity in UK Biobank (22% increase per 10 points) but were null in the EPIC study, although unhealthful scores were generally associated with higher risks of first cancer and CVD in both cohorts.

Age modified the benefits modestly: the healthful pattern was protective in both groups but a bit stronger under age 60 in UK Biobank with a similar though weaker pattern in EPIC. Adjusting for BMI barely changed the results, suggesting effects beyond weight alone. The authors conclude that diets centred on minimally processed plant foods, with small amounts of animal foods, may help prevent the accumulation of major chronic conditions into older age, while “plant-based” patterns built on refined, sugary foods may not.

This is now one of many studies that have associated plant-based eating patterns with healthy ageing and with plant sources of protein being one of the key elements.

Diet and Prostate Cancer

We have know for a while that diet and lifestyle approaches are beneficial for preventing and managing prostate cancer. Dr Dean Ornish was one of the first to demonstrate the ability to slow the progression of early stages of prostate cancer by using his plant-based lifestyle intervention.

This new comprehensive systematic review brings together evidence from 49 prospective cohort studies and 14 randomised trials to evaluate how whole dietary patterns influence prostate cancer risk, progression, and mortality. For men without prostate cancer, healthier patterns, whether described as plant-based, Mediterranean, or aligned with indices like the Healthy Eating Index or World Cancer Research Fund/American Institute of Cancer Research guidelines, were generally linked to lower overall or fatal cancer risk, although results were mixed for Mediterranean diet adherence. Diets high in processed meat, refined grains, sugars, or with high inflammatory or insulinemic potential tended to increase risk.

Among men already diagnosed with prostate cancer, the evidence was clearer and more consistent: Mediterranean, plant-based, and low-inflammatory dietary patterns were associated with reduced disease progression and prostate cancer–specific mortality. Conversely, Western, ultra-processed, and pro-inflammatory diets predicted worse outcomes. The few randomised trials available were short and heterogeneous, but some suggested benefits of vegan or high-fibre, plant-rich interventions on PSA levels, progression, or need for treatment, while others showed no significant change.

Taken together, the findings reinforce that diets rich in vegetables, fruits, whole grains, legumes, and healthy fats, while low in red and processed meat, added sugars, and ultra-processed foods, not only support cardiometabolic health but also appear to slow prostate cancer progression. The review highlights the need for longer, well-powered intervention studies and for integrating dietary counselling into standard cancer care as a safe, low-toxicity adjunct strategy.

You can read more about diet, lifestyle and prostate cancer in my article.

Food Groups, Physical activity and Kidney Health

Diet and lifestyle behaviours play a key role in maintaining kidney health. Much of the kidney community is now proactively endorsing plant-based diets given the ability to prevent and manage comorbidities implicated in promoting kidney failure i.e. hypertension and type 2 diabetes, and the accumulating evidence that plant-based diets can delay progression to end stage kidney failure and need for dialysis. In addition, the main cause of death in people with kidney failure remains cardiovascular disease, hence a further reason to promote plant-based diets. Don’t you love the infographics by the National Kidney Association?

This meta-analysis pooled results from 21 prospective cohort studies involving over 615,000 participants and nearly 30,000 cases of chronic kidney disease (CKD) to examine how different food groups relate to kidney health. The clearest finding was that higher red meat consumption significantly raised the risk of CKD, with each additional 100 grams per day linked to about a one-third higher risk. In contrast, greater intakes of legumes, grains, nuts, and fish were consistently associated with a lower risk. For example, 50 grams of legumes or 28 grams of nuts per day translated into a 13% and 21% reduced risk, respectively, while just 15 grams of fish daily lowered risk by about 6 percent. So although fish is better than eating red meat, there is greater benefit from getting protein from legumes and nuts.

The analysis did not find strong associations for total dairy, poultry, eggs, fruit, or vegetables overall, although moderate low-fat dairy consumption (500–1000 g/day) showed a potential benefit in a non-linear pattern. The evidence base was rated from very low to moderate in quality, reflecting differences in study design, dietary measurement, and potential confounders, but the dose–response consistency strengthens confidence in the results.

Mechanistically, red meat may promote CKD through glomerular hyperfiltration, fibrosis, and production of uraemic toxins, while legumes, grains, nuts, and fish may protect kidney function by lowering acid load, improving inflammation and oxidative stress, and supporting a healthier gut microbiome. The authors conclude that reducing red meat intake while increasing plant-based proteins and other protective foods could play an important role in primary prevention of CKD, which is increasingly recognised as a major global public health burden.

Regular physical activity also appears to play an important role in preserving kidney function. A large Norwegian cohort study followed more than 1,800 adults without diabetes, cardiovascular, or kidney disease for over 11 years, measuring kidney function with the gold-standard iohexol clearance method. The researchers found that those who exercised almost daily experienced a markedly slower decline in glomerular filtration rate and had a 71 percent lower risk of accelerated kidney function loss compared to inactive participants. Meeting World Health Organization activity guidelines was similarly protective, with a clear dose–response relationship between activity frequency and kidney health. These results suggest that regular physical activity, like healthy dietary patterns, should be prioritised as a low-cost, high-impact strategy to help prevent chronic kidney disease in ageing populations.

Dietary and Lifestyle Habits of Cardiologists

A national survey of 166 U.S. cardiologists highlights a striking gap between lifestyle medicine recommendations and personal practice. Although 41% of respondents frequently advised patients to adopt a whole-food plant-based diet for cardiovascular prevention, only 8% personally followed such a diet. Most cardiologists ate an omnivorous or semi-vegetarian diet, citing patient compliance, cultural barriers, and concerns about protein adequacy as reasons for hesitation, despite strong evidence that plant proteins are sufficient when varied.

The survey revealed broader inconsistencies across lifestyle medicine pillars. While 91% of cardiologists routinely counsel patients on exercise, only 69% themselves met physical activity guidelines, and fewer than half engaged in regular strength training. Sleep averaged 6.8 hours nightly, but over one-third reported dissatisfaction with their patterns. Stress reduction practices were used by half, yet few engaged in structured stress management programs. Social connections were highly valued but often limited by professional demands. Substance use varied, with 92% abstaining from tobacco but 69% consuming alcohol, a third of them weekly—despite new evidence that even light drinking increases cancer risk.

These findings expose a paradox: cardiologists recognise and promote the role of lifestyle in preventing cardiovascular disease, but many struggle to integrate the same practices into their own lives. The lack of formal training in lifestyle medicine, reported by 87% of respondents, likely contributes to these gaps. The authors conclude that greater education, structural support, and personal adoption of evidence-based lifestyle practices are needed to improve both physician well-being and the credibility of their patient counselling

Culinary Medicine in Clinical Practice

The concept of “food as medicine” is moving from theory to practice. At UT Southwestern Medical Center in the United States, a novel culinary medicine service line has been launched and reimbursed through insurance, marking a breakthrough in integrating nutrition into routine clinical care. Patients, most commonly referred for hypertension, diabetes, and hyperlipidaemia, were jointly seen by physicians and culinary-trained dietitians, and could also attend group medical visits in teaching kitchens. Nearly 400 referrals were received in the first 2.5 years, with high completion and satisfaction rates, and insurance coverage close to 100 percent. Patients valued the practical support, while referring clinicians recognised the program filled a long-standing gap in nutritional care. This model shows that embedding culinary medicine into health systems is both feasible and financially sustainable, with potential to transform chronic disease management.

The Environmental Case for Plant-Based Eating

Food production is now recognised as a central driver of the climate, biodiversity and pollution crises. Four new analyses deepen our understanding of how different food choices impact both the planet and human wellbeing, and together they show that animal agriculture is consistently the most damaging sector, while plant-based foods emerge as healthier, environmentally preferable, and often more affordable.

In a study from Loma Linda University, researchers introduced a novel “matrix” that clearly illustrates both the health and climate impacts of 30 major food groups. By plotting carbon footprints against long-term health outcomes, they showed that the very foods most protective against chronic disease, fruits, vegetables, whole grains, legumes, nuts, are also those with the lowest environmental burdens. By contrast, beef sits alone as an extreme outlier, combining the highest carbon footprint with clear links to increased mortality and disease risk. Processed and red meats fell into the “double negative” zone, being harmful for both people and planet.

A global analysis of over 48,000 food prices from 181 countries examined whether sustainable diets are unaffordable. The findings overturn the common belief that healthier, lower-impact foods are always more expensive. Within most food groups, lower-priced items actually carried smaller carbon and water footprints, particularly for animal-source foods where each price increase was strongly tied to greater emissions and water use. Staples such as beans, lentils, and grains not only scored highest for nutrient density but were consistently among the least expensive options, showing that eating well within planetary boundaries need not cost more.

At a continental scale, a new high-resolution ammonia emissions map for Europe revealed that over 90% of harmful ammonia pollution comes from agriculture, with farmed animals, especially dairy and beef cows and pigs, responsible for two-thirds of total emissions. Ammonia reacts in the atmosphere to form dangerous particulate matter, leading to millions of years of life lost annually across Europe, while deposition onto soils and waters drives biodiversity loss and eutrophication. In fact, critical nitrogen thresholds for nature are exceeded on the majority of European farmland because of livestock manure and fertilizer use. This quantification underscores how animal agriculture is not only a climate and land-use issue but also a major public health and biodiversity threat.

Finally, a landmark biodiversity assessment linked detailed food production and consumption data with extinction risk estimates for 30,000 vertebrate species. It found that animal products, particularly ruminant meat, impose extinction costs hundreds of times higher per kilogram than grains, legumes, fruits, or vegetables. More than three-quarters of global agricultural land is devoted to animal production, yet it provides less than one-fifth of human calories. The study showed that even modest reductions in ruminant meat intake could free vast areas for habitat restoration and sharply reduce extinction pressures. By contrast, staple crops like beans, grains, and root vegetables carried minimal extinction risk and high yields, making them vital for feeding populations while safeguarding biodiversity.

The latest World Bank report Reboot Development: The Economics of a Livable Planet makes clear that protecting natural resources is not only an ecological necessity but also an economic imperative. It highlights how air pollution, water stress, and land degradation now affect over 90 percent of the world’s population, undermining productivity, health, and food security. The report shows that the scale of human impact has been driven in large part by the growth of farm animal populations: humans and their livestock now make up 95 percent of all land mammal biomass, leaving wild mammals at just 5 percent. Forest loss, much of it for grazing and feed crops, is drying soils, reducing rainfall, and costing billions in lost agricultural and energy output, while the overuse of nitrogen fertilisers for animal feed increasingly harms crops instead of helping them. Yet the report also shows that solutions bring outsized benefits: restoring forests, managing nitrogen wisely, and investing in cleaner industries generate returns that far exceed costs, often creating more jobs per dollar than polluting sectors. Its central message is that investing in nature is not a constraint on growth but a foundation for long-term prosperity

Taken together, these studies reinforce a clear message: diets rich in minimally processed plant foods are a win–win for health, climate, and biodiversity, and they need not be more costly. By reducing reliance on animal agriculture, especially beef and dairy, societies can cut greenhouse gas emissions, air and water pollution, and biodiversity loss, while making healthy diets more affordable and accessible for all.

See you back in October!

As evidence continues to grow, the message is becoming clearer: lifestyle medicine is not an optional extra but the foundation of good health. Across mental health, heart disease, dementia, diabetes, and even mortality itself, the same story repeats - what we eat, how we move, how we sleep, and the environments we live in shape health outcomes more powerfully than medication alone. This month I highlight some of the most significant new studies reinforcing the role of plant-based nutrition and lifestyle approaches as first-line strategies for prevention and treatment.

Lifestyle Medicine in Mental Health Care

People living with mental illness face profound health inequalities, dying 13–15 years earlier on average than the general population. Most of this gap is not due to suicide but to preventable physical diseases such as heart disease, diabetes, and cancer, conditions strongly shaped by diet, physical activity, sleep, and smoking.

The Lancet Psychiatry Commission’s 2025 report makes a compelling case for embedding lifestyle interventions into mental health care as core clinical practice rather than optional extras. Diet quality is consistently lower in people with mental illness, and nutrition-focused programmes, particularly those based on a Mediterranean-style eating pattern rich in whole plant foods, have been shown to improve both mental health symptoms and physical outcomes. In some trials, these dietary changes even reduced overall health service costs, highlighting that food can be both therapeutic and economical. Exercise, too, emerges as a powerful form of medicine: structured programmes improve mood, support recovery, and lower cardiometabolic risk while building quality of life and resilience. Better sleep hygiene plays an equally important role, and smoking cessation remains one of the most effective and cost-saving interventions available. Importantly, the report emphasises that multi-component programmes that bring these elements together are the most effective of all.

Yet, lifestyle medicine remains poorly integrated into routine psychiatric care. The barriers are familiar: under-resourced services, lack of specialist training for clinicians, persistent stigma, and a default reliance on medication alone. The Commission calls for a paradigm shift, one that involves employing dietitians and exercise professionals within mental health teams, supporting peer-led initiatives, tailoring programmes to cultural and personal needs, and addressing the wider determinants of health such as poverty, housing, and food insecurity.

This is more than a matter of physical health. It is about re-imagining mental health care as holistic, humane, and preventive. The evidence is clear: food, movement, sleep, and social connection are not “nice add-ons” but evidence-based therapies that can transform outcomes when given the priority they deserve.

Lifestyle First in Preventing and Treating High Blood Pressure

High blood pressure remains the most common, preventable risk factor for heart disease, stroke, dementia, kidney disease, and premature death. The 2025 American Heart Association and American College of Cardiology guideline underlines what we already know but too often fail to act upon: diet and lifestyle must be the first-line treatment for raised blood pressure.

The evidence is unequivocal. Weight gain, poor diet quality, lack of physical activity, disrupted sleep, alcohol use, and stress are the drivers of hypertension across the lifespan. Conversely, a shift toward healthier behaviours can both prevent blood pressure from rising and bring it down once elevated. A diet based on whole plant foods, rich in fruits, vegetables, whole grains, beans, nuts, and seeds, naturally lowers sodium intake while providing abundant potassium, fibre, magnesium, and plant protein, all of which help reduce blood pressure. The DASH (Dietary Approaches to Stop Hypertension) diet, itself rich in plant foods, remains the most effective eating pattern studied, but Mediterranean and vegetarian diets also consistently improve outcomes. Don’t forget that the DASH diet was modelled on the blood pressure lowering effects of the vegetarian diet, but researchers added animal-sourced foods to make it ‘more acceptable’.

Lifestyle is powerful medicine. On average, dietary change can reduce systolic blood pressure by 5–8 mmHg, while regular physical activity contributes similar reductions. Weight loss, even as little as 5% of body weight, can lower blood pressure further. Salt reduction, particularly when combined with a potassium-rich diet, has profound effects, with trials showing meaningful drops in blood pressure and even fewer strokes and heart events at the population level. Stress-reduction practices such as meditation and yoga add additional benefit. Together, these approaches rival or exceed the effect of a single antihypertensive drug, but without side effects, and with wide-ranging benefits for overall health.

Despite this, medication continues to dominate hypertension management, often prescribed before people are given the tools and support to make meaningful lifestyle changes. The new guideline recognises that in lower-risk adults, medication should only be considered after a 3–6 month trial of lifestyle modification, if blood pressure remains elevated. This reflects a crucial shift: acknowledging that lifestyle is not a soft option, but an evidence-based therapy that should form the cornerstone of care.

The challenge is implementation. Achieving healthier lifestyles requires more than just individual willpower. It demands supportive environments, affordable access to healthy food, opportunities for movement, and culturally tailored interventions. Clinicians have a central role in advocating for these changes, but policy, community, and public health action are equally vital.

Preventing Cognitive Decline with Lifestyle

The search for effective ways to slow or prevent dementia has often focused on drugs. Yet lifestyle medicine is proving to be just as important, if not more so. The US POINTER trial, just published in JAMA, provides some of the strongest evidence yet that multi-domain lifestyle interventions can protect brain health in later life.

This large, multi-centre, randomised clinical trial enrolled more than 2,100 adults aged 60–79 at elevated risk of cognitive decline due to sedentary lifestyles, suboptimal diets, cardiometabolic risk, or family history. Participants were assigned to either a structured, high-support programme or a lower-intensity, self-guided programme. Both emphasised the same principles: a healthier diet modelled on the MIND diet (rich in plant foods with proven brain benefits), regular physical activity, cognitive and social engagement, and cardiovascular risk monitoring.

After two years, cognition improved in both groups, but gains were greater in the structured intervention, where regular meetings, coaching, and accountability helped people stay on track. The structured group showed significantly better improvements in global cognition, particularly in executive function, compared to the self-guided group. Importantly, the benefits were consistent across key subgroups, including those at genetic risk of Alzheimer’s disease.

This study is unique in its scale, diversity, and length of follow-up, and it reinforces the lesson from the landmark Finnish FINGER study: targeting multiple risk factors through diet, movement, social connection, and vascular health can slow cognitive decline. Unlike pharmaceuticals that act on a single pathway, lifestyle interventions address the full spectrum of risks, offering safe, affordable, and broadly effective protection for brain health.

Plant-Based Diets and Mental Health and Neurocognitive Outcomes

The role of diet in mental and cognitive health has been controversial, with mixed results from past studies on vegetarian and vegan diets. This new systematic review and meta-analysis, including over 700,000 adults worldwide, helps clarify the picture: the quality of the plant-based diet is key.

High adherence to healthy plant-based diets, those rich in whole fruits, vegetables, whole grains, legumes, nuts, and tea/coffee, and low in refined or ultra-processed plant foods, was associated with better mental and cognitive outcomes. People eating this way had significantly lower odds of anxiety, depression, and psychological distress in cross-sectional studies, and reduced risk of depression, cognitive decline, and dementia in long-term cohort studies. In contrast, unhealthy plant-based diets high in refined grains, sugary drinks, sweets, and processed plant foods were linked with higher rates of depression and anxiety.

This is an important corrective to the narrative that meat-free or plant-based diets might harm mental health. Past studies often grouped all plant-based diets together, failing to distinguish between minimally processed whole plant foods and heavily processed plant-based options. The new findings reinforce that a whole food, plant-based pattern supports brain health while a diet built on refined, processed foods, even if technically “plant-based”, may be detrimental.

The mechanisms make sense: fibre, polyphenols, antioxidants, and unsaturated fats in healthy plant foods reduce inflammation, support vascular and gut health, and thus promote mental well-being. Meanwhile, ultra-processed foods, whether animal or plant-based, destabilise glucose regulation, disrupt the gut microbiota, and contribute to inflammation, all of which can undermine mood and cognition.

Ultra-Processed vs Minimally Processed: Same Guidelines, Different Outcomes

Ultra-processed foods (UPFs) now make up more than half of daily calories for people in the UK, and similar levels are seen worldwide. While observational studies have long linked UPFs with obesity and chronic disease, critics argued the evidence was only correlational. The new UPDATE trial, published in Nature Medicine, is the first to directly compare ultra-processed and minimally processed diets while ensuring both met official UK dietary guidelines. The results confirm that processing may matter more, over and above nutrients alone.

In this crossover trial, adults living with overweight or obesity ate two different diets for eight weeks each: one based on minimally processed foods and the other on ultra-processed products, both meeting the Eatwell Guide targets for nutrients and food groups. Despite similar nutrient profiles, outcomes diverged. Participants lost significantly more weight and body fat on the minimally processed diet, along with better control of food cravings and improved triglyceride levels. By contrast, the ultra-processed diet led to smaller weight losses, less fat reduction, and more fatigue, constipation, and reflux.

It is important to note, however, that the difference in weight loss between the two diets was modest, about 1 kilogram over 8 weeks, and both groups lost weight and improved some health markers when following the Eatwell Guide. We do not yet know whether the benefits of minimising ultra-processed foods would widen, persist, or diminish over longer periods. Participants also reported preferring the ultra-processed diet for taste and convenience, and fewer dropped out during that arm. This underscores that sustainability and acceptability of a diet are equally crucial for long-term outcomes. Importantly, the study also demonstrates that adhering to dietary guidelines, even when some processing is involved, can still promote health improvements (UPF group had greater LDL-cholesterol lowering for example).

The UPDATE trial strengthens the case for looking beyond nutrients to the degree of processing, but it also reminds us that dietary change must be both effective and sustainable if it is to make a lasting difference.

The American Heart Association Calls Time on Ultra-Processed Foods

The American Heart Association (AHA) has now weighed in on one of the most urgent nutrition issues of our time: the dominance of ultra-processed foods in the modern diet. Their new 2025 science advisory reviews the evidence and issues a clear message: excess intake of UPFs is a major driver of cardiometabolic disease, and policies must move beyond nutrients to address processing itself.

UPFs, as defined by the Nova system, are industrial formulations made with additives, refined ingredients, and processes not used in home cooking. Observational studies consistently show that high UPF intake raises the risk of heart disease, type 2 diabetes, obesity, and premature death, with risks rising by 25–60% in the highest consumers. Importantly, these associations persist even after adjusting for fat, sugar, and salt, suggesting that the harms of UPFs cannot be explained by nutrients alone.

The advisory notes several pathways: UPFs tend to be hyper-palatable, calorie dense, and easy to overeat; they disrupt appetite regulation and the gut microbiome; and packaging introduces contaminants such as bisphenols and microplastics. At the population level, they displace healthier foods, entrench poor diet quality, and are aggressively marketed to children and vulnerable communities.

The advisory clearer notes that not all UPFs are equal. Some fortified products like whole grain breads or unsweetened soya milks can play a useful role in an otherwise whole food diet. Most UPFs associated with poor health outcomes are HFSS foods i.e high in saturated fat, salt and sugar. The AHA calls for a multi-pronged strategy including front-of-pack labelling, taxes on HFSS UPFs, stricter regulation of food additives, and action on marketing. Importantly, they stress that UPFs are not just a matter of personal choice but of food environments shaped by industry and policy.

This advisory represents a turning point. Just as trans fats were once ubiquitous before regulation, UPFs are now recognised as a systemic health threat. The next step is embedding this understanding into dietary guidelines and creating food systems that make minimally processed, whole foods the affordable, easy choice.

Potatoes, Diabetes, and Diet Quality

Potatoes receive a less favourable score in plant-based diet indices, largely because some studies have linked high potato intake, especially white potatoes, to weight gain, high blood pressure, and type 2 diabetes. But this new analysis from three major US cohorts, with over 200,000 participants and decades of follow-up, offers a more nuanced picture.

The study found that French fries were consistently associated with a higher risk of type 2 diabetes: people eating three extra servings of fries per week had about a 20% higher risk. In contrast, baked, boiled, or mashed potatoes were not linked to increased risk after accounting for lifestyle and dietary factors. In other words, the cooking method matters. Frying potatoes, especially in oils that generate harmful compounds at high temperatures, appears to drive the association with diabetes, not the potato itself.

The researchers also modelled dietary substitutions. Replacing potatoes, particularly fries, with whole grains was associated with a lower risk of diabetes, while replacing them with white rice slightly increased risk. This reinforces a central principle: the health impact of any food depends not just on its own qualities but on what it displaces in the diet. Whole grains, rich in fibre and micronutrients, remain a more protective staple, but potatoes can still play a role in a balanced diet.

These findings suggest that potatoes have been unfairly maligned in some diet scoring systems. When prepared without excess fat or salt and eaten as part of a varied, predominantly plant-based diet, they can provide valuable nutrients such as vitamin C, potassium, fibre, and polyphenols. The real risks come from processing and preparation methods that strip away these benefits and add harmful compounds.

Omega-3 Fats: Rethinking DHA and EPA for a Sustainable Future

For over 50 years, the long-chain omega-3 fatty acids EPA and DHA have been linked to heart, brain, and eye health. Higher intakes are associated with reduced risk of heart disease, dementia, and premature death, with emerging benefits for conditions such as fatty liver disease and obesity. Yet despite their importance, most people in the UK and globally consume far less than recommended, with average intakes under 250 mg per day compared to guidance of 450–500 mg. For vegans and many vegetarians, intakes are close to zero given the absence of fish from the diet.

This new review highlights two important realities. First, relying on oily fish is neither sustainable nor sufficient. Farmed salmon today contains about half the omega-3 it did 20 years ago, while global demand for fish far exceeds supply, contributing to overfishing and environmental damage. Second, even for those who do eat fish, intake levels remain too low to reach optimal blood levels of omega-3, suggesting the need for broader strategies.

What does this mean for people on a plant-based diet? While the body can convert some alpha-linolenic acid (ALA, found in flax, chia, and walnuts) into EPA and DHA, conversion to DHA is limited. This raises ongoing questions about whether direct supplementation with algal oil, the only reliable vegan source of EPA and DHA, should be recommended. Evidence from trials shows algal oil raises blood omega-3 levels just as effectively as fish oil, supporting its role as a sustainable alternative. The review also explores promising innovations such as bioengineered oilseeds (like Camelina and canola) and fortified plant foods, which could help close the global supply gap.

Importantly, the review suggests that current recommendations may actually be too low. While 450–500 mg per day is advised, cardiovascular and anti-inflammatory benefits often require intakes closer to 1–1.5 g daily, especially if we consider omega-3 index of greater than 8% as optimal for cardiovascular health outcomes. Cognitive benefits may also depend on higher intakes, with EPA showing particular promise for supporting brain function.

For those on a plant-based diet, the jury is out with regards the need for DHA/EPA supplementation. For certain life stages such as pregnancy and lactation and in babies and young children up to the age of two years, it is considered essential. The updated guidance from the Academy of Nutrition and Dietetics in the US does not consider DHA/EPA supplements essential for adults on a vegan or vegetarian diet. There are some intervention studies in the pipeline that will hopefully answer some of these outstanding questions in the near future.

Physical Activity Across Life: How Much, How Long, and Why It Matters

Physical inactivity is one of the leading global risk factors for death, yet much of the evidence linking activity to health outcomes comes from studies that measured it at just one point in time. A major new systematic review and meta-analysis, covering 85 prospective studies and millions of participants, has now looked at how physical activity patterns over the life course shape health and survival.

The findings are striking. Adults who were consistently active throughout life had about a 30–40% lower risk of dying from any cause, and a similar reduction in cardiovascular mortality, compared with those who remained inactive. Encouragingly, people who increased their activity later in adulthood still gained substantial benefits, with around 20–25% lower risk of premature death. In contrast, people who reduced their activity over time lost much of this protection, highlighting the importance of maintaining movement throughout life.

The analysis also confirmed the dose-response relationship: meeting the current World Health Organization guidelines of at least 150 minutes of moderate activity per week (or 75 minutes of vigorous activity) was enough to cut the risk of early death by about one third. Even activity levels below these recommendations provided measurable benefits, reminding us that some movement is always better than none. Beyond the guideline range, however, additional benefits were smaller, suggesting that the biggest gains come from moving inactive people into the “guideline zone.”

This life course approach underscores an important message: it is never too late to start, but consistency matters most. Activity patterns that persist into older age bring the greatest protection, particularly against cardiovascular disease. The study also suggests that leisure-time activity, walking, cycling, sports, confers stronger benefits than occupational or incidental movement, likely because it is more sustained and intentional.

Taken together, these studies show that the building blocks of health are the same across conditions and across the life course: a diet based on whole plant foods, limited ultra-processed foods, regular physical activity, restorative sleep, meaningful social connection, and attention to environmental and social determinants. The evidence is not only strong but increasingly precise, with long-term, randomised, and meta-analytic data showing the same consistent patterns.

The challenge now is not a lack of knowledge but a lack of implementation. Lifestyle medicine must become central to routine care, backed by supportive policies and food environments that make the healthy choice the easy choice. As health professionals, advocates, and community members, we have the opportunity to ensure that the science of prevention becomes the practice of everyday health.

See you back in September!

Cardiovascular disease (CVD) remains the leading cause of death globally, yet substantial gains in health and longevity are possible through addressing modifiable lifestyle factors. A large international pooled analysis, with data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents, published in The New England Journal of Medicine, has quantified this potential. Individuals free from five classic risk factors - hypertension, high cholesterol, smoking, obesity, and diabetes - at age 50 gained over a decade of life free from CVD compared to those with all five risks. Women gained 13.3 additional CVD-free years and 14.5 years free from all-cause mortality, while men gained 10.6 and 11.8 years, respectively. Importantly, modifying hypertension and smoking in midlife was associated with the greatest gains in disease-free life expectancy, underscoring the value of preventive strategies and risk factor modification. It is worth noting however that these risk factors only explain 50% of the risk of CVD. Other risk factors such underlying inflammation and genetically determined risk factors such as LP(a) are likely to be important.

The Role of Diet in Cardiovascular Risk

Diet quality is a crucial lever in modifying multiple risk pathways, including hypertension. Diet patterns known to reduce the risk of hypertension are ones that emphasise healthy plant foods i.e. Stop Hypertension (DASH) diet, Mediterranean diet, and vegetarian diet. A complementary analysis from the US National Health and Nutrition Examination Survey (NHANES) evaluated the link between plant-based dietary patterns and subclinical cardiovascular disease i.e. in the absence of symptoms. Using biomarkers like cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)], the study found that higher adherence to a healthy plant-based diet (rich in whole grains, fruits, vegetables, and legumes) was associated with a significantly lower likelihood of elevated cTnI, indicating reduced subclinical myocardial damage. Conversely, higher intake of unhealthy plant-based foods (e.g., refined grains, sugary drinks) was associated with greater cTnI elevation. This association persisted after adjustment for sociodemographic characteristics, lifestyle behaviours, and health status. There were no significant associations between plant-based diet indices and cTnT or NT- proBNP.

The study findings reiterate the importance of diet quality when consuming a plant-based dietary pattern. It should be noted though that the paper does not provide information on the exact quantities of food consumed. But given that this is a representative US cohort, it can be assumed that in general, consumption of healthy plant foods was not terribly high. The research conclude ‘Encouraging healthcare providers, policymakers, and other health authorities to recommend and support access to and adoption of healthy plant-based diets may be beneficial for promoting cardiovascular health in both individuals and communities.’

In addition, a new report has demonstrated that a healthy plant-based diet, low in animals foods, can support better health in Black and low income Americans, as evidenced by lower all-cause and CVD mortality. This suggests that different ethnicities and socioeconomic groups can benefit from eating more plants.

Diet vs. Physical Activity in Body Weight Management

With the advent and availability of effective weight loss medication, there has been a lot of discussion about the best methods for maintaining a healthy body weight. The relative contributions of diet and physical activity is often discussed. A comprehensive global analysis reported in Nature Metabolism challenges assumptions around energy expenditure. The study examined energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialised populations.

The study showed that with economic development is associated with increased prevalence of obesity but also energy expenditure and activity-related energy expenditure is higher in more developed populations. This is related to larger body size. Variations in total energy expenditure across economic strata are relatively modest. In contrast, rising obesity rates correlate more strongly with increasing caloric intake, suggesting diet plays a far larger role in body weight regulation than physical activity alone. The study concludes ‘Regulating food environments to maximise the benefits of increased calorie availability without promoting a nutrient-poor, obesogenic diet remains a crucial challenge in public health that will only become more acute as economic development continues globally.’ There is plenty of evidence that a dietary pattern high in whole plant foods and low/absent in animal food and ultra-processed foods, helps to support a health body weight.

Lifestyle Factors Remain Crucial with GLP-1 Agonists

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide has revolutionized obesity and diabetes management by delivering weight loss of 15–21%. However, a recent clinical review in JAMA Internal Medicine stresses that these pharmacologic tools do not eliminate the need for dietary quality or physical activity. We know that dietary quality remains poor in most people using weight loss medication. Muscle loss remains a concern since up to 40% of lost mass with GLP-1 RAs may be lean tissue. This necessitates adequate protein intake and resistance training. The authors propose a “MEAL” framework: Muscle maintenance, Energy balance, Avoid side effects, and Liquid intake. Diets should prioritise nutrient density over calorie restriction, with Mediterranean, DASH, or plant-based patterns recommended for their cardiometabolic benefits. Protein recommendations are 1.0-1.5 g/kg and >1.5 g/kg for older or people post-bariatric surgery. Protein meal replacements are recommended for those with smaller appetites. Physical activity, particularly strength training, is also recommended to help mitigate lean tissue loss and supports long-term success.

Plant-Based Protein and Muscle Strength

A frequent concern about plant-based diets is their adequacy for maintaining muscle mass and function. A new systematic review and meta-analysis of eight randomised controlled trials provides reassuring evidence: plant-based protein interventions are not detrimental to muscle strength. In fact, across multiple studies in varied populations, including older adults, plant protein intake was associated with comparable gains in strength relative to animal protein, provided protein intake met recommended thresholds. This evidence supports the inclusion of plant-based sources in muscle maintenance strategies, particularly for populations using GLP-1 therapies or engaging in resistance training

Chronic Disease Prevention: Beyond Cardiometabolic Health

While cardiovascular disease remains a dominant global health burden, chronic inflammatory conditions such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and diverticulitis also carry substantial morbidity and cost. Diet and lifestyle factors plays an increasingly recognised role in modulating risk for these diseases, offering new avenues for prevention.

Dietary Patterns and Risk of Rheumatoid Arthritis and Inflammatory Bowel Disease

Evidence from a nested case–control study within the Malmö Diet and Cancer Study (MDCS) in Sweden has provided new insights into the link between diet and incident RA. This analysis focused on components of the 2015 Swedish food-based dietary guidelines, including fruit and vegetable intake, red and processed meat consumption, and fibre intake. Two key dietary factors stood out. First, consumption of at least 400g/day of fruits and vegetables was associated with a 36% reduced risk of developing RA. Second, adherence to a red and processed meat intake below 500 g/week was associated with a 40% lower risk. Importantly, the association between meat consumption and RA risk was primarily observed in seropositive RA, a more severe form of the disease. These findings suggest that plant-forward, low-meat dietary patterns may reduce systemic inflammation and autoimmune risk.

There is now also convincing evidence on the benefits of diet and lifestyle interventions for people living with RA. The Plants for Joints study demonstrated that a whole food plant-based diet, physical activity and stress management was effective at alleviating symptoms of arthritis, improving cardiometabolic health and supported some people to reduce their reliance on medications.

A growing body of research links dietary patterns to the risk of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). A large-scale prospective study using data from 143, 434 participants of the UK Biobank study found that adherence to a healthy plant-based diet (hPDI) was significantly associated with a reduced risk of both UC and CD. Specifically, each standard deviation increase in hPDI was associated with an 8% reduction in UC risk and a 14% reduction in CD risk. Conversely, higher scores on the unhealthy plant-based diet index (uPDI), characterised by high intakes of refined grains, sweets, and sugary beverages, were associated with increased CD risk.

Mediation analyses suggested that the protective effects of a healthy plant-based diet were partially explained by reductions in systemic inflammation, as measured by C-reactive protein, white blood cells, and neutrophils, and by improved metabolic and liver function markers. These findings highlight the anti-inflammatory potential of whole-food plant-based diets and their role in preventing chronic gastrointestinal inflammation.

Similarly, another analysis using data from the UK Biobank study and the EPIC study, including more than 500,000 participants, also showed that a healthy plant-based diet was associated with a lower risk of IBD. In addition, it was able to show that a healthy plant-based diet resulted in fewer complications and less requirement for surgery in people with an established diagnosis of IBD. The authors conclude ‘We show that adherence to a healthy plant-based dietary index might be a strategy to alter the natural history of IBD, especially in individuals with moderate or high genetic risk'.

A prior study demonstrated that healthier lifestyles, that included maintaining a healthy body weight, regular physicial activity, eating sufficient fibre and fruits and vegetables and not smoking, could reduce the burden of inflammatory bowel disease by up to 60%. This suggests that a large proportion of cases are preventable.

Inflammatory diets are typically high in red and processed meat, refined grains and free sugars, whilst being low in healthy whole plant foods. Recent additional studies include one that suggests inflammatory diets during pregnancy may increase the risk of type 1 diabetes in children and that inflammatory diets may also increase the risk of developing osteoporosis.

Lifestyle and Genetic Risk in Diverticulitis

Diverticulitis, a common gastrointestinal condition, has traditionally been attributed to ageing and structural factors. However, a recent integrated analysis of four large US cohort studies (including the Nurses’ Health Studies and the Health Professionals Follow-Up Study) and validation in the Mass General Brigham Biobank challenges this notion. Researchers developed a “healthy lifestyle score” based on five modifiable factors: body mass index <25, regular physical activity, non-smoking status, high fiber intake, and low red meat consumption. Each point increase in this score was associated with a significantly lower risk of diverticulitis, independent of genetic risk. Even among individuals with a high polygenic risk score, adherence to a healthy lifestyle reduced the likelihood of developing diverticulitis. These results highlight the power of lifestyle intervention to mitigate genetic susceptibility and suggest that public health strategies should prioritise fibre-rich, plant-based diets alongside other modifiable behaviours.

One of the key beneficial impacts of a full plant-based or vegan diet is a significant reduction in the risk of diverticular disease as demonstrated by the results of the EPIC-Oxford study. This is at least in part due to the higher fibre intakes associated with plant-based diets.

Food, Health, and Planetary Boundaries: Aligning Nutrition and Sustainability

As the climate crisis intensifies, the intersection of diet, health, and environmental impact demands urgent attention. Food systems contribute approximately one-third of global greenhouse gas (GHG) emissions, with the production of animal-based foods, especially red and processed meats, disproportionately responsible for emissions, land use, and biodiversity loss.

From Fuel to Fork: The Fossil Fuel Footprint of Modern Diets

The IPES-Food report Fuel to Fork draws attention to the deep entanglement of food systems with fossil fuel dependency. Approximately 15% of all fossil fuels globally are consumed by food systems. Fertilizers alone, mostly derived from fossil gas, account for one-third of global petrochemical use. Additionally, plastic packaging for food and drink represents a major source of pollution and carbon emissions. The report calls out industrial agriculture for its reliance on energy-intensive inputs - fossil-based agrochemicals, plastic films, and synthetic nitrogen fertilisers - which not only harm the environment but also exacerbate health disparities and food insecurity. Transitioning to agroecological farming, local supply chains, and dietary patterns rich in minimally processed plant-based foods is a critical pathway to a more sustainable and just food.

Protein Quality and the Shift to Plant-Based Meat Alternatives

Reducing meat consumption is widely recognised as beneficial for the environment, but concerns remain about nutritional adequacy, particularly protein quality. A new Dutch modelling study addressed this by evaluating the impact of replacing animal meat with plant-based meat alternatives (PBMAs) on dietary protein adequacy. The study found that while total and utilizable protein intake declined modestly with a full replacement scenario, 86% of the adult population would still meet protein adequacy thresholds. Ensuring variety and sufficient total intake, particularly of high-quality plant proteins like soya and mycoprotein, was key to maintaining nutritional balance. These findings support broader adoption of PBMAs in national dietary strategies, provided that formulation and fortification support essential amino acid requirements.

A new review article from the UK summarises the evidence on PBMAs for health and the environment. There clearly is a role for these products to support reduction in meat consumption, but the food industry needs to ensure they are formulated to provide essential nutrients, cost needs to come down to encourage more widespread uptake and consistent education of consumers is needed to facilitate less meat consumption.

UK Food Production: A Systemic Mismatch

Despite clear evidence of the health and environmental benefits of plant-based diets, food production in the UK remains misaligned with dietary guidelines. A dietary gap analysis found that only 7% of UK-produced food in 2022 was fruit and vegetables compared to the recommended ~40% share in the Eatwell Guide. Instead, disproportionately high production of dairy, oils, and sugar beets reflects entrenched agricultural subsidies and market structures. The report argues for reorienting food policy to better match national dietary and environmental targets, including through investment in horticulture and plant protein crops. Aligning food production with health needs is not only a matter of agricultural reform, it is a matter of public health equity and ecological resilience.

Let’s hope that the National Food Strategy delivers on this. So far the Government have set out their ten priority outcomes for the new food strategy and are now engaging various stakeholders, including citizens. Let’s hope the final strategy is one that aligns food production with both health and sustainability goals.

See you back in August!

The recent report by the Scientific Advisory Committee on Nutrition (SACN), in collaboration with the Committee on Toxicity (COT), assessing the health benefits and risks of consuming plant-based drinks, is a significant and timely contribution to public health discourse. The report focuses specifically on soya, oat and almond drinks, commonly used as an alternative to cows’ milk, and compares their nutritional and toxicological profiles to cows’ milk, with a special focus on children aged 1 to 5 years. It’s important to note that the nutrient profiles were based on purchasing data for products that were sold in the UK in 2019 to 2020 and nutritional composition data on these products that were obtained from manufacturer product descriptions on supermarket websites in January 2022. Since then, the market has continued to evolve, with more fortified and lower-sugar options now widely available. In that sense, the report is already slightly outdated, but its conclusions remain relevant.

We welcome its central message: cows’ milk is not a necessary component of the diet, for children or adults. This is a critical and overdue clarification. The report makes it clear that all essential nutrients provided by cows’ milk can be obtained through other dietary sources, including fortified plant-based milk alternatives. This gives welcome support to those following vegan or predominantly plant-based diets, as well as families with ethical, cultural or medical reasons to avoid dairy.

However, while the scientific content of the report is detailed and thoughtful, its overall tone remains overly cautious. From a public health messaging perspective, this caution may unintentionally discourage the use of plant-based milk alternatives, despite the report’s own findings that these drinks can be nutritionally appropriate for all age groups.

A missed opportunity to inspire confidence

Although the report rightly states that cows’ milk is not essential, the framing throughout is hesitant. For instance, rather than embracing the term “plant milks,” which is familiar to most consumers, the report refers instead to “plant-based drinks.” While this complies with EU and UK legal definitions of “milk,” (i.e. animal-derived products), it may be unclear to the public, many of whom don’t immediately connect the phrase “plant-based drinks” with soya or oat milk.

More significantly, the report omits one of the most compelling reasons many people choose plant-based alternatives: the environmental impact of dairy production. Cows’ milk has a far greater carbon, land and water footprint than all plant-based alternatives, whilst also contributing significantly to air and water pollution. If sustainability considerations had been included in this report, an aspect SACN explicitly excluded from its scope, the case for plant-based milks would have been even stronger. As we look to align dietary recommendations with climate goals, it is increasingly important that national nutrition guidance reflects environmental realities.

The report finds benefits and disadvantages of plant-based drinks and cows’ milk with the relevance of these considerations varying by age group. Yet, the tone of the report leaves the reader with the impression that cows’ milk is the preferred option. This is despite stating the relative benefits of plant drinks, including being lower in energy and saturated fat and higher in fibre and vitamin D. The disadvantages include the potential for higher intakes of free sugar and reduced intakes of certain micronutrients that are typically found in cows’ milk (vitamin A, vitamin B12, calcium, iodine and riboflavin), concerns easily addressed by choosing products wisely.

On nutrition, soya is the standout option

The report’s comparative nutritional modelling provides helpful guidance. Of the three plant-based drinks assessed, soya is nutritionally the closest to cows’ milk in both protein quantity and quality. Fortified soya milk can also deliver adequate levels of calcium, riboflavin, vitamin B12 and vitamin D, and increasingly includes iodine, making it a suitable and nutritionally complete replacement for cows’ milk at all ages from one year onwards.

Nonetheless, the report continues to express concern about isoflavones, plant compounds found in soya that have weak oestrogen-like activity. While it is right to consider all potential risks, the evidence-base for isoflavone harm in humans, particularly children, is extremely limited. Large population studies, particularly in Asia where soya intake is high from a young age, show no adverse reproductive or developmental effects. On the contrary, soya and isoflavone consumption has been associated with numerous benefits to health.Randomised studies have shown that soya drinks, when compared to cows’ milk, have benefits for cardiometabolic indicators of health, regardless of their sugar content. These potential benefits are briefly acknowledged in the report but are quickly overshadowed by speculative concerns drawn mostly from animal studies. This could unnecessarily deter families from choosing the most nutritionally robust plant milk available.

Clear guidance on fortification and free sugars

One of the strengths of the report is its practical advice on choosing appropriate products. It emphasises the importance of selecting unsweetened plant-based drinks that are fortified with key nutrients, especially calcium, iodine, vitamin D and B12, if these drinks are used to replace cows’ milk. This is essential guidance, and we strongly endorse it. The report also provides a helpful classification system for products as “typical,” “enhanced,” or “unfortified and/or sweetened,” based on their nutritional content. The report also makes useful recommendations to Government and the food industry, including the need to standardise the nutritional profile of plant-based drinks.

It’s worth highlighting that most of the “unfortified” products identified in the report were organic, which under current UK regulations cannot be fortified. Consumers often perceive organic products as healthier, but when it comes to plant-based milks for young children, unfortified organic options are not advisable. Health professionals must be aware of this and support families in making informed choices.

The report reiterates that plant-based drinks should not be given as the main milk drink to children under 12 months, a position we agree with. However, for children over 1 year of age, there is now strong evidence that appropriately fortified plant-based milks can support healthy growth and development.

Policy must catch up with the evidence

Despite the report’s clear scientific conclusions, UK government policy remains out of step. Schemes like Nursery Milk and Healthy Start still restrict reimbursement to cows’ milk, excluding plant-based alternatives even for children who follow a vegan diet or have dairy allergy or lactose intolerance. This approach is outdated, inequitable, and unsupported by the evidence in this report. The Scottish Government’s more inclusive approach, allowing fortified soya drinks to be reimbursed through its Healthy Snack Scheme, should become the standard across the UK. Don’t forget that dairy alternatives, such as soya, are already part of the UK dietary guidelines, the Eatwell Guide.

Conclusion: confidence, not caution

This SACN report offers a much-needed evidence base to support the safe use of plant-based milks, particularly soya, as a suitable alternative to cows’ milk from age one onwards. It confirms what we as plant-based health professionals have long known: that these drinks, when chosen wisely, can support optimal health at every life stage.

But the message must be clearer. With the right guidance on fortification and sugar content, plant-based milks, especially soya, are not just a viable alternative, but a positive choice for human and planetary health. Health professionals, parents, and policymakers should embrace this shift with confidence.

For more information on plant-based diets for children visit our dedicated website section. To ensure a well planned plant-based diet, see our plant-based adaptation of Eatwell Guide.

The newly published 10 Year Health Plan for England sets out an ambitious vision to shift from a sickness service to one rooted in prevention, and for that, it deserves genuine praise. A renewed focus on keeping people well, rather than simply treating illness when it arises, is exactly the direction we need. As a doctor and advocate for public and planetary health, I welcome many of the plan’s proposed interventions.

The good bits

Measures like restricting junk food advertising to children, expanding free school meals to those on Universal Credit, improving school food standards, and restoring the value of the Healthy Start programme are long overdue. These actions go beyond rhetoric and begin to acknowledge the role that our food environment plays in shaping health outcomes, especially for children and the most vulnerable. The plan also breaks important new ground by introducing mandatory reporting of healthy food sales for large companies, a bold step toward holding the food industry to account for the health impacts of what it promotes.

The Plan’s approach to alcohol consumption is also encouraging. New standards for labelling and support for the growing no- and low-alcohol market reflect a mature, evidence-based strategy for tackling one of the UK’s most under-addressed public health challenges.

Misplaced emphasis on tech and pharma

But these strong foundations are undermined by an overreliance on high-tech interventions and pharmaceutical fixes. Technology, AI, wearables and genomic sequencing are positioned as transformative solutions to our healthcare crisis. While these tools have potential in specific contexts, they cannot replace the hard work of rebuilding a just and equitable health system. We do not suffer from a lack of tech, we suffer from a lack of joined-up records, adequate staffing, and access to the basics of care. It is difficult to imagine a seamless AI-powered NHS app delivering personalised care when many parts of the country still lack integrated electronic health records.

The emphasis on genomics as a tool for prevention is also misplaced in my view. While understanding genetic predispositions can inform care in certain cases, the vast majority of chronic diseases, such as type 2 diabetes, heart disease, dementia and many cancers, are overwhelmingly driven by lifestyle and environmental factors. Even individuals with high-risk genetic variants can significantly reduce their risk through healthy behaviours, including a nutritious, predominantly whole food plant-based diet, regular physical activity, and avoidance of smoking and alcohol. Genomic information might tell us ‘who is at risk,’ but it doesn’t tell us ‘what to do’ and the solutions remain the same. Pouring resources into genomic screening risks diverting attention and funding away from proven, population-level public health strategies. Whilst the NHS is proud of pioneering whole genomic sequencing into routine care for people with cancer, I am yet to see high quality data (i.e. randomised controlled trials) that demonstrates this high resource endeavour has significantly impacted patient outcomes. Conversely, cancer outcomes would be improved if we got the basics right i.e. addressing delays in referral, diagnostics and treatment, whilst ensuring equity of access. The cynical view here would be that this emphasis on tech and genomics is in part driven by private enterprise rather than public good.

The same applies to the plan’s embrace of weight-loss injections. While GLP-1 drugs may play a role for some individuals, they should not become a cornerstone of our national strategy. The causes of obesity are complex, rooted in socioeconomic disadvantage and driven by a food system that promotes ultra-processed products at the expense of affordable, nutritious whole foods. The Plan wants to widen access to weight loss drugs to afford everyone the same access as those with greater means (including, it would seem, many parliamentarians). But medicalising this issue will further burden the NHS without addressing the structural drivers of poor diet and chronic disease. We should be using our public health resources to fix food deserts, support UK growers and ensure every child grows up with access to healthy food, not subsidising expensive drugs. Even if drugs are required for some people, there still needs to be a wraparound service that supports a diet and lifestyle approach to ensure improved long-term outcomes.

Is this truly about prevention?

Much of what is described as ‘prevention’ in the Plan centres on early detection and diagnosis. This is not the same as preventing disease in the first place. True prevention involves creating the conditions for good health through clean environments, healthy food systems, and addressing the root causes of ill health long before screening tests can detect disease. Atherosclerotic heart disease, for example, begins in childhood, if not earlier in a mothers womb. Screening tests, especially for cancer, have become more and more resource intense only to find that they don’t deliver on predicted outcomes and are serving private interests over public good. Instead, identifying those who are not exercising, drinking too much, and eating a poor diet, will provide clinicians with a good indicator of who is on their way to developing cardiovascular disease and at higher risk of cancer and dementia.

The Plan’s commitment to neighbourhood health services is an encouraging step toward making care more accessible, continuous, and rooted in the community. Bringing services closer to where people live and integrating teams around patient needs reflects a long-overdue rebalancing of our healthcare model. However, the suggestion that these services should be personalised based on genomics has little evidence to support it. Most chronic conditions have modifiable risk factors that respond powerfully to diet and lifestyle interventions that are well-studied, low-cost, and scalable. Personalising care should mean enabling healthy choices for all.

Illusion of choice

The emphasis on “patient choice” throughout the Plan reveals a fundamental misunderstanding. Most people don’t want more choice; they want fair access. They want to know they can see a GP when they need one, access mental health support without endless delays, and trust that the care they receive will be consistent in quality regardless of postcode or income. Choice without access is a hollow promise and a distraction from the deeper reforms needed to make the NHS truly universal and equitable.

True prevention must start with social justice. That means confronting inequality, supporting healthy environments, and making nutritious, largely plant-based diets accessible and affordable for everyone. It means prioritising the basics: good food, clean air, secure housing, and a health system that delivers compassionate care without delay. Only then can we bend the curve of chronic disease, significantly reduce the burden on NHS services, and build a system that serves both people and planet. Where the plan acknowledges staff are demoralised and demotivated, reducing demand through these basic measures would go a long way to making the day job seem more manageable.

To conclude

The 10 Year Health Plan contains sparks of hope. But prevention cannot be achieved through apps and algorithms alone. Nor can it be outsourced to pharmaceutical companies. If we are serious about creating the healthiest generation in history, we must put people, food, and fairness first.

Our focus at PBHP UK will be to continue to advocate for a plant-based lifestyle approach to protecting our health and the health of the planet. We want the medical profession to evolve into one that focuses on promoting chronic health rather than tracking and mopping up chronic disease.

Prevention first: Scotland’s new Population Health Framework marks a major shift toward primary prevention and a whole-systems approach, recognising that health isn’t solely the NHS’s responsibility but shaped by social, economic, environmental, and community factors. Its five prevention drivers are:

• Addressing socioeconomic determinants: such as poverty, quality housing, and employment to prevent ill health before it begins.
• Improving places and communities: such as developing “Marmot places” (e.g. in Aberdeen, North Ayrshire, South Lanarkshire) to embed health in local planning
• Promoting healthy living: by tackling obesity, encouraging physical activity, and continuing efforts like smoking bans and minimum alcohol pricing.
• Ensuring equitable health and care: by embedding prevention in every health and social care service, including strong community-focused midwifery and mental health initiatives.
• Embedding a prevention-focused system: including creating health impact assessments (“health lens”), shifting budgets to prevention, and using real-time data to guide decisions.

Although praised for its strong evidence base and clear emphasis on prevention, independent reviews note that many of the Framework’s proposed actions remain vague or limited to health and social care, with less clarity on implementation, resource allocation, and cross-government accountability, especially in areas like housing, justice, and reducing deaths of despair.

Declaring obesity as an early priority, the Framework acknowledges the obesogenic environment in Scotland, where two-thirds of adults are overweight, and commits to making healthy lifestyles more accessible and affordable.

Financial modelling warns that without effective prevention, Scotland may face a fiscal crisis as its population ages: healthcare costs are projected to rise from around 40% to 55+% of devolved spending, potentially creating a £14–£16 billion annual gap by 2075. Prevention is presented not only as a moral imperative but also as essential economic policy.

In England, the long awaited National Diet and Nutrition Survey 2019-2023 highlights the problems we are facing when it comes to health promotion. Diet quality appears to have further deteriorated since the 2019 report. Key findings of the survey include:

• On average children aged 11 to 18 years ate 2.8 portions of fruit and vegetables a day. Less than 1 in 10 children aged 11 to 18 years (9%) met the ‘5 A Day’ recommendation.

• On average, adults consumed 3.3 to 3.7 portions per day (depending on age). Less than 1 in 5 adults (17%) met the 5 A Day recommendation.

• Red and processed meat consumption is generally under 70g/day as recommended in the Eatwell Guide. But, men eat more than women and nearly one third of men aged 19 to 64 years eat more than 90g of red and processed meat a day.

• 96% of children aged 11-18 years and adults do not meet recommended intakes of fibre. Cereals and cereal products are the main source of fibre for all ages, providing up to 50% of intake in the diet

• 85% of children and 82% of adults consume over the recommended limit of saturated fat. The main contributors are sandwiches, pizza, sweet biscuits and cakes. Meat and meat products also contribute 12%-19% to saturated fat intake across all ages

• Children aged 11-18 years drink the highest amount of sugary drinks, In all age groups, people consume more free sugar than recommended. 95% of children age 11-18 and 83% of adults consume more free sugar than recommended.

• There was evidence of insufficient iodine status for girls aged 11 to 18 years and women of childbearing age (16 to 49 years).

• Around three-quarters of people reported buy food or drink from the ‘out of home’ sector, mostly commonly ‘fast food’ or ‘take-away’. For participants who reported eating ‘out of home’, almost a quarter (23%) of their energy (calorie) intake came from these eating occasions. This was also true for their intake of other nutrients, including saturated fat, free sugars and sodium.

The results clearly demonstrate the scale of the problem. This needs to be addressed through Government regulation and policy initiatives to improve the food environment and to incentivise healthy eating. Sadly, again and again the UK Government have failed to do the right thing, caving to lobbying from the big food companies. We eagerly await NHS England’s 10-year health plan, which we hope will prioritise prevention. I am feeling a little hopeful as the UK Government announces plans to work with supermarkets and food manufacturers to incentivise purchases of healthy foods and make them more appealing. However, the scheme will remain voluntary so the impact on health outcomes is likely to be small.

Diet, lifestyle and cancer: Forty to 50% of cancers could be prevented if we addressed behavioural and metabolic risk factors. A healthy diet and lifestyle is key for both preventing cancer and living well after a cancer diagnosis. Regarding dietary recommendations, the American Cancer Society (ACS) considers a healthy diet for cancer as ‘one that is diet rich in vegetables, fruits, legumes, and whole grains and limits or does not include red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. Several eating patterns can meet this definition, including the Mediterranean diet, the DASH diet, and vegetarian diets.’

With regards dietary patterns for cancer prevention, there is a growing body of evidence demonstrating that meat-free diets reduce the risk of cancer. This has been shown in prospective cohorts such as the Adventist Health Study-2, the Epic-Oxford cohort and Oxford Vegetarian study and analysis of from the UK Biobank study. There is some heterogeneity in data when it comes to specific cancer sites.

A new analysis from the Adventist Health Study-2 aimed to assess the impact of vegetarian and vegan diets on a broader range of cancer types, including so called ‘medium frequency’ cancers (melanoma, endometrial, renal, urothelial, thyroid, ovarian, central nervous system, lung, rectal, pancreatic, primary liver, stomach, oesophageal, mouth-pharyngeal-laryngeal, lymphoma, lymphoid and myeloid leukemias). The study included 79,468 adults in North America, including 20,662 black participants, who were cancer-free at recruitment and followed for an average of 8 years. Vegetarian as a general term in this analysis includes pesco-vegetarians, lacto-ovo vegetarians (LOV) and vegans, i.e meat-free.

Compared to omnivores, LOV had a 9% reduction and vegans a 24% reduction in overall cancer risk. For medium frequency cancers, LOV had a 18% reduction and vegans a 23% reduction in risk. Younger (at age 65 years) but not older vegans (at age 85 years) had a lower risk of prostate (43% reduction) and breast cancer (31% reduction). At age 85 years, vegans had a significantly lower risk of lymphoma (56% reduction). LOVs also had a lower risk of lymphoproliferative disorders in general. Pescovegetarians showed a reduced risk of total and medium frequency cancer, although to a lesser degree. They did however show a reduced rate of colorectal cancer (39% reduction) and breast cancer at an older age (43% reduction). Lower rates of carcinoma of the stomach were seen among all vegetarians combined, and also in LOVs.

Overall the results demonstrate the benefits of meat-free diets for cancer prevention. There are a number of reasons why this may be the case. In general, meat free diets result in lower exposure to dietary carcinogens such as those associated with processed meat and cooking meat at high temperatures. Vegetarians and vegans have been shown to have lower levels of inflammation and a healthier gut microbiome, due to higher intakes of fibre. The lower rates of various co-morbidities, such as cardiovascular diseases and type 2 diabetes may also have an impact.

The authors conclude that in vegetarians the ‘decreased risk of all cancers, and medium frequency cancers as a group, in this North American cohort, were strong and persuasive. The public health significance is clear, with the risk of adverse effects being very small or non-existent (for vegetarian dietary patterns), and that some benefits are likely real, although an observational study cannot establish causality with certainty’.

Of course, reduced risk of cancer does not mean no risk. But even after a diagnosis of cancer, there are positive actions one can take to improve outcomes. This new study investigated whether following the ACS 2022 Nutrition and Physical Activity Guideline after a cancer diagnosis is associated with improved survival among non-smoking survivors of obesity-related cancers. Using data from the Cancer Prevention Study-II Nutrition Cohort, the researchers followed 3,742 individuals diagnosed between 1992 and 2002, tracking outcomes through 2020.

Participants were scored from 0 to 8 based on post-diagnosis adherence to recommendations on body mass index (BMI), physical activity, diet, and alcohol consumption. Optimal scores were obtained when participants maintained a healthy weight/BMI, met physical activity guidelines, did not consume alcohol and adhered to principles of healthy eating.

The analysis found that survivors with the highest adherence scores (6–8) had significantly lower risks of all-cause, cardiovascular, and cancer-specific mortality compared to those with low scores (0–3). Specifically, high adherence was associated with a 24% reduction in all-cause mortality, a 33% reduction in cardiovascular mortality, and a 21% reduction in cancer-specific mortality. These associations remained consistent across several cancer types, including breast and colorectal cancer.

Among the individual components of the guideline, maintaining a healthy weight and engaging in regular physical activity were the most strongly associated with improved survival. Interestingly, dietary quality alone did not show a strong relationship with mortality, and abstaining from alcohol was linked to a slightly higher risk of all-cause mortality, particularly among women. The paradoxical association with alcohol consumption may reflect reverse causation as people with more advanced cancer or other adverse health conditions may have purposefully cut down/stopped their alcohol intake.

The study also showed that survivors who either maintained a high adherence score or improved their lifestyle after diagnosis had significantly better survival outcomes than those who consistently had low adherence. These findings underscore the importance of encouraging lifestyle improvements after cancer diagnosis, especially in survivors of obesity-related cancers, as part of survivorship care planning.

Interestingly, this new systematic review and meta-analysis of 17 studies including more than 2.2 million participants found that adherence to a sustainable diet (similar to the plant-rich Planetary Health Diet) was associated with lower incidence of and mortality from cancer. Of note, the analysis did not find an association between organic food consumption and improved cancer outcomes.

Bone health on a plant-based diet: Bone health has been an area of concern for people eating a plant-based diet. Four studies have highlighted an increased risk of fractures in people following meat-free diets, particularly in women of lower body weight. This new systematic review and meta-analysis specifically examined the association between plant-based diets, i.e. vegetarian and vegan, and bone mineral density (BMD) compared to an omnivorous diet. Low BMD indicates osteoporosis. The analysis included 20 studies that used imaging techniques to evaluate BMD in the lumbar spine and femoral neck. Sixteen studies were cross sectional in design and 4 case-control. A total of 243, 366 people participated in these studies, with mean ages ranging from 25 to 80 years. Thirteen studies included only females, while 7 studies included both females and males.

The results suggested that vegetarians and vegans tended to have a lower bone mineral density at the femoral neck that was lower compared to omnivores, but pooled estimates (combined results) did not reach statistical significance. However, the pooled results did show that vegetarians and vegans had significantly lower BMD at the lumbar spine. When considering vegetarians and vegans separately, there was a trend towards increased risk of osteoporosis for both groups but confidence intervals are wide and of borderline statistical significance. The association with lower BMD was greater for people who had been following a PBD for more than 10 years and older than 60 years.

Given the limitations of the study design (no prospective cohort studies included), the results demonstrated a high degree of heterogeneity and can’t be used to infer causality. Many studies included did not adjust for potential confounders such as BMI.

As we continue to gain more understanding of the impact of diet on bone health, there are plenty of positive actions we can take. First and foremost, we should prioritising weight-bearing and strength exercises.

Diabetes remission: A new clinical practice guideline, issued by the American College of Lifestyle Medicine in 2025, provides evidence-based recommendations for the treatment and remission of type 2 diabetes and prediabetes in adults through comprehensive lifestyle interventions. It has been endorsed by a number of medical associations in the US. The guideline emphasises that lifestyle modification, particularly dietary change, is not only effective in managing type 2 diabetes but can also lead to remission in many cases. The foundation of the recommended approach is a predominantly whole food, plant-based diet that is high in fibre and minimally processed, with low levels of added sugars and saturated fats. This dietary pattern is supported by robust evidence showing improvements in glycaemic control, insulin sensitivity, weight, and cardiovascular risk factors.

The guideline stresses the importance of regular physical activity, restorative sleep, stress management, avoidance of harmful substances, and social support as essential pillars of lifestyle medicine. It recognises that a structured, multidisciplinary approach involving physicians, dietitians, diabetes educators, and behavioral health professionals is key to supporting sustainable lifestyle changes. Specific attention is given to tailoring interventions to individual needs, cultural contexts, and readiness for change.

Importantly, the guideline recommends that medications be reduced or de-prescribed as appropriate in response to improvements from lifestyle interventions, but this should be done under careful clinical supervision to avoid hypoglycaemia or other complications. For patients with prediabetes, the recommendations focus on prevention of progression through the same comprehensive lifestyle measures, with the goal of restoring normal glycemic control without pharmacologic intervention.

Overall, the guideline positions lifestyle intervention as the first-line and central strategy for managing and potentially reversing type 2 diabetes and prediabetes, shifting the clinical focus from glucose management alone to addressing root causes through sustainable behaviour change.

A new systematic review and meta-regression of randomised controlled studies demonstrates that weight loss is key for diabetes remission. The analysis found that for every 1% point decrease in bodyweight, the probability of reaching complete remission increased by 2·17% (95% CI 1·94–2·40) and the probability of reaching partial remission increased by 2·74% (2·48–3·00). No significant or appreciable associations were observed between age, sex, race, diabetes duration, baseline BMI, HbA_1c, insulin use, or type of bodyweight loss intervention and remission. For those that lost more than 30% body weight, remission was achieved in almost 90% of people. It doesn’t really matter how weight loss is achieved, although focussing on sustainability and healthy dietary habits should be key.

The ReTUNE study has previously demonstrated that even in people with normal or only mildly elevated body weight (BMI <27), weight loss is useful for remission induction. This is because it is the visceral fat that is important when it comes to the development of type 2 diabetes. We all have a personal fat threshold that when exceeded will result in deposition of fact in organs such as liver, pancreas and muscle. Weight loss is usually needed to remove the visceral fat.

Fasting has emerged as a popular tool for calorie restriction and thus aiding weight loss. There are different ways to fast and there remain unanswered questions about its efficacy, sustainability and benefits to cardiometabolic health. A new analysis has brought together the findings from 99 randomised studies that compared continuous energy restriction and ad libitum diets with any of the three main modalities of intermittent fasting: alternate day fasting, time restricted eating, and whole day fasting. Overall, the results showed that all fasting strategies and continuous energy restriction diets showed a reduction in body weight when compared with an ad-libitum diet. However, there was a greater albeit small advantage for alternate day fasting, which showed benefit in body weight reduction compared with continuous energy restriction. All diet strategies presented similar benefits in cardiometabolic risk over an ad-libitum diet. In general, for longer running studies, adherence was an issue and declined overtime. Ultimately, these results demonstrate that the goal of any diet change should prioritise sustainability and dietary quality, as these qualities will support better longer term health.

Alcohol and cardiovascular health: We have known for a while that zero is the safest amount of alcohol to consume when it comes to improving cancer outcomes. However, there are often mixed messages when it comes to cardiovascular health.

It useful to have this scientific statement from the American Heart Association, which addresses the complex relationship between alcohol use and cardiovascular disease (CVD). Drawing from a comprehensive review of the latest evidence, the guideline emphasizes that any potential cardiovascular benefits of alcohol have been overstated in the past, largely due to methodological limitations in earlier studies, such as misclassification of former drinkers and other confounders. More recent and robust research, including Mendelian randomization studies, suggests that even low to moderate alcohol consumption does not confer significant cardiovascular protection and may in fact increase risks for several cardiovascular conditions.

The statement concludes that alcohol is not a recommended strategy for improving heart health. While earlier observational studies linked moderate drinking, especially red wine, with reduced coronary heart disease risk, current evidence indicates that these findings were likely influenced by biases and cannot be interpreted as causal. Furthermore, alcohol consumption is clearly associated with increased risks of atrial fibrillation, hypertension, stroke, and cardiomyopathy, even at low levels.

The guideline affirms that the safest level of alcohol intake for cardiovascular health is likely none, and it explicitly advises against initiating or continuing alcohol use for perceived heart benefits. Instead, it recommends focusing on proven lifestyle strategies such as healthy diet, physical activity, smoking cessation, and management of blood pressure, cholesterol, and blood sugar. It also highlights the need for clinicians to provide clear, non-ambiguous guidance to patients, avoiding the suggestion that alcohol might be protective and encouraging reduction or cessation, especially among those with or at high risk of cardiovascular disease.

See you back in July!

An update to the pillars of lifestyle medicine

This month the American College of Lifestyle Medicine (ACLM) updated two of its six foundational pillars, stress management and social connection, to reflect evolving scientific understanding and clinical practice. These revisions emphasise a more holistic approach to health, integrating psychological, social, and spiritual dimensions.

The "stress management" pillar now acknowledges the interplay between objective stressors and subjective perceptions, recognising that individual factors such as temperament, personality, and past experiences influence stress responses. The updated framework highlights the importance of addressing both external stressors and internal perceptions through interventions like positive psychology, psychotherapy, and resilience-building strategies. It also considers the cumulative effects of chronic stressors, including discrimination and socioeconomic challenges, which can lead to allostatic load (cumulative burden of chronic stress and life events) and health deterioration.

The "social connection" pillar has been renamed "connectedness" to encompass a broader spectrum of meaningful relationships, extending beyond interpersonal connections to include bonds with nature, companion animals, and spiritual or transcendent elements. This expanded perspective recognises that both horizontal (social) and vertical (spiritual) relationships contribute to an individual's sense of purpose and meaning, which are crucial drivers of health behaviour change and overall well-being. Connectedness is further described in this review article.

These updates underscore the ACLM's commitment to a comprehensive, evidence-based approach to lifestyle medicine, integrating mental, emotional, and spiritual health into the prevention and treatment of chronic diseases.

Meat consumption, health outcomes and industry influence

Red meat consumption continues to be a significant focus of public health research due to its association with chronic diseases such as type 2 diabetes, cardiovascular disease, and certain forms of cancer. An analysis of over 200,000 participants across three major U.S. cohorts, followed for 28 years, found that higher intakes of both processed and unprocessed red meat were consistently linked to an increased risk of type 2 diabetes, even among those following an otherwise high-quality diet (as assessed using the Alternative Healthy Eating Index). The higher risk persisted even after adjusting for BMI, waist circumference, and weight change, suggesting the harms of red meat are independent of body weight. The study also demonstrated that substituting red meat with healthier foods, such as plant-based proteins, whole grains, or seafood, was associated with lower diabetes risk. The benefit of lowering red meat consumption was greater in participants with a higher diet quality.

This study helps to counter the narrative that the negative health impacts of red meat consumption are due to the fact that consumption is associated with an overall unhealthy diet. In fact, there was a greater risk associated with red meat in those who ate a healthier diet. In addition, it has been suggested that it is the food that red meat is consumed with that is responsible for harm. But this study also addressed this and showed that even in people with the lowest french fries consumption there was still a greater risk of developing type 2 diabetes. Substitution analysis showed that replacing red meat for refined grains was also beneficial, so we can’t even blame the bun!

Processed meats, in particular, raise significant concerns given their classification as carcinogenic by the World Health Organization. Rates of cancer, particularly in people under the age of 50 years continues to rise, with diet and lifestyle factors most certainly implicated. A new report from the Food Foundations called Meat Facts finds that in the UK, nearly one-third of meat consumed is processed, with especially high intakes seen among children and younger men. The UK is consuming twice as much meat as the global average and 42% of meat consumed is chicken, despite the concerns around antibiotic resistance, pandemic risk, use of soya feed from areas of deforestation. Sadly, chicken consumption is likely to only increase especially with KFC investing 1.5 billion into the UK. There is an urgent need for public health messaging and government policies to support the reduction of meat consumption whilst increasing consumption of healthy plant-based foods.

The scientific literature on red meat is further complicated by issues of industry influence. A 2025 systematic review revealed that studies with financial ties to the red meat industry were far more likely to report neutral or favourable health outcomes related to unprocessed red meat consumption. In contrast, all studies without industry ties reported either neutral or unfavorable outcomes. This pattern mirrors what has been observed in other areas of public health research, including studies on tobacco and sugar-sweetened beverages, raising serious concerns about the role of industry sponsorship in shaping scientific narratives.

Importantly, the health effects of reducing red meat depend significantly on what replaces it in the diet. Research has shown that substituting red meat with refined carbohydrates or other animal proteins such as white meat or fish may not lead to significant health improvements, and in some cases may even be detrimental. This is a study design ‘trick’ used by industry players to minimise the effect size of any potential harm attributed to red meat consumption. However, replacing red meat with high-quality plant-based foods like legumes, nuts, and whole grains consistently yields better outcomes for cardiovascular and metabolic health. This highlights the importance of specificity in dietary recommendations, general advice to reduce red meat intake is insufficient without guidance on appropriate substitutions.

Despite mounting evidence, UK dietary guidelines offer only broad recommendations to reduce red and processed meat with relatively high upper limit of 70g per day of red meat.. In contrast, international frameworks, such as the EAT-Lancet Planetary Health Diet, advocate for more precise limits, recommending no more than 14 grams of red meat per day for both health and environmental sustainability. The Planetary Health Diet was first and foremost based on health and secondarily found to also be sustainable for planetary health. Public education, policy interventions, and industry accountability are needed to bring consumption in line with current scientific understanding. It’s worth noting that men in general consume more meat than women as shown in the Meat Facts report and corroborated by this new study from France. These habits are formed early in life according to this study from Sweden, in which diets of 4-years olds failed to meet sustainability goals with boys more likely to be consuming higher quantities of environmentally damaging foods such as meat.

The AHDB (Agriculture and Horticulture Development Board), a farmer levy board supported by Defra, continues to try and persuade us that red meat is a necessary component of a ‘healthy, balanced diet’. Their new report ‘Balancing health and sustainability: the role of red meat in the UK diet’ is counter to all the available evidence. The seventh carbon budget from the UK’s Climate Change Committee make it clear that the UK needs to reduce the number of farmed cows and sheep and significantly reduce the consumption of red meat and dairy to meet climate and nature goals. The target set is to reduce red meat consumption by 40% by 2050. There is no role for red meat consumption in a sustainable future.

A key argument remains the fact that red meat is a source of readily bioavailable iron and diets low or absent in red meat will increase the risk of iron deficiency. Interestingly, new research challenges this assumption. A controlled trial titled Dietary Adaptation of Non-Heme Iron Absorption in Vegans found that long-term adherence to a vegan diet is associated with physiological adaptations that enhance non-haem iron absorption. The study, which compared iron absorption between omnivores and vegans, demonstrated that despite the absence of haem iron in the vegan diet, overall iron status remained within normal ranges. Vegans exhibited increased fractional absorption of plant-based (non-haem) iron, suggesting that the human body may up-regulate absorption mechanisms in response to lower dietary iron bioavailability. These findings call into question the prevailing narrative that red meat is indispensable for maintaining adequate iron status and support the feasibility of plant-based diets in meeting nutritional needs when appropriately planned. Of course longer more in depth studies are required, but available evidence does not find an increased risk of iron deficiency anaemia in people following meat-free diets.

Weight loss medications and the need for complementary nutrition and lifestyle approaches

The recent surge in the use of GLP-1 receptor agonists (GLP-1RAs) like semaglutide and tirzepatide for obesity treatment has raised important concerns about nutritional adequacy. People on these medications report a marked reduction in appetite and thus risk nutritional deficiency if diet quality is not addressed at the same time.

A cross-sectional study published in Frontiers in Nutrition examined dietary intake in GLP-1RA users and found that many individuals using these medications do not meet the recommended dietary intake (DRI) for essential nutrients. Across a sample of adults using GLP-1RAs for at least one month, researchers found consistent shortfalls in intake of fiber, calcium, iron, magnesium, potassium, choline, and key vitamins including A, C, D, and E. Participants also had lower-than-recommended protein intake when calculated per kilogram of body weight, which is especially concerning given that rapid weight loss on GLP-1RAs can lead to significant loss of lean body mass. The study concluded that tailored nutrition interventions are urgently needed for this population to support adequate intake, maintain muscle mass, and prevent long-term nutritional deficiencies.

Complementing this, a joint advisory from leading organisations, including the American College of Lifestyle Medicine and the American Society for Nutrition, underscores that GLP-1 therapies are most effective when combined with comprehensive nutrition and lifestyle support. This includes ensuring sufficient intake of protein (1.2–2.0 g/kg/day during weight loss), calcium, iron, magnesium, zinc, and vitamins A, D, E, K, B1, B12, and C. Without structured dietary guidance, individuals may experience not only micronutrient deficiencies but also functional impairments such as muscle wasting and bone loss. The advisory also recommends that clinicians integrate registered dietitian / nutritionists and health coaches into care teams to provide personalised support before, during, and after weight loss therapy. Structured physical activity, particularly strength training and consistent movement, is also considered as an essential part of any care plan for patients using GLP-1 medications, to preserve lean mass, support metabolic health, and improve long-term outcomes. Additional challenges include prevention of weight regain after stopping weight loss medications. New research shows that most people have regained the lost weight within a one year period.

These findings point to the need for a shift in how GLP-1-based weight management is delivered. Historically, medical nutrition therapy and lifestyle medicine approaches have not kept pace with pharmacologic advances, similar to early gaps in support for bariatric surgery patients. Now, the evidence clearly calls for the development of specialised nutritional guidelines, food-as-medicine programs and lifestyle medicine support for those using GLP-1RAs. Doing so not only mitigates risks of malnutrition and lean mass loss but may also help patients sustain weight loss and improve long-term health outcomes.

New studies addressing common misconceptions about plant-based diets

Plant-based diets are often criticised for being high in ultra-processed foods, which of course is not a problem unique to this diet pattern. So it is useful to see this secondary analysis of a randomised trial, including 244 overweight adults assigned to either a vegan diet group or a control group for 16 weeks. The vegan group avoided all animal products and minimised oils but was not restricted in energy intake or the inclusion of processed foods. Dietary intake was analysed using the NOVA classification system, which categorises foods from unprocessed (category 1) to ultra-processed (category 4).

At the end of the study, the vegan group experienced an average weight loss of 5.9 kg compared to the control group, a statistically significant result. Crucially, weight loss was strongly associated with reduction in animal product intake across all NOVA categories, including unprocessed, processed, and ultra-processed forms. In contrast, there was no significant association between consumption of processed plant-based foods and weight gain.

Multivariate regression analysis confirmed that the top three predictors of weight loss were reduced intake of unprocessed or minimally processed animal foods, processed animal foods and ultra-processed animal foods

Even when adjusting for total energy intake and other confounders, reductions in these categories remained significantly predictive of weight loss. Importantly, participants in the vegan group consumed a variety of plant-based foods across all processing levels, yet still lost weight, suggesting that the origin of the food (animal vs. plant) is a more critical determinant of weight outcomes than the level of processing alone.

The authors conclude that replacing animal products with low-fat plant-based foods, even if some are processed, can be an effective strategy for weight loss. This challenges common criticisms that vegan diets are inherently unhealthy due to their potential inclusion of ultra-processed foods. While the study does not suggest that all processed foods are nutritionally optimal, it highlights that processed plant-based foods do not negate the benefits of a plant-based diet when replacing higher-fat, calorie-dense animal products.

Additionally, plant-based diets are also criticised for being high in carbohydrates, with carbohydrates being blamed for obesity and type 2 diabetes. Of course not all carbohydrate-rich foods are created equal. This large prospective cohort study followed over 90,000 women from the Nurses’ Health Study for more than 30 years and analysed their dietary patterns in relation to a comprehensive index of healthy ageing. “Healthy ageing” in this study was defined as survival to at least age 70 without major chronic diseases (such as cancer, diabetes, or cardiovascular disease), cognitive impairment, or physical disabilities. Carbohydrate intake was assessed in midlife and ranged from 37-57% of total energy.

The analysis showed that both higher total intake and higher-quality intake of carbohydrates were associated with healthier ageing. Diets rich in high-quality carbohydrates, such as whole grains, fruits, vegetables, and legumes, were positively associated with healthy ageing. The benefits seen were greater in those consuming the most fibre. Conversely, diets with a higher glycaemic index or higher intake of refined carbohydrates, added sugars and starchy vegetables were associated with worse outcomes. In substitution analyses, high-quality carbohydrate intake was associated with higher odds of healthy ageing when replacing energy from refined carbohydrates, total fat, animal protein, and trans fatty acids, but not when compared with energy from total or plant protein, saturated or polyunsaturated fatty acids. So there is absolutely no need to fear carbohydrates when consumed in minimally processed plant-based foods, including fruit.

Finally, there is still doubt around adherence and quality of a plant-based diet. This new study “Scoring Adherence to Voluntary Restriction Diets (SAVoReD) in the ADAPT Study” developed and validated a scoring tool to measure how closely individuals follow self-selected dietary patterns, including vegan, whole food plant-based (WFPB), vegetarian and paleo diets. Using data from over 2000 adults, the study applied the SAVoReD index to assess diet quality, consistency, and the degree to which people adhered to the core principles of their chosen diet, based on self-reported food frequency questionnaires.

The WFPB diet was defined not just by the absence of animal products, but by a focus on unrefined plant foods, vegetables, fruits, legumes, whole grains, nuts, and seeds, with minimal intake of added oils, sugars, and processed foods. In contrast, the vegan diet excluded animal products but allowed for a broader range of processed foods, including many ultra-processed vegan products.

Sixty-one percent of participants reported that they have been following their chosen diet for >2 years and 46% reported following for >5 years. The mean adherence score for all diets was 71.3% (range 25-100 %). Vegans had the highest mean adherence score (75.2%), followed by vegetarians (74.6%), WFPB (70.2%), with Paleo diet followers found to have the lowest adherence score (64.9%). Adherence to a vegan or WFPB diet was associated with a lower BMI compared to the other diet groups, with longer duration (>2 years) of following the diet associated with a lower BMI. A WFPB diet was associated with higher diet quality as defined by the healthy eating index (HEI) whereas the Paleo diet had the lowest quality due to higher intakes of saturated fat and lower intakes of fruit, plant protein and whole grains.

The authors conclude ‘greater adherence to more plant-based diets may support nutritional health…….healthier BMI and with diet quality. While, our results suggest that individuals may benefit from being encouraged to follow these diets with greater adherence, our results also indicate even imperfect or flexible adherence to these diets may be associated with improved levels of health indicators like HEI and BMI’.

Do meat-free diets increase the risk of hypothyroidism?

An interesting new study suggests that there may be a higher risk of hypothyroidism in people eating a meat-free diets. The study included 466,362 participants from the UK Biobank, of which 220,514 followed a high meat, 221,554 a low meat, 5242 a poultry-based, 10,598 a pescatarian, 8057 a vegetarian, and 397 a vegan diet. During a median follow-up of 12.7, 10,831 participants developed hypothyroidism. Only after adjusting for BMI, researchers found an increased risk of hypothyroidism in low-meat, poultry-based, pescatarian and vegetarian participants compared to high meat eaters, with the strongest association for vegetarian participants. The vegan group was too small for meaningful results.

The researchers discuss whether BMI in this setting is a ‘collider’ rather than ‘confounder’. A collider is a variable that is influenced by both the exposure (in this case, diet) and the outcome (hypothyroidism). Adjusting for a collider in statistical models can introduce spurious associations or mask true ones, leading to biased estimates. This is a well-known concept in epidemiology and causal inference. In this study, diet affects BMI: Vegetarians and vegans typically have lower BMI than meat-eaters. BMI is associated with hypothyroidism: Higher BMI is linked to higher risk of hypothyroidism. Therefore, BMI is a collider on the path between diet and hypothyroidism.

Interestingly, data from the Adventist Health Study 2 also found that vegetarians, but not vegans, had an increased risk of hypothyroidism after adjusting for BMI. In this study, higher BMI was associated with increased incidence and prevalence of hypothyroidism.

The most plausible mechanism is that people eating vegetarian and vegan diets have a lower intake of iodine as demonstrated by the results of the current study. In the presence of low iodine intakes, higher intakes of cruciferous vegetables, may also affect thyroid hormone synthesis. Interestingly, vegetarians who consume dairy, which is a major source of iodine, still had lower intakes compared to meat and fish eaters. Vegetarian and vegans in this cohort also had lower intakes of zinc, selenium and vitamin B12 that could be in part responsible for the higher risk of hypothyroidism.

Whilst we have two studies to date on the topic of plant-based diets and hypothyroidism, further research is needed to establish if there is a true increase in risk for people on meat free diets and whether this is fully explained by lower intakes of certain micronutrients. We also need to understand if a fully plant-based/vegan diet also carries a similar risk to a vegetarian diet. In the meantime, the advice to people on a meat free diet remains the same. Make sure you plan appropriately at all stage and ages of life to obtain sufficient amounts of essential nutrients. In the UK, where salt is not routinely iodised, it is advisable to take an iodine supplement.

Are vegan diets worse for glucose regulation than vegetarian diets that include dairy?

A randomised study of 30 participants in India compared the impact of a vegan versus lacto-ovo vegetarian diet on glucose regulation over a 14 day period. Both diets provided approximately 2,000 kcal/day and were matched for energy, macronutrients, fibre, and added sugar. To replicate typical Indian dietary preferences, dairy milk was substituted for chocolate soya milk, since tea is usually drunk with added sugar. A subset of participants underwent testing for various plasma metabolites that reflecting metabolic pathways relevant to diet.

While the study reports statistically significant elevations in mean glucose levels in individuals consuming a vegan diet compared to a lacto-vegetarian diet, the clinical significance of these findings is limited. The reported mean glucose concentration in the vegan group, 85.5mg/dL or 4.75 mmol/L remained well within the normoglycemic range and only modestly exceeded the lacto-vegetarian value, 78.5mg/dL or 4.36mmol/L. This small difference, approximately 7 mg/dL or 0.39mmol/l, does not meet thresholds for concern in healthy individuals, especially over a short, 14-day intervention. Similarly, other glycemic parameters such as the Glucose Management Indicator (5.4% vs. 5.2%) and time-in-range (70–140 mg/dL), which was in fact higher in the vegan group (79.7% vs. 66.9%), do not suggest impaired glucose regulation.

It is critical to distinguish statistical significance from clinical relevance. In a cohort of young, healthy adults, marginal elevations in mean glucose without evidence of glucose dysregulation or reduced time-in-range should not be interpreted as evidence of metabolic harm.

Concerns might be raised about the observed decrease in acetylcarnitine (C2), a key short-chain acylcarnitine involved in mitochondrial fatty acid oxidation. However, this is best understood as a reflection of dietary intake (low carnitine and saturated fat) and a shift in energy substrate use, rather than mitochondrial dysfunction. There is no evidence that this would have a detrimental effect on health outcomes, especially, when healthy vegan diets have been associated with lower rates of type 2 diabetes and used to induce diabetes remission.

In summary, the short-term vegan dietary intervention produced a modest, clinically insignificant increase in mean glucose, alongside a suite of metabolomic changes of indeterminant significance. It’s worth noting the authors conflict of interests include funding from the dairy industry. Also, if one truly wanted to test the impact of a fully plant-based diet without dairy and optimised for health, chocolate soya milk is not the ideal substitute!

See you all in a month!

My selection of papers this month demonstrate we have reached a level of consensus when it comes to diet and health. A healthy diet is one which prioritises whole plant foods and may or may not contain small amounts of animal-sourced foods. Ultra-processed foods (UPFs) in general should be minimised, whilst remembering that the NOVA UPF category is quite heterogenous and that some UPFs, such as whole grain breads and cereals and fortified plant-based milks and meat alternatives, may actually be a useful source of nutrients and not inherently unhealthy.

My conclusion is based in part on the results of a new study from the Harvard School of Public Health that assessed the impact of eight dietary patterns on healthy ageing amongst the 105,015 participants of the Nurses’ Health Study and the Health Professionals Follow-up study. The eight dietary patterns analysed were those known to be associated with a reduced risk of major chronic non-communicable diseases (the Alternative Healthy Eating Index, Mediterranean diet and healthful plant-based diet), hypertension (Dietary Approaches to Stop Hypertension diet), cognitive decline (the Mediterranean-DASH Intervention for Neurodegenerative Delay diet), hyperinsulinaemia (reverse empirical dietary index for hyperinsulinaemia score), inflammation (reverse empirical dietary inflammatory pattern score) and planetary health (planetary health diet index). In addition, the impact of UPF consumption was assessed.

The results showed that only 9.3% of the participants achieved healthy ageing, defined by the lack of 11 major chronic diseases and no impairment in cognitive, physical or mental function by the age of 70 years. Adherence to all of the dietary patterns mentioned was associated with a higher odds of healthy ageing, whilst a higher consumption of UPFs was associated with a lower likelihood of healthy ageing. The foods most associated with healthy ageing were fruits, vegetables, whole grains, beans, nuts, seeds and low-fat dairy. Interestingly fish did not stand out as a food that was associated with better health.

It should be noted that the population studied were mostly of White ethnicity and therefore more likely to be able to digest lactose in cow’s dairy. In non-White populations, lactose intolerance is more prevalent and thus cow’s dairy would not be an appropriate food to have in the diet. For this reason, the 2025 Dietary Guidelines Advisory Committee in the US considered fortified soya alternatives alongside and equivalent to low-fat dairy beverages and recognises in its new ‘Eat healthy your way’ framework, that dietary guidelines can be adapted to suit cultural and traditional preferences as long as the key components are included. The committee recommended prioritising plant sources of protein over animal-sourced foods for better individual and planetary health outcomes.

The DGAC was criticised by some for not making specific recommendations on UPFs, due to insufficient evidence and inconsistencies in defining and classifying UPFs in the scientific literature. Here in the UK, the Scientific Advisory Committee on Nutrition, an independent body that advises the Government, has just released an updated report on processed food and health. As expected, their conclusions are very sensible and based on the available evidence. They state, ‘not all UPFs affect health in the same way. The categories of UPF consistently associated with adverse health outcomes were those including meat and animal products and sweetened drinks.’ They also reported ‘UPF categories including vegetarian alternatives were not associated with adverse health outcomes.’

I was interested to read the Lancet Commission on rethinking coronary artery disease. The commission recommends reclassifying the condition as atherosclerotic coronary artery disease (ACAD) and to move away from focussing only on ischaemia and acute cardiac events and instead to focus on the development of atheroma and atherosclerosis. The intention is to shift emphasis away from end stages of the disease and instead to prioritise prevention and early detection. ACAD can start in utero and hence a life course approach is needed if we are to truly impact prevention and prevent premature mortality.

This is where healthy diets and lifestyle medicine come to the forefront. Ninety percent of coronary heart disease could be prevented by addressing modifiable risk factors. We already have a large body of evidence to support dietary interventions for preventing and managing atherosclerotic cardiovascular disease. Most data point towards a diet pattern centred around fruit, vegetables, whole grains, legumes, nuts, seeds and fish akin to the Mediterranean-style diet, which has been extensively studied. This type of diet is rich in fibre and micronutrients, whilst being lower in saturated fat. The requirement for fish in the diet remains debated. The study on optimal diets for healthy aging highlighted above does not find an essential role for fish and vegetarian/plant-based dietary patterns are part of evidence-based recommendations within chronic disease guidelines. This new review outlines where we are with dietary evidence for ACAD, the limitations of the data and the need for implementation science i.e. getting this knowledge into the real world and clinical practice.

Despite the potential limitations and criticisms of nutrition studies, in my view, we know enough to devise recommendations that will serve to improve the diet quality of most individuals and significantly improve population health. Of course there continues to be interest in precision nutrition approaches, which consider differences in responses to foods and nutrients between and within individuals. This reflects a general trend in medicine for personalised approaches, but cynically I feel the movement is being driven, in part, by commercial interests. Precision nutrition companies make strong health claims that are not always supported by the available evidence and may serve to widen health inequalities given the associated costs. This new review on the topic of precision nutrition in cardiometabolic diseases is worth reading. Take home message is that precision nutrition is not ready for prime time but is worth studying if this is done using robust research approaches and driven by clinical need rather than profit.

Unhealthy diets continue to cost society enormously as dietary risk factors are the leading cause of chronic ill health and premature mortality. This study aimed to comprehensively assess the macroeconomic burden of 15 dietary risk factors for 204 countries and territories from 2020 to 2050. The dietary risk factors considered were those identified from the 2019 GBD study. These were diets high in processed meats, high in red meat, high in sodium, high in sugar-sweetened beverages, high in trans fatty acids, low in calcium, low in fibre, low in fruits, low in legumes, low in milk, low in nuts and seeds, low in polyunsaturated fatty acids, low in seafood omega-3 fatty acids, low in vegetables and low in whole grains.

The analysis found that these dietary risk factors would result in an estimated global macroeconomic burden of INT $15.5 trillion from 2020 to 2050, equivalent to 0.34% of the total GDP. This economic burden was mostly related to three conditions: ischaemic heart disease (60.6%), type 2 diabetes (15.4%) and stroke (12.6%). Among all dietary factors, a diet low in whole grains incurred the largest economic burden and was the leading dietary risk factor in most countries and regions. For the UK, the estimated cost of unhealthy diets from 2020 to 2050 was INT $8.1 billion.

Dietary risk factors also contribute to significant numbers of preventable cancers, mainly from insufficient consumption of fibre-rich plant foods and overconsumption of processed and red meat and alcohol. What is not often discussed is the impact of other chronic conditions on cancer risk. A secondary analysis of a cancer screening study from the US found that the presence of chronic conditions in midlife, including cardiometabolic, respiratory and gastrointestinal conditions, significantly increased the risk of various types of cancer over a 20 year follow up period. This points towards shared mechanisms of disease development and highlights opportunities for prevention.

What we eat needs to be sustainable for the planet. This month has seen a number of misleading reports, including a new one from the AHDB that tries to persuade us that red meat should be part of our diet, provides essential nutrients and can be sustainable from an environmental perspective. This goes against all the available science. For health, the evidence supports limiting or avoiding red meat for prevention of chronic conditions. For planetary health, red meat production, especially from ruminant animals such as cows and sheep, is hugely damaging. Another paper examines the environmental impact of grass-fed beef production in the US. The analysis finds that grass-fed beef production produces significantly more greenhouse gas emissions than cows raised in factory farms and also much more compared to meat from other animals and plant sources of protein. A great article by George Monbiot for the Guardian clarifies why farming cows and sheep can never be considered sustainable.

As usual, the right wing media continue to undermine efforts to transition to a plant-based diet. The Times ran a headline suggesting vegans can’t build muscle. This was based on a new study from New Zealand that analysed protein intake in long-term vegans and found that lysine and leucine intakes fell short of recommended intakes. I was able to bring some balance to the conversation with my interview for BBC Science Focus. The paper did not assess health outcomes, let alone ability to build muscle. In fact, a few days later mainstream media reported on a randomised controlled study that found that a vegan diet matched for protein intake was equivalent to an omnivorous diet for building muscle in young, healthy men and women.

With all this misinformation circulating about the role of meat in healthy and sustainable diets, we need to change food culture and environments to support behaviour change. This qualitative study revisits public awareness and attitudes toward sustainable diets in the UK, a decade after a similar investigation in 2013/14. The researchers conducted nine focus groups with 60 adults across different rural/urban and deprivation settings in Scotland, aiming to determine whether understanding of the environmental impact of food, particularly meat consumption, had improved. The study found that while awareness of the environmental implications of food choices, including meat, has increased, especially among more affluent groups, significant barriers to reducing meat consumption remain. These include taste preferences, cultural attachments to meat, cost concerns, and scepticism about meat alternatives and conflicting dietary messages.

What remains clear is that in food service, swapping meat-based meals to equivalent whole food plant-based versions can provide nutritional, environmental and cost benefits. A new policy report published jointly by The Food Foundation, Green Alliance and The Good Food Institute provides recommendations for Government on how to support the transition towards plant-rich diets. This needs a farm to fork approach with the UK producing and eating more plant-based foods. This would bring an array of health, environmental and economic benefits.

Read my article on food industry influence and see you later in May for my next review of the plant-based and lifestyle medicine news.

Life expectancy growth stall in Europe

This study examines changes in life expectancy in European countries, including the UK, from 1990 to 2021, using data from the Global Burden of Disease Study 2021. The research identifies three key periods: 1990–2011 (steady improvement in life expectancy), 2011–2019 (a slowdown in improvement), and 2019–2021 (a decline due to the COVID-19 pandemic). In the UK, life expectancy improved at a rate of 0.25 years per year from 1990 to 2011 but slowed to 0.07 years per year between 2011 and 2019. The slowdown was attributed to reduced progress in reducing deaths from cardiovascular diseases and cancers.

Between 2019 and 2021, life expectancy declined across most European countries, with the UK experiencing some of the largest reductions. In England, life expectancy fell by an average of 0.6 years annually during this period, largely due to COVID-19-related deaths and respiratory infections. There are notable exceptions with Norway, Iceland, Sweden, Denmark and Belgium continuing to make progress after 2011. These countries (except Belgium) also maintained improvements in life expectancy in 2019–21 during the COVID-19 pandemic, when life expectancy decreased in all other countries except Ireland. These country differences appear to be due to continued reduction in deaths from cardiovascular diseases and cancer, from long-term policy interventions that address risk factor modification.

The research highlights key risk factors contributing to life expectancy trends in the UK, including high blood pressure, dietary risks, high LDL-cholesterol, high BMI, and tobacco use. While smoking rates declined, the prevalence of obesity and poor dietary habits increased, counteracting gains in cardiovascular health. The study suggests that government policies and public health interventions play a crucial role in shaping life expectancy trends. Countries that maintained reductions in major health risks, mainly due to risk factor modification, tended to show better resilience to health crises like the COVID-19 pandemic. The findings emphasise the need for stronger policies to address obesity, dietary risks, and physical inactivity to prevent further stagnation or decline in life expectancy. The authors also note that their findings do not support the hypothesis that the slowing of life expectancy improvements is because a natural longevity ceiling has been reached at around 110 years of age. This is because life expectancy is driven by changes in mortality below 100 years, where there remains scope for significant improvement through risk factor modification.

It’s worth mentioning that the BMJ this week provides an editorial on the topic UK mortality rates and raises the fact that the study discussed along with a recent BBC article fails to acknowledge the impact of the austerity programme. Austerity as a Government policy introduced in 2010 led to cuts to social security benefits and public services, disproportionately affecting the most vulnerable in society. This led to worsening of health inequalities with mortality rates increasing more in areas with greater socioeconomic deprivation. A reminder of the importance of social determinants of health and that economic policies also significantly impact health outcomes.

Nature versus nurture

This new study answers the age old question as to whether genetics or environmental exposures contribute most to health outcomes The study used rather complex methodology to analyse data from participants of the 492,567 UK Biobank study. Researchers identified 25 independent environmental exposures associated with both mortality and biological aging. These exposures were also associated with major age-related diseases, biomarkers, and risk factors. Th environmental exposures were then correlated with polygenetic risk scores for 22 major diseases.

The analysis found that genetics factors contributed less than 2% of the risk of developing serious diseases. In contrast, environmental factors explained 17% of the risk of these chronic conditions. Genetic factors contributed more to dementia and certain cancers (10-26%), whereas environmental exposures played a greater role in lung, heart, and liver diseases (5.5-49%).

The environmental factors having the most negative impact on ageing were smoking, socioeconomic deprivation, physicial inactivity and living conditions. Other negative factors included low household income, unemployment, experiencing financial difficulty in the past two years, short sleep duration (<7 hours per day), living alone (without a partner), maternal smoking around birth and greater body size at 10 years old

This is one of many studies that demonstrate the impact of lifestyle and environmental factors on health and longevity. For example, last year I covered a study from the Million Veteran Program that showed that lifestyle factors were responsible for 64% of the risk of premature death. These studies reiterate the enormous potential we have to prevent chronic ill health by addressing both socioeconomic and lifestyle determinants of health.

Dietary patterns and colorectal cancer risk

Colorectal cancer (CRC) is soon be the leading cause of cancer death in people under that age of 50 years. Yet, this is one of the cancers that can benefit hugely from adopting healthy habits, with dietary factors being key.

This systematic literature review conducted as part of the Global Cancer Update Programme (CUP Global) examines the association between dietary patterns and colorectal cancer (CRC) risk. This updated review includes data from randomised controlled trials and prospective cohort studies published up to March 2023. The analysis categorises dietary patterns based on derivation methods— a priori (predefined dietary guidelines), a posteriori (data-driven approaches), and hybrid methods— and assesses their impact on CRC risk and mortality.

The findings indicate that adherence to certain a priori dietary patterns, including the Mediterranean diet, healthful plant-based index, Healthy Eating Index (HEI), and Dietary Approaches to Stop Hypertension (DASH), is associated with a lower risk of CRC. These diets commonly feature high intake of plant-based foods and limited consumption of red and processed meats. Conversely, hybrid dietary patterns such as the Empirical Dietary Index for Hyperinsulinaemia (EDIH) and the Empirical Dietary Inflammatory Pattern (EDIP) show strong probable evidence of increasing CRC risk, likely due to their links to inflammation and insulin resistance. These dietary patterns have high intakes of meat, refined grains and free sugars and ultra-processed foods.

The review finds only limited evidence supporting the role of low-fat dietary interventions in reducing CRC risk, with studies showing no strong or consistent associations. Similarly, a posteriori dietary patterns, including “Western” and “Meat-heavy” diets, did not show conclusive associations with CRC risk, reflecting inconsistencies in their composition across studies. By cancer subsite, the Mediterranean diet appears to be linked to a lower risk of rectal cancer, while HEI and DASH are associated with reduced risks of both colon and rectal cancers.

The study highlights the complexity of assessing dietary patterns, noting that different methods of classification, regional variations, and lifestyle factors can influence findings. While no strong conclusions are drawn regarding dietary patterns and CRC mortality due to limited data, the evidence suggests that diets high in fruits, vegetables, and whole grains, and low in processed meats and inflammatory foods, may play a role in reducing CRC risk. The findings reinforce the need for public health policies promoting balanced dietary patterns as a preventive strategy against colorectal cancer. It’s worth noting that a recent analysis found that in 2018, 21.5% of cancers of the gastrointestinal tract were related to dietary risk factors.

Calcium intake and risk of colorectal cancer

We commonly hear that dairy consumption is associated with a lower risk of CRC. This is true, but it is purely related to the calcium content. This is nicely demonstrated in this new study, which investigates the association between calcium intake and CRC risk using data from the NIH-AARP Diet and Health Study, which followed 471,396 participants aged 50 to 71 years over a median of 18.4 years. The study assessed total calcium intake from dietary and supplemental sources and examined its impact on CRC risk across different tumour sites and racial and ethnic groups. Findings indicate that higher total calcium intake was significantly associated with a lower risk of CRC, with those in the highest quintile of intake experiencing a 29% lower risk compared to those in the lowest quintile. This inverse relationship was consistent across calcium sources, including dairy and non-dairy dietary sources as well as supplements, and was observed for both proximal and distal colon cancers as well as rectal cancer.

Despite overall benefits, the study found no significant association between calcium intake and CRC risk among non-Hispanic Black participants, possibly due to lower overall calcium consumption within this group. The results support prior research indicating calcium's protective role against CRC, potentially through mechanisms such as binding carcinogenic bile acids and fatty acids in the gut or reducing cellular proliferation in the colon. It’s worth noting that the production of carcinogenic or secondary bile acids is higher in people eating a meat-heavy diet. The study emphasises the importance of increasing calcium intake, particularly among populations with lower consumption, as a potential strategy to reduce CRC risk. However, further research is needed to understand variations in risk reduction across different racial and ethnic groups.

Healthy lifestyles after a diagnosis of prostate cancer

All stages of prostate cancer appear to be greatly influenced by lifestyle factors, with a growing body of evidence supporting the role of a plant-based diet. The study investigates the association between lifestyle, diet, and survival outcomes in men diagnosed with non-metastatic prostate cancer (PCa) across diverse racial and ethnic groups. Using data from the Multiethnic Cohort study, 2603 men aged 45 to 75 years were followed for a median of 10.9 years after completing a post-diagnosis lifestyle and dietary questionnaire. The study evaluated three prostate cancer behavior scores and multiple dietary indices, including the Healthy Eating Index-2015 (HEI-2015), Healthful Plant-Based Diet Index (hPDI), and dietary inflammatory and hyperinsulinemia indices.

Results showed that healthier lifestyle behaviors, as measured by the 2021 PCa Behaviour Score (which considers smoking status, BMI, and physical activity), were associated with a significantly lower risk of all-cause and cardiovascular disease (CVD) mortality. Each additional point in the score was linked to a 31% reduction in overall mortality and a 33% reduction in CVD-related deaths. The association was particularly strong among African American men, where higher lifestyle scores were associated with a 54% lower risk of PCa-specific mortality. However, no significant association between lifestyle or dietary scores and PCa-specific mortality was observed in other racial groups.

Regarding dietary patterns, the HEI-2015 and hPDI were associated with reduced all-cause mortality, while the Empirical Dietary Index for Hyperinsulinemia (EDIH) and Energy-Adjusted Dietary Inflammatory Index (E-DII) were associated with increased mortality risk, particularly from CVD. Japanese American men had the highest adherence to healthy diets, while African American and Native Hawaiian men reported higher consumption of pro-inflammatory and pro-insulinemic diets. Although no single dietary pattern showed a significant link to PCa-specific survival, the study underscores the importance of lifestyle and diet in reducing overall and CVD-related mortality among men with prostate cancer. These findings highlight the need for targeted dietary and behavioural interventions to improve survival outcomes in diverse populations. The study reminds us that 85% of deaths in the study population were due to causes other than PCa and thus addressing traditional cardiometabolic risk factors remains equally important in people with cancer.

Diet quality and psoriasis severity

There are limited data on the role of diet in psoriasis in terms of risk and severity. In general, we know that healthier diet patterns are beneficial. This is a welcome new study that examines the relationship between diet quality and psoriasis severity in UK-based adults with psoriasis. Using data from the Asking People with Psoriasis about Lifestyle and Eating (APPLE) study, researchers analysed dietary patterns through a 147-item food frequency questionnaire, assessing adherence to the Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH) score, and different versions of the Plant-Based Diet Index (PDI). Psoriasis severity was self-reported using the Simplified Psoriasis Index.

Findings indicated that lower adherence to health-promoting dietary patterns was associated with greater psoriasis severity. Individuals with very low adherence to the DASH and healthy Plant-Based Diet Index (hPDI) had significantly higher odds of reporting severe psoriasis. Similarly, those with low adherence to the original Plant-Based Diet Index (oPDI) had an increased likelihood of severe psoriasis. Conversely, individuals with low adherence to the unhealthy Plant-Based Diet Index (uPDI) had a reduced risk of higher psoriasis severity. Further analysis showed that BMI mediated the association between dietary patterns and psoriasis severity, except in the case of the DASH diet, which retained an independent effect.

Specific dietary components were linked to psoriasis severity. Higher intakes of red and processed meat were associated with worse psoriasis outcomes, while greater consumption of nuts, legumes, fruits, and vegetables was correlated with milder symptoms. These results suggest that dietary modifications may be beneficial in managing psoriasis severity and highlight the potential role of nutrition in psoriasis care pathways.

Although the study emphasises the need for further research to explore dietary interventions as an accessible and cost-effective strategy for improving psoriasis outcomes, there are no downsides to supporting people to implement the available evidence and to increase the consumption of plant-based foods. There can be some remarkable health transformations using a diet and lifestyle approach as documented by our patient advocate Kate Dunbar. Her story has been published in a medical journal and she is now 7 years free of medication and symptoms, whilst running marathons following a diagnosis of psoriatic arthritis.

Meat consumption and depression

This systematic review and meta-analysis investigated the association between meat consumption and depression through a meta-analysis of longitudinal studies. Given the inconsistency of prior research, the authors sought to clarify whether low meat consumption—either a meat-free or flexitarian diet—is linked to depression risk while also considering psychosocial factors.

A comprehensive literature search was conducted in multiple databases up to January 2024. The review included only longitudinal studies, ensuring a more reliable temporal relationship between diet and depression. The meta-analysis incorporated 20 samples from 17 studies, including both cohort and case-control designs, covering a total of 64,992 participants.

The results revealed a protective association between meat-free diets (vegetarian and vegan) and depression, with a 26% lower risk of depression among those who avoid eating meat. This association was consistent for cohort studies, studies of higher quality, and the most recently published studies. In contrast, the association between flexitarian diets (low meat consumption) and depression was inconclusive.

The study identified significant sources of heterogeneity, including study design, geographic region, gender inequality, and whether models adjusted for key psychosocial variables such as marital status, employment, and education. Subgroup analysis by population psychosocial variables supported that the relationship between a meat-free diet and depression could be influenced by psychosocial variables.

Despite some limitations, this meta-analysis provides compelling evidence that a meat-free diet may offer mental health benefits. However, it is not clear whether this association is due to dietary factors or psychosocial and cultural factors that motivate people to avoid meat in the diet.

Butter is NOT back

There remains confusion around healthy sources of fat, yet the scientific date has remains consistent for years. This study investigates the relationship between butter and plant-based oil consumption and the risk of total and cause-specific mortality among U.S. adults. Using data from three large, long-term cohort studies—the Nurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow-up Study—researchers analysed dietary patterns and mortality outcomes over a period of up to 33 years. Participants included adults without prior cancer, cardiovascular disease, diabetes, or neurodegenerative conditions at baseline, with dietary intake assessed every four years through validated food frequency questionnaires.

The analysis revealed that higher butter consumption was associated with a 15% increase in total mortality risk compared to lower consumption. In contrast, higher intake of plant-based oils, including canola, soybean, and olive oil, was linked to a 16% lower risk of total mortality. Every 10-gram daily increase in plant-based oil intake corresponded to an 11% reduction in cancer mortality risk and a 6% reduction in cardiovascular disease mortality risk. Replacing 10 grams of butter with an equivalent amount of plant-based oils was estimated to reduce total mortality risk by 17% and cancer mortality risk by a similar margin.

The findings suggest that butter, rich in saturated fats, may contribute to higher mortality, while plant-based oils, which contain unsaturated fats, may offer protective health benefits. The study supports dietary recommendations that favour plant-based oils over butter to reduce the risk of premature death. However, limitations include the reliance on self-reported dietary intake and the potential for residual confounding factors.

Butter is definitely not back, and favouring plant sources of fats is definitely a healthier choice.

See you all in April!

Vegetarian and vegan diets are nutritionally adequate and can offer health benefits:

This month we have the newly published position statement from the Academy of Nutrition and Dietetics. This has been long awaited since the previous statement from 2016 had been withdrawn. Of note, this relates to adults, 18 years and older (non-pregnant/non-lactating). We hope to see additional position statements for children and pregnancy.

The statement reaffirms that vegetarian and vegan diets are nutritionally adequate for adults and can have health benefits, although it correctly emphasises the important of diet quality. It highlights the need for vitamin B12 supplementation and additional potential deficiencies in micronutrients including, iodine, iron, calcium and choline. These can all be easily addressed through food sources and for iodine, either iodised salt, seaweed or supplementation. Fortified plant-based drinks, even if classified as ultra-processed, are acknowledged as a useful source of nutrients such as calcium and it is noted that there are no data to suggest these drinks are harmful. The statement recommends incorporating sources of alpha-linolenic acid (ALA) such as flaxseeds, chia and hemp seeds, but does not find that an algae-derived DHA/EPA is necessary for everyone. In addition, the statement acknowledges there may be benefits of a vegetarian and vegan diet for preventing and managing cardiometabolic conditions such as overweight/obesity, glucose dysregulation/diabetes, high blood lipids and blood pressure. There is also acknowledgment of the association between vegan diets and lower bone mineral density and potential increased risk of fracture. Thus ensuring sufficent intake of calcium and vitamin D and paying attention to diet quality to mitigate against these potential issues is important.

The document is aimed at dietetic, nutrition and health professionals who should have sufficient knowledge to support clients in both the outpatient, inpatient and community settings to adopt a nutrient-dense, vegetarian or vegan diet if that is their wish and that these dietary patterns can be used to manage chronic conditions. We know from our own research survey that dietitians in the UK and Ireland do not feel confident in supporting clients to adopt a plant-based diet, in part because the dietetic curricula do not sufficiently cover the topic and there is a lack of resources for use in clinical practice. It is well worth reading the full position statement which is available open access.

Plant-based diet and risk of all-cause mortality:

Plant-based diets have a number of benefits, especially for cardiometabolic health. The impact on longevity is less well studied. This systematic review and meta-analysis examined the relationship between adherence to a plant-based diet and the risk of cardiovascular, cancer and all-cause mortality. The researchers analysed data from 14 cohort studies, which had used the plant-based dietary index to categorise dietary intake into overall, healthy and unhealthy plant-based diets. The results showed that adherence to a more plant-based diet was associated with a lower risk of death (16% reduction), mostly driven by a reduction in cardiovascular disease (CVD) mortality (13%), with a small reduction in cancer mortality (4%). The benefits were greater in participants adhered to a healthy plant-based diet with reductions in all-cause, CVD and cancer mortality of 15%, 17% and 8%, respectively. In contrast, an unhealthy plant-based diet increased the risk of all-cause (18% increase), CVD (21%) and cancer (11%) mortality.

An additional study to highlight because it includes a non white population is one that used the planetary health diet index to assess adherence to the Eat Lancet Planetary Health Diet (PHD). The analysis used data from the prospective Black Women’s study in the US that followed 33,824 participants for a median of 18 years. It showed that women who adhered most to the PHD had a significantly lower risk of death during the study time period and this was driven mainly by a lower risk of cardiovascular disease. The reason for mentioning this study is that it does not matter what you call a diet, the health benefits are derived from eating whole plant foods. The Eat Lancet PHD is more than 85% plant-based. In addition, this way of eating is also predicted to be able to keep our food system within planetary boundaries, thus limiting the negative impact on environmental health. A win win. However, we need to remember that the quality of diet is key for harnessing the protective properties of a plant-based diet.

By far the greatest health benefit of a plant-based diet is for cardiometabolic health and hence the lower CVD-related mortality. Yet, one topic of continued debate in the nutrition community is the contribution of dietary cholesterol, only found in animal-sourced foods, to heart disease. This new study examines this question by analysing data from the Million Veteran Program, a prospective cohort database collecting genetic and nongenetic factors influencing chronic diseases. Researchers analysed data from 180,156 veterans and assessed the association between dietary cholesterol and myocardial infarction (MI). The results showed a linear, dose–response association between dietary cholesterol intake and risk of MI, with every 100mg/d increment in cholesterol intake associated with a 5% higher MI risk. Participants consuming >300mg/d of cholesterol had a 15% increased MI risk compared with those consuming less than 300mg/d. The authors conclude that public health guidance should recommend limiting the consumption of dietary cholesterol, which means reducing the consumption of meat and egg. The beauty of a plant-based diet is that it is free of dietary cholesterol, whilst also being low in saturated fat.

Plant-based diet and survival among patients with metastatic colorectal cancer

There are limited data on the role of plant-based diets in people with metastatic cancer, so its good to see a study on the topic. The study investigated the impact of a plant-based diet on survival outcomes in people with metastatic colorectal cancer (CRC), a topic that had not been previously explored. Using data from the CALGB/SWOG 80405 clinical trial, researchers analysed dietary habits from 1,284 people who completed food frequency questionnaires at the beginning of their treatment. The study assessed three types of plant-based diets: an overall plant-based diet (PDI), a healthful plant-based diet (hPDI) that emphasised whole grains, fruits, and vegetables, and an unhealthful plant-based diet (uPDI) that included refined grains and sugary beverages.

The findings revealed that patients who adhered most closely to a plant-based diet had significantly better survival outcomes. Those in the highest quintile of PDI experienced a 24% lower risk of death compared to those in the lowest quintile. Similarly, a diet rich in healthy plant-based foods (hPDI) was associated with improved survival, though the statistical significance was slightly weaker. In contrast, consuming a diet high in unhealthful plant foods (uPDI) did not appear to negatively impact survival. When looking at progression-free survival, both PDI and hPDI showed potential benefits, with hPDI demonstrating a modest (20%) but statistically significant improvement.

The study concludes that a plant-based diet, particularly one rich in whole, nutrient-dense foods, may offer survival benefits for patients with metastatic CRC. However, simply reducing animal foods is not enough; the quality of plant-based foods plays a crucial role. These findings highlight the need for further research to better understand the biological mechanisms behind the benefits of a plant-based diet in cancer progression and survival.

On February 4th, World Cancer Day, we launched our new factsheet on lifestyle strategies following a cancer diagnosis. We hope it’s useful given the growing number of cancer survivors. In addition, the World Cancer Research Fund launched their Policy Blueprint for Cancer Prevention. It is a package of policy recommendations for preventing cancer and living well beyond cancer, alongside their Cancer Prevention Recommendations, which have not changed since 2018.

Global food availability falls short in foods that promote health:

We know that our food and farming system does not align with health goals. In the UK, 85% of farmland is dedicated to raising animals for food, leaving only 15% of land used to produce crops for human consumption. This is far removed from the evidence we have showing that the foods that promote good health and prevent chronic conditions are fruit, vegetables, whole grains, beans, nuts and seeds. But it seems this is a global problem. This study examines global food availability in relation to dietary recommendations, highlighting persistent shortfalls and regional disparities in the accessibility of foods essential for health. While the global food supply is sufficient to meet caloric needs, it does not align with healthy dietary guidelines, particularly in terms of fruits, vegetables, and protein-rich plant foods. The research utilised the Healthy Diet Basket (HDB), a global benchmark developed by UN agencies and the World Bank, to evaluate national, regional, and global food supply trends.

The analysis revealed that while some progress has been made, significant gaps remain, particularly in low-income regions where access to nutritious foods is limited. The study identified a persistent undersupply of fruits, vegetables, and legumes, nuts, and seeds, while consumption of starchy staples, animal-source foods, and oils and fats often exceeds recommended levels. These disparities are particularly pronounced in sub-Saharan Africa and South Asia, where food supplies fall well below HDB targets. In contrast, regions like North America and Europe have an oversupply of certain food groups but still lack adequate availability of plant-based protein sources.

The research further explores future projections using economic models, suggesting that increased agricultural investment could slightly improve food adequacy in regions facing chronic hunger. However, even under optimistic investment scenarios, food supply gaps in key nutrient-rich food groups are likely to persist. The findings underscore the need for targeted policies that promote both the production and affordability of under-consumed food groups, particularly in low-income countries.

Overall, the study highlights the limitations of current food systems in providing balanced nutrition and calls for a shift in agricultural investment strategies. Efforts must go beyond increasing overall food production to focus on improving the availability of diverse and nutrient-rich foods. Addressing these shortfalls is crucial for achieving global health and nutrition goals, particularly in the context of climate change and population growth. Forward thinking countries such as Denmark, Portugal and South Korea have already produced policies and action plans to transition to a plant-based food system. We are hoping the new Government in the UK will also follow suit.

Lifestyle intervention for preventing cognitive decline

Dementia remains a key society challenge. We know that up to 45% of case could be prevented if we paid attention to known risk factors. Understanding how to deliver prevention strategies is key. This study investigated the effectiveness of an online multidomain lifestyle intervention aimed at preventing cognitive decline in older adults at risk of dementia. The study explored a scalable and personalised intervention strategy targeting modifiable risk factors.

Conducted as a single-blind randomized controlled trial, the study enrolled 6,104 dementia-free Australian adults aged 55 to 77 years, who had at least two modifiable risk factors for dementia. Participants were randomly assigned to either an intervention group, which received personalised online coaching in physical activity, nutrition (Mediterranean diet), cognitive training, and mental well-being, or a control group that received only general health information without individualised coaching. The primary outcome was cognitive performance, measured using a global cognitive composite score over three years.

The results demonstrated a significant improvement in cognitive function in the intervention group compared to the control group. Specifically, the intervention group showed a greater increase in global cognitive composite scores, with a between-group difference of 0.18 standard deviations (P < 0.001). Secondary outcomes also supported the effectiveness of the intervention, showing improvements in attention, executive function, and memory. Participants who adhered more closely to the intervention demonstrated even greater cognitive benefits. Additionally, health-related outcomes, including physical activity levels, dietary habits, and psychological well-being, improved significantly in the intervention group.

The study found that the intervention was safe, with low rates of adverse events. However, engagement levels varied, with some participants completing all assigned tasks while others engaged minimally. The intervention was particularly beneficial for younger participants (ages 55–65) and women, suggesting that early and targeted interventions may yield the most significant benefits.

Overall, the findings suggest that an online, scalable, and multidomain intervention can effectively improve cognitive function and reduce dementia risk in older adults. This approach has the potential to be implemented at the population level, providing a feasible and accessible strategy for delaying cognitive decline. The study highlights the importance of targeting multiple lifestyle factors simultaneously and reinforces the role of digital interventions in public health strategies for dementia prevention.

Time restricted eating for cardiometabolic health

The topic of fasting still gets a lot of airtime. There are different ways of fasting and it is not clear if the health impact of various fasting protocols relate to their ability to reduce calorie intake or whether there is something more special about fasting per se.

This study explored the effects of one type of fasting protocol where you eat your food with a set time period i.d. time-restricted eating (TRE). The aim was to assess the impact on visceral adipose tissue (VAT) and cardiometabolic health in adults with overweight or obesity. Conducted as a randomised controlled trial, it compared three TRE schedules—an early 8-hour eating window, a late 8-hour eating window, and a self-selected eating window—against a control group receiving usual care, which included education on the Mediterranean diet. The primary goal was to determine whether TRE, regardless of timing, had a significant impact on reducing VAT, a key factor in metabolic health.

A total of 197 participants were randomised into four groups, and their VAT levels were measured using MRI over a 12-week period. The study found no significant differences in VAT reduction among the TRE groups compared to the control group. Additionally, there were no major differences in other key metabolic indicators, including insulin resistance, blood lipid profiles, and blood pressure. However, all TRE groups showed modest weight loss, with participants losing approximately 2.4 to 3.1 kilograms, which was statistically significant when compared to the control group. The early TRE group also demonstrated greater reductions in subcutaneous adipose tissue and improved fasting glucose levels compared to the other groups.

Despite these modest benefits, the study concluded that TRE did not provide additional advantages over adherence to a Mediterranean diet alone in terms of VAT reduction. TRE was well-tolerated, with high adherence rates across all groups, and no serious adverse events were reported. The findings suggest that while TRE may support weight management, its effects on metabolic health markers, particularly VAT, remain uncertain. Future research is needed to explore longer-term effects and whether specific TRE strategies could offer additional metabolic benefits beyond conventional dietary approaches.

This is an evolving field with practitioners and individuals still trying to tease out the place for fasting protocols for prevention and managing chronic conditions. There is also a new large umbrella review that provides a comprehensive overview and in-depth evidence assessment of associations between different types of intermittent fasting and various health outcomes. Overall, the analysis showed that TRE was associated with significant improvements in cardiometabolic parameters, including weight loss, fat mass reduction and improvements in fasting insulin and HbA1c levels. The authors conclude that TRE may have a role to play in improving health outcomes in people living with overweight and obesity.

For me, adding in a period of fasting is secondary to addressing diet quality. You are going to get most of the gains from your diet by centring it around healthy plant-based foods. If you then want to trial fasting to see if that helps you achieve your health goals, then it is worth a try.

See you all in March!