Review of the plant-based nutrition and lifestyle medicine news June 2025
This month I highlight Scotland's bold plans to prioritise prevention, the dire state of nutrition in England, the power of plants for cancer prevention and survivorship and diabetes remission.
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, HbA1c, 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!