Benefits of eating more beans

By Isabelle Sadler, Research Assistant at Plant-Based Health Professionals UK

This article explores why beans deserve a place on our plates, how they can support our health, why they’re one of the most environmentally friendly protein sources available, and simple ways to enjoy more of them every day.

What is a bean?

Beans belong to the legume family, meaning they grow in pods. They are one type of pulse – the dried edible seeds of legumes – alongside chickpeas, lentils and dried peas. Pulses have been dietary staples across the world for thousands of years and remain central to many traditional cuisines.

The world of beans extends far beyond the UK’s beloved baked bean. It is estimated that there are over 400 varieties of dry beans grown globally, with around 20 commonly available in UK supermarkets. Popular varieties include kidney beans, cannellini beans, butter beans, black beans, borlotti beans, haricot beans and fava (broad) beans.

Beans are delicious and nutrient-dense

Beans are nutrient-dense: meaning they’re packed with nutrients for relatively few calories.

They are a great source of plant protein. Regardless of dietary pattern, current dietary guidance encourages us to eat more plant-derived proteins, both for health and environmental reasons. This includes the UK Eatwell Guide, which recommends consumption of 80 g/day of pulses as protein sources, which also contributes one portion to the five a day recommendation! Unlike many animal protein sources, beans provide protein alongside fibre, vitamins, minerals and phytochemicals, while naturally being low in saturated fat and containing no cholesterol.

One of beans’ greatest nutritional strengths is their fibre content. Most adults in the UK consume considerably less fibre than the recommended 30 g per day, and beans offer one of the easiest ways to increase intake. The fibre found in beans supports digestive health, helps lower cholesterol, slows the absorption of glucose after meals and promotes satiety, helping us feel fuller for longer.

While nutritional content can vary slightly by variety, beans and other pulses are a rich source of folate, thiamine, riboflavin, vitamin B6, niacin, iron, zinc, magnesium and potassium. They also provide zinc, copper, manganese, selenium, and vitamins E and K.

Beans are also an excellent source of polyphenols and other antioxidants, which help protect our cells from oxidative stress and contribute to many of their health benefits.

Health benefits of beans

Heart health and cholesterol lowering effects of beans

Regular bean consumption has been linked to reductions in LDL-cholesterol, and they can contribute to the prevention of cardiovascular diseases. A comprehensive 2026 systematic review and meta-analysis found that across 28 trials, bean consumption resulted in a significant reduction in LDL-cholesterol. Trials including chickpeas, mixed pulses and legumes showed similar benefits.

The same review also found that bean consumption resulted in significant reductions in non-HDL cholesterol and apolipoprotein B (apoB), a marker that reflects the total number of cholesterol-containing particles capable of causing atherosclerosis. Lower apoB concentrations are associated with a reduced risk of cardiovascular disease.

Hypertension is a leading driver of cardiovascular disease. Higher legume consumption has also been associated with lower odds of developing hypertension in a UK population. In a 2026 systematic review and dose-response, meta-analysis, higher legume consumption, including soya, was associated with a reduced risk of developing hypertension, with 170g per day being the optimal intake.

Healthy weight management

Eating more beans may also support healthy weight management.

A 2026 meta-analysis of 36 clinical trials found that regularly consuming beans and peas was associated with significant reductions in waist circumference, body fat, and body weight. While no significant changes were seen in body mass index (BMI), reductions in waist circumference and body fat suggest that beans and peas may improve body composition even when BMI remains unchanged.

The greatest benefits were seen in studies lasting longer than eight weeks, indicating that regular, long-term consumption is likely to be most effective.

Several characteristics of beans may explain these effects. Their high fibre and protein content slows digestion and increases feelings of fullness, helping to naturally reduce overall energy intake. Beans also contain resistant starch, polyphenols and the amino acid L-arginine, all of which may contribute to healthier body composition.

Gut health

Beans are among the best foods we can eat to support a healthy gut microbiome and likely to be one of the main reasons why people eating plant-based diets consistently show evidence of better gut health.

In one trial including 55 participants with obesity and a history of colorectal neoplasia, 8-weeks of regular bean consumption increased beneficial gut bacteria and improved microbial diversity, both of which are increasingly recognised as important contributors to overall health.

As previously mentioned, beans are rich in different types of fibre, including resistant starch, which is a type of carbohydrate that is fermented by beneficial bacteria in the large intestine. This fermentation produces short-chain fatty acids, including butyrate, which provide energy for the cells lining the colon, help maintain the gut barrier and play an important role in regulating inflammation.

Beans are also rich in non-digestible oligosaccharides, compounds that reach the colon intact and have been shown to stimulate the growth of beneficial gut bacteria, while constraining pathogens to support immune function and reducing inflammation.

The fibre in beans also supports bowel regularity and contributes to long-term digestive health.

Other health benefits of beans

The benefits of beans extend beyond heart health and weight management. Thanks, in part, to their high fibre content and naturally low glycaemic index (GI), beans cause a slower rise in blood sugar after meals, helping to improve blood glucose control. In a Danish study, replacing unprocessed red meat with beans and other pulses was associated with a reduced risk of colorectal cancer, type 2 diabetes and ischaemic heart disease. A 2024 network of case-control studies also found that consuming just one serving of legumes daily was associated with a 21% lower risk of colorectal cancer.

Why beans are good for the planet

Beans are not only good for our health, they are also one of the most sustainable protein sources available.

Compared with animal proteins, producing beans requires substantially less land and water while generating far fewer greenhouse gas emissions.

Many legumes also improve soil health through nitrogen fixation, a natural process in which specialised bacteria convert nitrogen from the air into forms plants can use. This reduces the need for synthetic nitrogen fertilisers, lowering environmental impacts while improving soil fertility for future crops.

Buying British-grown beans

Although many beans are imported to the UK, interest in British-grown pulses is growing. Choosing UK-grown beans can help support local farmers, improve crop diversity and reduce transport emissions.

Companies such as Hodmedod’s have helped reintroduce a wide range of British-grown beans and pulses, making it easier than ever to buy locally produced legumes.

How to eat more beans

Beans are incredibly versatile, which means there are plenty of different ways to add more into your diet, here are just a few ideas:

• Blend softer beans such as butter beans or cannellini beans into pasta sauces for a naturally creamy texture without cream.
• Swap out some potato in your mashed potato to create a butter bean mash.
• Add kidney beans or black beans to chilli, tacos and burritos.
• Stir chickpeas into curries, salads or roasted vegetable dishes.
• Add cannellini or butter beans to soups and stews.
• Swap half the meat in recipes such as Bolognese or cottage pie for lentils or beans.
• Mash beans with herbs, garlic and lemon for a quick sandwich filling or dip.
• Roast chickpeas with herbs and spices for a crunchy snack.
• Use silken tofu (made from soya beans) to create creamy desserts such as chocolate mousse or smoothies.
• Try making your own bean burgers and falafels, or you can buy them premade
• Experiment with new recipes from different cuisines that where beans are the star of the show, such as Fagioli all’uccelletto (Tuscan baked beans), Gigantes plaki (from Greece, great served with bread), and Ful Mudammas (Egyptian Fava Beans)

Check out a variety of bean-based recipes on the following websites: Hodmedod’s, Veg Power and Bold Bean Co.

Help people eat more beans!

If you’re a nutrition professional or work in a sector such as public health, policy, or food industry, you could be part of the campaign that aims to double bean consumption by 2028, check it out here and here.

Summary

• Beans are rich in plant protein, fibre, vitamins and minerals, while being low in saturated fat.
• Regular bean consumption supports heart health and can help lower cholesterol.
• Their high fibre and protein content promotes fullness and can support healthy weight management.
• Beans nourish beneficial gut bacteria and support digestive health.
• Their low glycaemic index helps regulate blood sugar levels.
• Add beans to soups, salads, stews and pasta sauces for an easy nutrition boost.
• Blend butter beans or cannellini beans into sauces for a creamy texture.
• Roast chickpeas for a healthy snack or mash beans into sandwich fillings and dips.
• Experiment with different varieties, such as kidney, butter, cannellini and black beans, in everyday meals.

Plant-based diets for maintaining a healthy weight

By Dr Shireen Kassam, Director of Plant-Based Health Professionals UK

Plant-based diets are a great way to maintain a healthy weight, and in doing so, can lead to significant reductions in the risk of chronic conditions associated with carrying excess body fat, particularly when this fat accumulates in body organs (visceral fat).

Overweight and obesity are at epidemic proportions with 1 in 8 people globally living with obesity. In the UK, around 65% of adults are either overweight or living with obesity, with rates higher in those living in deprived areas and in non-White ethnicities. Overweight and obesity also affects around 22-25% of children.

Living with overweight and obesity significantly increases the risk of common chronic conditions including cardiovascular diseases, type 2 diabetes, certain cancers, fatty liver diseases and arthritis, whilst also lowering life expectancy and adversely impacting quality of life.

Definition of overweight and obesity

The definition of obesity up till now has mainly been based on the body mass index (BMI). BMI is calculated as weight (kg) divided by [height (m)2] with normal considered as 18.5-24.9. The best health outcomes are associated with a BMI of 20-22. People from Asian, Middle Eastern, Black African and African–Caribbean backgrounds are prone to central adiposity, resulting in cardiometabolic conditions occurring at lower BMI levels, so a normal BMI is considered up to 22.9.

BMI is a useful tool for assessing overall health of populations, but on an individual level has been criticised as a flawed method of determining body fatness and hence health status because the measure does not distinguish between fat and muscle mass. To overcome these issues, two recent pieces of guidance – The Lancet Commission on obesity and the UK’s NICE guidance – recommend the use of anthropometric measurements, such as waist to height ratio, or waist circumference, alongside BMI.

Evidence supporting plant-based diets for weight management

The causes of overweight/obesity are numerous and multifactorial and the magnitude of the problem should not be underestimated. However, dietary behaviours are important for prevention and treatment. In general, diets high in meat, especially red meat, and ultra-processed foods, whilst low in fruit and vegetables are associated with an increased risk of overweight and obesity. In contrast, healthy plant-based diets are a very effective way of maintaining a healthy weight and losing weight if needed.

Observational studies have consistently shown that people eating diets centred on fruit, vegetables, whole grains, beans, nuts and seeds tend to have a healthier body weight. The greatest advantage is seen in people following a 100% plant-based or vegan diet. For example, in both the EPIC-Oxford study and the Adventist Health Study-2, vegans had the lowest BMI when compared to vegetarians, pescatarians and meat-eaters.

Combined data from the Nurses’ Health Studies and the Health Professionals Follow-up study show that consumption of certain foods is associated with either weight gain or weight loss over time. Regular consumption of processed foods (sweets and desserts, fries, butter, refined grains), sugary beverages, processed and unprocessed meat was associated with weight gain. Regular consumption of vegetables, fruits, whole grains, yogurt and nuts was associated with weight loss.

A more recent analysis of these study cohorts examined associations of changes in intake of overall, healthful, and unhealthful – with weight change tracked over 4-year intervals spanning more than 20 years. Adherence to an overall plant-based diet was associated with significantly less weight gain over each 4-year period, with greater benefit seen for those adhering to a healthful plant-based diet. However, an unhealthful plant-based diet (emphasising refined grains, potato/fries, sweets, sugar-sweetened drinks/juices) was associated with significantly more weight gain over the follow-up period. Similarly, in a subgroup analysis of the Nurse’s Health Study, a diet high in healthy plant-based foods was associated with less weight gain around the menopause.

Randomised studies on dietary patterns and weight management

The PCRM conducted a randomised study of a whole food plant-based (WFPB) or healthy vegan diet and compared it to the National Cholesterol Education Program recommended diet (control group). Sixty-four overweight women were included.

After 14 weeks, the mean weight loss in the WFPB diet group was 5.8kg, which was significantly greater than in the control group (weight loss 3.8kg).

Another randomised study from PCRM included 244 participants with a BMI of 25–40 who were randomised to follow either a low-fat, WFPB/vegan diet or to make no dietary changes.

After 16 weeks, the results showed that the vegan group lowered their body weight by 6.4 kg and reduced liver and muscle fat by 34% and 10%, respectively, which correlated with improvements in insulin resistance. They also increased their after-meal metabolism by 18.7%. There were no significant changes in the measured parameters in the control group.

The BROAD study was a randomised trial using a low-fat WFPB diet in a community setting for people with obesity, ischaemic heart disease or type 2 diabetes. The intervention led to a significant and sustained reduction in weight and BMI at all time points when compared to the control group with improvements sustained for the 12-month follow-up.

What is notable about all three studies mentioned is that food was not provided to participants, there was no requirement to restrict calorie intake or reduce portion size and exercise was not part of the intervention. This is especially important because many diet programs for weight loss focus on restricting calories and portion sizes. When focusing on whole-food, plant-based eating, the diet is not restrictive, but rather has an abundance of plant foods and meals, making it an enjoyable and sustainable way of eating.

A 2025 meta-analysis of randomised studies shows clear benefits for a WFPB/vegan diet for weight reduction.

How do plant-based diets help maintain a healthy weight?

1) Reduced energy density: Plant foods are lower in energy density, whilst still being high in healthy nutrients, when compared to animal-sourced foods. Most people eat the same volume of food everyday — around 1.8kg or 4lbs. So, on a plant-based diet you can generally eat to fullness whilst consuming less calories compared to other diet patterns.

2) Increased fibre intake: The increased fibre consumption on a plant-based diet is more satiating, giving the feeling of fullness with less calorie intake. Fibre also supports a healthier gut microbiome, which in turn has been associated with a healthier body weight. Fibre does not provide calories and is only present in plant foods.

3) Reduced fat intake: The lower fat intake, particularly saturated fat, can be helpful. This is because fat has nine calories per gram but carbohydrates and protein only four calories per gram.

4) Increased postprandial (post-meal) energy expenditure: Daily total energy expenditure is as follows; resting energy expenditure — 60–75% of total, physical activity — 15->30% of total, thermic (effect of food) — 10% of total. Physical activity is the energy expenditure we have most control over and the ability to change.

However, there are differences in the energy expenditure after eating, based on the diet composition. Studies have shown that a low fat, WFPB diet results in greater postprandial energy expenditure. This is because the fat content of a meal influences the action of mitochondria in the cells. Mitochondria in cells convert fuel to energy. A high fat meal adversely affects mitochondrial function resulting in reduced energy expenditure.

5) Modulation of appetite hormones: A number of hormones control our feelings of hunger and satiety. The hypothalamus, in the brain, is the control centre of hunger and satiety and hormones are produced in the hypothalamus and in the gastrointestinal tract.

Gastrointestinal hormones are involved in regulation of glucose metabolism, energy regulation, satiety, and weight management. Consumption of food triggers secretion of incretin hormones from the gastrointestinal tract, namely glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), which enhance insulin secretion and help maintain glucose control. The satiety hormones GLP-1, peptide YY (PYY), pancreatic polypeptide (PP) and amylin control appetite and energy regulation. The release of these satiety hormones can depend on meal composition and differs between states of normal and abnormal glucose control.

A study conducted by PRCM involved a randomised crossover design and examined the effects of two energy- and macronutrient-matched meals – a processed-meat and cheese meal and a vegan meal with tofu – on gastrointestinal appetite hormones and satiety in 20 men with type 2 diabetes, 20 men with obesity, and 20 healthy men. The results showed that the vegan meal led to a greater increase in the levels of gut satiety hormones, which led to greater satiety in the participants.

Areas of continued debate

Low-carbohydrate diets

There are continued debates within the scientific community as to whether a low-carbohydrate diet (however that may be defined) is more effective than a low-fat diet. However, diet quality matters more, with different macronutrient combinations leading to similar weight loss, if the overall diet emphasises healthy foods.

There are long-term adverse effects of a low-carbohydrate diet, especially when carbohydrates are replaced by animal-sources of protein and fat. This includes elevated LDL-cholesterol, increased risk of cancers and premature death.

Genetics predict response to different diets

Another common narrative is that body weight and response to different diets is dependent on genetic factors. Both the low-carbohydrate diet and genetic theory were put to the test in the DIETFITS study, which compared weight loss on a low-fat diet with a low-carbohydrate diet. After 12 months, there was no significant difference in weight change between a healthy low-fat diet versus a healthy low-carbohydrate diet. In addition, this study examined different genes that had previously been suggested to affect response to fat and carbohydrate. However, these genes did not predict weight loss or associate with the effectiveness of either diet pattern.

GLP-1 medications and dietary strategies

GLP-1 weight loss medications have significantly changed the management of obesity. These medications are hugely effective, more so than diet and lifestyle interventions. However, it must be remembered that individuals on these medications require appropriate nutrition and lifestyle support. This is to counter the effect of reduced appetite and food intake, which leads to nutritional deficiencies, especially if diet quality is not addressed. In addition, loss of lean muscle mass can be a problem and requires adequate strength building exercise along with sufficient protein intake (1-1.5g/kg/day). This is also an opportunity to embed healthy, sustainable, lifestyle habits, because when the medications are discontinued, most of the weight is regained within a year.

Summary

1. Fruit, vegetables, whole grains, legumes and nuts are key foods associated with a healthier body weight.
2. There is robust evidence to support a plant-based diet, including healthy vegan/whole food plant-based diets, for preventing and treating overweight and obesity.
3. When using a WFPB diet for weight loss, calorie counting and portion control is generally not required making this way of eating more sustainable.
4. Meat and ultra-processed foods are associated with higher body weight.
5. Any shift towards eating more plant-based foods, whilst reducing meat intake and ultra-processed foods, is going to have a positive impact on body weight if weight loss is desired.
6. Plant-based diets can support people on GLP-1 medications maintain adequate protein and nutrient intakes

Resources

10 tips for weight management on a plant-based diet

Energy density – the key to successful weight loss

Better results, starting now. Your nutrition roadmap for GLP-1 therapy – Proveg International

Nutritional priorities to support GLP-1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society.

Plant-Based Health Professionals UK (PBHP UK) is a non-profit organisation dedicated to transforming UK healthcare into a healthier, fairer and more sustainable system. We rely on conferences, teaching, grants and membership to continue our work. If you enjoyed this article please join as a member and receive discounts, exclusive events and promotion on our platforms in return. Together, we can transform UK healthcare. https://plantbasedhealthprofessionals.com/membership

Diet, lifestyle and brain health

By Dr Shireen Kassam, Director Plant-Based Health Professionals UK

Cognitive impairment refers to a decline in brain function, including forgetfulness, poor concentration and difficulty making decisions, which can then lead on to dementia. The most common types of dementia are Alzheimer’s disease and vascular dementia.

The greatest global challenge for health and social care in the 21st century

Currently more than 57 million people live with dementia worldwide and there are nearly 10 million new cases every year. In 2019, the estimated total global societal cost of dementia was US$ 1.3 trillion, and these costs are expected to surpass US$ 2.8 trillion by 2030 as both the number of people living with dementia and care costs increase.

In the UK, almost 1 million people are living with dementia. This number is expected to rise to 1.4 million by 2040, resulting in costs of up to £90 billion annually. Most of these costs are related to family and social care rather than medical care.

What is driving the development of dementia?

Although there are genetic factors that increase a persons risk of developing dementia, these genetic factors account for less than 10% of cases. Instead, the development of dementia is driven by the same mechanisms as other chronic conditions, namely inflammation, dyslipidaemia, oxidative stress, insulin resistance and an unhealthy gut microbiome. Healthy lifestyle habits are able to address these key mechanisms and chronic conditions through risk factor modification and help prevent or delay the condition. Even in individuals with a higher genetic predisposition, healthy lifestyle habits can significantly reduce the future risk of developing dementia.

Forty-five percent of cases could be prevented or delayed

The Lancet commission on dementia initially reported that 40% of cases could be prevented or delayed by addressing 12 lifestyle-related factors; tobacco smoking, physical inactivity, depression, hypertension, obesity, diabetes, hearing loss and social isolation, excessive alcohol consumption, air pollution, attaining a good level of education and traumatic brain injury. In 2024, the Lancet commission provided an updated report adding two further risk factors; visual loss and high LDL-cholesterol. With these 14 risk factors it is now predicted that up to 45% of cases of dementia could be prevented or delayed.

The 2024 report specifically recognises the importance of healthy diets with a focus on the Mediterranean and MIND (Mediterranean-DASH diet Intervention for Neurodegenerative Delay) diet. The onset of Alzheimer’s disease (AD), the commonest type of dementia, is preceded by a long pre-clinical phase, as long as 15 to 20 years. This long pathological process offers opportunities for prevention. Another interesting observation made in the Lancet Commission report is that cognitive reserve i.e. preservation of cognition or everyday functioning, can be increased or maintained despite the presence of brain pathology and neuropathological changes associated with dementia. Early-life factors, such as less education, affect the resulting cognitive reserve. Midlife and old-age risk factors influence age-related cognitive decline and triggering of neuropathological developments.

Preventing dementia by addressing chronic health conditions

Dementia shares similar risk factors as cardiovascular disease (heart attacks and stroke). Those with high blood pressure, high cholesterol, type 2 diabetes and higher body weight are at significantly increased risk of developing dementia later in life. In fact, dementia has been termed ‘type 3 diabetes’ because of the association with insulin resistance. Addressing cardiometabolic risk factors through a healthy lifestyle approach is a very effective way to prevent dementia.

An analysis from the Whitehall study of UK British civil servants included data from 7899 participants and reported the association of cardiovascular health at age 50 with the incidence of dementia using the Life Simple 7 (now amended to 8 factors) cardiovascular health score devised by the American Heart Association. After a median follow-up of 25 years, the results demonstrated that the better the cardiovascular health score at age 50 years the lower the risk of dementia. For each 1-point increment in the score (14 points in total) there was a 11% reduction in the risk of dementia demonstrating that control of cardiovascular risk factors provides a powerful tool for prevention of dementia in later life.

A further analysis from the Whitehall study cohort assessed the association between underlying chronic conditions, termed multi-morbidity, and the risk of dementia after 32 years of follow up. The presence of two or more chronic conditions, was associated with a 2.4-fold increase in risk of dementia. The younger the onset of the chronic conditions the higher the risk of dementia with the strongest association at age 55 years. The commonest chronic conditions impacting risk were hypertension, depression, coronary heart disease and diabetes.

What is a healthy diet for prevention of dementia?

In general, diet patterns centred around healthy plant foods whilst being low or avoiding animal-derived and processed foods are best for preventing chronic diseases, including dementia. This includes diet patterns such as the Mediterranean, DASH (Dietary Approach to Stop Hypertension), MIND and mostly plant-based diets. Diets high in animal and processed foods and low in plant foods increase inflammation and oxidative stress, promote lipid and glucose dysregulation and result in insulin resistance. In contrast, healthy plant-based diets have been associated with lower levels of inflammation and are packed full of antioxidant compounds that help counteract different types of cellular stress, whilst promoting insulin sensitivity and a healthy gut microbiome.

The 2026 WHO guidelines on prevention of dementia states the following about healthy diets: ‘These diets emphasise fruits, vegetables, whole grains, nuts and legumes, while limiting red meat, saturated fats and sugary foods’.

What do we know about plant-based diets (vegetarian and vegan) and risk of dementia?

There are limited data on fully plant-based diets and risk of dementia. The only study we had for a while was a preliminary report from the Adventist Health Study suggesting that meat eaters had a significantly higher risk of developing dementia compared to vegetarians. A  more recent publication analysed data from the prospective Tzu Chi Vegetarian Study. It included data from 5710 participants who were aged 50 years or older at the time of recruitment in 2005 and followed till 2014. The participants were all Buddhist volunteers, 3154 were non-vegetarian and 1737 were vegetarian. During the average follow up of 9.2 years there were 121 cases of dementia (37 vegetarians and 84 non-vegetarians) identified and vegetarians had a 33% reduction in the risk of dementia. Subgroup analysis found that vegetarians were specifically protected against dementia under the age of 75 years.

An updated analysis of causes of death of participants in the Adventist Health Study-2 found that people consuming meat-free diets, including vegans, had a lower risk of premature mortality (<65 years), mainly due to the lower risk of conditions such as heart and kidney diseases and type 2 diabetes. However, by the age of 85 years this advantage had disappeared because of a weak association with an increased risk of neurological conditions, including dementia, stroke and Parkinson’s disease. It is not entirely clear how to interpret these findings, but one suggestion is that lower lifelong intakes of long-chain omega-3 fatty acids could adversely impact brain health late in life.

Which foods are best to avoid or reduce in the diet?

Higher intake of saturated fat is associated with an increased risk of dementia. Saturated fat in the diet comes predominantly from animal foods and the consumption of processed red meat seems to be particularly bad for brain health. Diets high in refined sugars, especially sugar-sweetened beverages, adversely affect brain health. Even artificially-sweetened beverages may be detrimental because of associations with higher risks of obesity, type 2 diabetes, hypertension and cardiovascular disease.

Which foods and nutrients are particularly good for preventing dementia?

The best foods for brain health are the brightly coloured fruit and vegetables with particular benefits for consuming leafy greens and cruciferous vegetables and berries. Intervention studies have shown that eating more fruit and vegetables can improve memory and attention at all ages of life.

Fibre intake is correlated with lower risk of many chronic diseases, including those that increase the risk of dementia, such as type 2 diabetes and high blood lipids. Fibre also benefits the gut bacteria, which then can make short chain fatty acids needed for brain hormone production and for reducing inflammation. In a Japanese cohort of 3739 individuals, dietary fibre intake was inversely associated with risk of dementia. Those consuming the most, particularly soluble fibre, had a 26% reduction in the risk of developing dementia over the almost 20 year follow up. Similarly, in a US population study, fibre intake was associated with better cognitive function.

Eating fruit and vegetables that are high in flavonoids may be of particular benefit. Flavonoids are a class of polyphenols representing more than 5,000 bioactive compounds that are found in a variety of fruit and vegetables, including grapes, berries, apples and in tea. Several studies have reported a beneficial effect of flavonoids for preventing cognitive decline, reducing the risk by around 20%. One reason why polyphenols in general may be beneficial for brain health is because they lead to the generation of beneficial bioactive compounds by the gut microbiota that can be detected in the blood and are associated with a reduced risk of cognitive decline.

Higher intakes of carotenoids from yellow/orange vegetables and dark leafy green have also been found to protect brain health. A study that followed 927 elderly US residents for 7 years found that those consuming the most carotenoid-rich foods had a 48% reduction in the risk of developing dementia. Higher blood levels of carotenoids and other plant-derived antioxidants are also associated with a significant reduction in the risk of dementia.

The long-chain omega-3 fatty acid docosahexaenoic acid (DHA) is very important for the developing brain and has also been shown to be important in protecting the ageing brain. The brain is composed of around 50–60% fat and has a particularly high content of DHA. Regular consumption of fish appears to reduce the risk of dementia and it is thought that this is due to the high DHA content. Although the data on the role of DHA supplementation is not always consistent, it may be prudent for older adults on a plant-based diet and those at higher risk of dementia to take an algae-derived DHA supplement. We know that algae supplements raise blood levels to a similar degree to fish consumption.

Alcohol and risk of dementia

We have been wrongly convinced that light to moderate alcohol is good for health, especially the consumption of red wine. However, the prevailing narrative is now changing and it is generally accepted that there is no safe limit of alcohol to consume when it comes to optimising cardiovascular health and reducing the risk of cancer. The same applies to brain health. Studies have shown that even small amounts of alcohol can negatively impact the structure of the brain and contribute to an increased risk of dementia.

The importance of healthy lifestyle habits

All aspects of our lifestyle are important for prevention of dementia, not only diet. This includes regular physical activity, restorative sleep, stress management and maintaining healthy social connections. An analysis from the The Chicago Health and Aging Project, a population-based cohort study in the United States, assessed the impact of 5 healthy lifestyle habits on life expectancy and the risk of AD in 2449 men and women aged 65 years and older. A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay — MIND diet score), late life cognitive activities, moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1–15 g/day; men 1–30 g/day). Participants most adherent to a healthy lifestyle had a longer life expectancy and were more likely to spend these extra years without AD. Of note, the lifestyle score without including alcohol consumption was also associated with a lower risk of AD and mortality and therefore the advice remains that people who do not consume alcohol should not be encouraged to do so. Healthy lifestyles in general are independently associated with a lower risk of cognitive impairment and dementia, regardless of genetic risk or the presence of brain pathology determined at autopsy.

It’s never too late to adopt healthy lifestyle habits

This was demonstrated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which examined the effects of a two-year comprehensive lifestyle intervention in 1,269 adults (60–77 years old) at risk of developing dementia. One group received the following intervention: a diet intervention based on the Finnish Nutrition Recommendations (emphasises whole plant foods and minimises animal-derived and processed foods), regular aerobic exercise and resistance training, cognitively challenging computer programmes, and intensive management of metabolic and vascular risk factors. The second group received standard care (simply advice to eat healthily and exercise). After 2 years, the intervention group had a significantly higher score in overall cognitive performance.

The POINTER study is unique in scale, diversity and duration and reinforces the findings of the FINGER study. 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.

Dr Dean Ornish has published the first randomised study of an intensive plant-based lifestyle intervention in people with mild cognitive impairment or early dementia. The intervention was similar to his previous studies with a 100% plant-based diet, regular physical activity, social support and stress management. Of note, a number of nutritional supplements were also used, including omega-3 fatty acids. 51 participants were enrolled, and the study lasted for 20 weeks. Compared to the control group in which no participants demonstrated improvement, the intervention group were more likely to have stable cognitive function or demonstrate significant improvements.

Conclusions

We have enough evidence to support the important role of a healthy plant-based diet alongside other health lifestyle habits for promoting brain health and preventing dementia. Lifestyle interventions not only reduce the risk of common chronic health conditions known to increase the risk of dementia, but also address the underlying pathogenic mechanisms at play in the development of dementia.

Resources

Factsheet on Alzheirmer’s disease

Everything you need to know about soya and health

By Isabelle Sadler, PBHP UK Research Assistant, MSc Nutrition Student

Introduction

Soya has been part of the human diet for thousands of years, with records suggesting it was first consumed in China more than 2,000 years ago. Since then, it has spread across Asia and, more recently, into mainstream diets in the UK, appearing in everything from tofu and edamame to soya milk and meat alternatives.

All soya foods originate from the soya bean, a nutrient-rich member of the legume family. Broadly, soya foods can be divided into fermented varieties, such as natto, tempeh, and miso, and unfermented forms, including tofu, edamame, and soya milk.

Despite its long history and growing popularity, soya remains one of the most debated foods in nutrition science. Here we summarise some of the most important, and latest, evidence on consuming soya. From the health benefits, to the myths, and best ways to eat (or drink!) it.

Soya as part of a healthy dietary pattern

Soya is widely considered a healthy food to include regularly in the diet, and is included in many recommended dietary patterns and country dietary guidelines.

The Portfolio diet is a plant-based eating pattern that is designed to lower cholesterol. It is low in saturated fat and includes specific cholesterol lowering foods, namely soya and legumes, nuts, plant sterols, and foods rich in viscous fibres such as oats and beans. A higher Portfolio Diet Score has been associated with a lower risk of cardiovascular disease, coronary heart disease, and stroke in observational studies, as well as a more favourable blood lipid and inflammatory profile.

Soya is also included in the UK Eatwell Guide, you can find fortified soya drinks in the ‘dairy and alternatives food’ group and soya proteins such as tofu and beancurd, within the ‘beans, pulses, fish, eggs, meat and other proteins’ group.

The 2025 EAT-Lancet Planetary Health Diet recommends 2-3 servings of legumes per day, which includes soya and soya products.

Phytoestrogens and isoflavones

Soya beans are a uniquely rich source of compounds called isoflavones – particularly two types known as daidzein and genistein. Isoflavones belong to a broader family of naturally occurring plant compounds called phytoestrogens, so named because they weakly mimic the effects of the human hormone oestrogen.

Isoflavones have a similar structure to the hormone oestrogen, which allows them to interact with the body’s oestrogen receptors – the docking sites that oestrogen normally binds to. However, they are not the same as oestrogen, and should not be considered equivalent. The differences matter both at a molecular level and in terms of their effects in the body.

Oestrogen receptors come in two forms: alpha and beta. Human oestrogen binds to both equally, but isoflavones show a strong preference for the beta type. This distinction is significant, because alpha and beta receptors are distributed differently across tissues in the body. By preferentially targeting beta receptors, isoflavones can have different effects in different tissues. For this reason, they are classified as selective oestrogen receptor modulators, or SERMs.

It is largely this phytoestrogen content that has given soya its controversial reputation. The belief is that these compounds might interfere with the body’s hormonal system, which has led some to think that eating soya could affect breast cancer risk, male and female hormone levels, and thyroid function. There is no evidence to suggest that soya adversely affects hormonal health in men or women, in fact studies demonstrate beneficial impacts.

Soya and health outcomes

Soya contains all nine essential amino acids in quantities that closely match human requirements and is therefore an excellent source of protein. It is also a good source of fibre, calcium, non-haem iron and omega-3 fatty acids. This combination of nutrients, alongside isoflavones, contributes to soya being a health-promoting food, and its association with a reduced risk of several chronic diseases.

Cardiovascular diseases

In 2026, a comprehensive umbrella review of meta-analyses on soya consumption and health was published. Across seven studies, regular soya intake was associated with a large reduction in incidence and mortality of cardiovascular diseases, up to 21% in one of the included meta-analyses. The two studies that looked at stroke incidence and mortality also found a reduction in risk between 18% and 12%.

This may be, in part, due to soya’s effect on cholesterol. The same review found that soya protein significantly reduces total cholesterol and LDL-cholesterol. LDL-cholesterol is linked to a higher risk of heart disease. Soya may also help lower blood pressure, providing another route through which it could support heart health.

Cancer

Research also suggests benefits for cancer risk. The same 2026 review found that regular soya consumption was associated with a reduced risk of colon cancer, gastrointestinal cancer, gynecological cancer, lung cancer, prostate cancer, and rectal cancer. A large systematic review and meta-analysis previously published in 2022 reinforced this, finding that higher soya intake was associated with a 10% reduction in overall cancer risk, with each additional 25g of soya per day linked to a 4% reduction. For site-specific cancers, lung and prostate cancers showed some of the most consistent effects for a reduction in risk. One exception worth noting is an increased risk of stomach cancer was observed in men consuming one to five cups of miso soup per day, though this is most likely due to miso’s high salt content rather than the soya itself.

On breast cancer specifically, a 2024 systematic review found that intake of soya protein and products was associated with a significantly reduced risk of breast cancer recurrence. While no association was seen for risk of breast cancer-specific mortality, a significant reduction in risk was found for estrogen receptor-positive disease in breast cancer-specific mortality. Soya foods should therefore be encouraged, even for women at high risk or with a diagnosis of breast cancer.

Soya protein has also been associated with a reduced risk of kidney disease and type 2 diabetes, better cognitive function, and improved bone health in women, suggesting that its benefits extend beyond heart health and cancer prevention.

Menopausal hot flushes

The idea that soya might ease menopausal hot flushes dates to the early 1990s, when researchers proposed that the weak oestrogen-like activity of isoflavones could help cushion the drop in oestrogen that women experience during the menopause transition. Three decades worth of clinical trials later, and the evidence is still somewhat mixed.

The majority of these trials have used isolated soya isoflavone supplements to test whether they can alleviate hot flushes, which may contribute to the wide variation in results seen in clinical trials. The supplements used can either be produced from whole soya beans with an isoflavone profile similar to that found in soya foods (genistein is the predominant isoflavone) or from the germ portion of the soya bean which is much lower in genistein. The trials using the former, with at least 20 mg genistein and 50–60 mg total isoflavones consistently show isoflavones to be efficacious for reducing the frequency and severity of hot flashes.

There has been a small, randomised study of a whole food plant-based diet with the addition of 86g of cooked soya beans in the intervention arm, compared to the usual diet in the control group. The impact on hot flashes assessed after 12-weeks showed that although both groups reported improvements, participants on a plant-based diet with added soya had a greater reduction in the frequency and severity of hot flashes.

Despite these inconsistent results, it can be argued that results are good enough to recommend the regular intake of soya as a food (not as a tablet), not least because of a number of other benefits and the absence of side effects. Soya foods should be recommended over isolated soya isoflavones where possible, as these foods are a composite of intricate biologically active molecules rather than containing just isoflavones.

Thyroid function

Scientists have been investigating the relationship between soya and thyroid function since as far back as 1933. Decades of research since then have produced a fairly clear picture: isoflavones do not affect thyroid hormone levels in people with normal thyroid function.

Even in people with subclinical hypothyroidism (where the thyroid is underactive but not yet causing obvious symptoms), or in those whose iodine intake is on the low side, current evidence suggests isoflavones are unlikely to cause significant problems.

One practical consideration does apply to people taking levothyroxine, the medication commonly prescribed for an underactive thyroid. Soya may reduce how well the drug is absorbed, though it‘s worth noting that this is also true of food in general, as well as many other supplements and medications. This does not mean people on levothyroxine need to avoid soya altogether. The simplest solution is timing. Taking the medication around an hour before eating, or waiting several hours after a meal before taking it, is enough to get around the issue. For those who eat soya regularly and consistently, another option is for their doctor to adjust their levothyroxine dose to account for it, but please note this is something for individuals to discuss with their healthcare professional.

Soya protein for muscle mass and strength

Evidence indicates that soya protein is as effective as whey and other animal proteins for supporting gains in muscle strength and lean body mass. A 2018 meta-analysis of nine studies comparing soya protein with animal proteins found that supplementing resistance training with either whey or soya protein resulted in significant improvements in strength, with no significant differences between groups. Similarly, both lean body mass and strength increased in participants consuming soya protein and those consuming other protein sources (including beef, milk, and dairy proteins), with no significant differences in outcomes between the groups.

Soya and the environment

Since the 1950s, global soya bean production has increased 15 times over. Growing soya at such a massive scale is not sustainable, and has led to vast areas of forest being burnt and cut down to make way for soya plantations. Converting forests and grasslands into farmland for soya also releases carbon dioxide and other greenhouse gases which cause climate change.

Some have blamed plant-based diets for the increase in soya production and the associated environmental damage. But that’s far from the reality. Globally, around 90% of all soya is fed to chickens, pigs and cows, and only around 5% is eaten by humans. The huge increase in soya production is therefore mostly the result of meeting the growing demand for foods made from animals. This is also true in the UK, where 90% of imported soya is fed to chickens and pigs and can be directly linked back to deforestation in the Global South. Eating soya directly is far more efficient than feeding it to animals first.

Soya allergy

While soya can be beneficial for almost everyone, those with a soya allergy need to completely avoid it. Soya is classed as one of the 14 main food allergens in the UK, and all food and drinks ingredient labels for sale within the UK must clearly state soya as an allergen.

Those with a soya allergy don’t need to worry, there are many other health-promoting foods to include in the diet instead. For more information on soya allergy, please refer to the factsheet on our website. Please consult your doctor if you suspect you have an allergy or intolerance to soya or need to avoid it for medical reasons.

Ways to include soya in the diet

Take home points

• Soya provides a high quality protein source containing all nine essential amino acids and many other vitamins, minerals, and plant compounds, making it an excellent addition to any dietary pattern.
• Regular soya consumption is associated with many health benefits, including a reduced risk of cardiovascular disease, several cancers, as well as potential benefits for bone health, kidney health, and menopausal symptoms.
• Soya foods do not adversely affect hormonal health. Individuals with breast cancer can be reassured that regular soya intake is safe and can be encouraged.
• Soya production has significantly lower impacts on the environment compared to the production of animal-sourced foods.
• Aiming for around two portions of soya food a day is recommended, for example, a glass of calcium-fortified soya milk, 4 tablespoons of tofu, tempeh, or edamame beans.

Resources:

• What you need to know about soy and health
• The health effects of soy: A reference guide for health professionals
• Soya Nutrition, Health and Sustainability
• In a Nutshell podcast episode on soy

The Mediterranean diet: how does it compare to a plant-based diet?

By Dr Shireen Kassam, Director of Plant-Based Health Professionals UK

The Mediterranean diet is one of the most well-researched dietary patterns in the medical literature and is universally considered to be one of the healthiest ways to eat.  The diet is best known for its positive impact on cardiovascular health.

The Mediterranean diet is not just a single diet because the region itself is large with a variety of traditional ways of eating. The usual image that comes to mind when thinking about the Mediterranean diet is sitting on a white, sandy beach on a warm summer’s day sipping red wine and eating olives and maybe even grilling fish on an open barbecue. In fact, Sardinia in Italy and Ikaria in Greece are both Blue Zones, diverse regions of the world where people live the longest and healthiest lives and have the greatest chance of living to 100 years old.

What is important to understand is that the Mediterranean diet is beneficial because of the emphasis on whole plant foods.

Evidence supporting the Mediterranean diet

Primary prevention

The PREDIMED study is usually cited as the landmark study that demonstrated that the Mediterranean diet is good for cardiovascular health. This study randomised 7,447 participants who were at high risk of developing cardiovascular disease (CVD) into three groups; two intervention groups and a control group. The intervention groups were randomised to a Mediterranean diet with added extra-virgin olive oil (50 grams/4 tablespoons) or a daily portion of nuts (30 grams).

After following the participants for 4.8 years, the results showed only minimal weight loss in each group, with no difference between the intervention and control groups. However, both intervention groups had a lower combined risk of experiencing a heart attack, stroke, or dying from CVD compared to control. The main contributor to this significant finding was a 40% reduction in the risk of stroke in the nut consuming group rather than any reduction in heart attacks or risk of dying from CVD. There was no reduction in the risk of death.

Secondary prevention

The Lyon Diet Heart Study was a randomised secondary prevention trial aimed at testing whether a Mediterranean diet could reduce the risk of recurrent myocardial infarction (heart attack) after a first myocardial infarction.

The intervention arm on the Mediterranean diet included eating alpha-linolenic acid (omega-3 fatty acid) and linoleic-acid (omega-6 fatty acid) supplemented margarine in place of butter and cream. The study was stopped early due to the benefits in the Mediterranean diet group, which showed a significant reduction in recurrent cardiac events and death.

The CORDIOPREV study (Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention) is the latest randomised study of a Mediterranean diet. 1002 participants with heart disease were either assigned to a Mediterranean diet or a low-fat diet and followed for 7 years. The goal in the Mediterranean diet group was to consume >35% of calories from fat mainly from olive oil. In the low-fat group the aim was to lower fat consumption to <30% of calories. Protein consumption was intended to remain constant and hence fat was replaced by carbohydrates. In the Mediterranean diet group, fat was increased by consuming more olive oil, nuts and fatty fish. In the low-fat group these foods were reduced and replaced by more whole grains, legumes and low-fat dairy. Of note, the low-fat group did not achieve the macronutrient goals, so this cannot truly be deemed a low-fat intervention.

Nonetheless, the results showed a significant benefit for the Mediterranean diet with participants having a 26% lower overall rate of cardiovascular events and mortality. Those with the greatest adherence to the Mediterranean diet had a 40% reduction in cardiovascular events.

What makes the Mediterranean diet healthy?

When researchers analysed the dietary data of more than 20,000 men and women in Greece, they found that vegetables, legumes, nuts, fruits and unsaturated fatty acids (from plant sources) were the components of the Mediterranean diet associated with health benefits. Dairy, fish, and meat as part of the Mediterranean diet did not appear to confer health benefits. So, the diet is healthy because of the strong emphasis on the plant-based foods and not because of the animal-based foods that are included.

When the PREDIMED study data were analysed using the provegetarian score, there was a significant reduction in the risk of all cause and cardiovascular mortality in participants consuming a diet with higher intakes of plant-based foods. The authors of this analysis concluded ‘we provide evidence to support that the simple advice to increase the consumption of plant-derived foods with compensatory reductions in the consumption of foods from animal sources confers a survival advantage to older subjects at high cardiovascular risk’.

Can the Mediterranean diet be made even healthier?

Researchers have tried to improve upon the traditional Mediterranean diet by adding more plant foods, less meat, green tea, walnuts and Mankai (duckweed), the so-called ‘Green Mediterranean diet’.

In randomised studies, this more plant-based version out-performed the traditional Mediterranean diet for improvements in cardiometabolic risk factors and fatty liver disease. These additional benefits of the Green Mediterranean diet correlate with increased intake of plants and reduced intake of meat and may be due to enhanced effects on the health of the gut microbiome.

Comparing Mediterranean diet to vegetarian and vegan diets

There are now a few, head-to-head comparisons of the Mediterranean diet versus a 100% plant-based diet or vegetarian diet.

The CARDIVEG study randomly assigned 118 overweight participants with high blood lipids or glucose, who were not on any medication, to either a vegetarian or Mediterranean diet. It was a 3-month intervention with both diet groups having the same but reduced calorie intake. After 3 months both groups crossed over to the other diet pattern.

Both diets were equally effective in reducing body weight, body mass index, and fat mass. The vegetarian diet was more effective in reducing total cholesterol, low-density lipoprotein (LDL) cholesterol and insulin levels, whereas the Mediterranean diet led to a greater reduction in triglyceride levels.

The OMNIVEG study compared the Mediterranean diet with a vegan Mediterranean diet in 14 healthy, physically active men. The results showed that the vegan version resulted in greater reduction in total and LDL-cholesterol and blood pressure and without compromising markers of athletic performance.

Another small study compared the vegan diet to a Mediterranean diet in 24 young, healthy volunteers. The Mediterranean diet led to improvements in microvascular function and the vegan diet led to greater reductions in total cholesterol and body weight. It is worth noting that the vegan diet in this study was relatively high in fat with participants consuming 35% of calories from fat.

At the start of 2021, a larger head-to-head comparison of the Mediterranean diet versus a low-fat vegan diet was published. The study randomised 62 overweight adults to either a Mediterranean or vegan diet for 16 weeks. After a 4-week washout period in which participants returned to their baseline diet, they then crossed over to the alternate diet for a further 16 weeks. Both groups could eat as much as they wanted. The Mediterranean diet followed the diet in the PREDIMED study and included 50g of olive oil daily. The vegan diet was intended to contain approximately 75% carbohydrates, 15% protein and 10% fat from whole plant sources, no added oil and a B12 supplement. Body weight, blood pressure, body composition, insulin resistance and glucose tolerance were measured before and after each phase.

The actual fat intake was 43% of calories in the Mediterranean group and 17% in the vegan group. Although participants could eat as much as they wanted, the vegan group consumed around 500 less calories per day and had a higher intake of fibre and lower intakes of saturated fat and cholesterol. The vegan group lost an average of 6kg, but the Mediterranean diet group lost no weight. The vegan group also had significant reductions in body fat and visceral fat and significant improvements in blood total and LDL-cholesterol levels and insulin sensitivity. These parameters did not change in the Mediterranean diet group. Both groups had reductions in blood pressure but there was a greater effect in the Mediterranean diet group.

Planetary health, cost and inclusivity

Where a fully plant-based or vegan diet has a clear advantage is the impact on planetary health and cost. All animal sourced foods have a greater environmental footprint compared to plant-based foods, regardless of farming methods and place of origin. The emphasis on fish and inclusion of other animal-sourced foods in the Mediterranean diet increase both the environmental impact and cost of the diet.

It’s also worth noting that many cultures around the world will not identify with the Mediterranean diet. Their traditional diet patterns may already be healthy due to an emphasis on healthy plant foods. This includes traditional Asian and African diets.

An Indian adaptation of the Mediterranean may even be healthier than the typical version due to the higher intakes of legumes, wider variety of whole grains such as millet, and the abundance of beneficial spices.

Summary

• The Mediterranean diet is beneficial because of the emphasis on whole plant foods.
• Compared to a typical Western-style diet it has significant benefits for health.
• Dietary components such as fish, poultry, alcohol and dairy may make the diet more acceptable within our cultural and societal norms, but are not essential components.
• Increasing the plant-based component of the Mediterranean results in improvement in body weight, LDL-cholesterol and fatty liver with variable results shown for blood pressure and triglyceride levels.
• The macronutrient ratio of the diet matters less than the quality of food being consumed.
• A fully plant-based diet is better for the environment and cheaper than the Mediterranean diet.
• A plant-based diet is more easily adapted to different cultural and traditional diet patterns, as most of the global population will not identify with the Mediterranean diet.

Low-carb plant-based diet – what to eat?

By Dr Shireen Kassam, Director of Plant-Based Health Professionals UK

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.

For some people, lowering the proportion of carbohydrates in the diet can help with achieving certain health goals, such as weight loss or better lipid and glucose control.

Diets lower in carbohydrates, or low-carb diets, have caught on in the UK, especially for the management of type 2 diabetes. However, the diet is not without its concerns, especially in the long-term, if not adequately planned.

Definition of a low-carb diet

There is no standard definition of a low-carb diet, but in general it is a diet that has a carbohydrate intake of <130 g/day or <26% of total energy.

The rest of the diet will come from different proportions and sources of fat and protein. The types of high fat and high protein foods consumed will determine the impacts they have on health.

Misguided fear of carbohydrates

Not all carbohydrate-rich foods are created equal. The carb-rich foods associated with poor health are those low in fibre and high in refined sugar and refined grains. This includes sugar-sweetened beverages, white bread, cakes and pastries. In contrast, whole or minimally processed plant foods such as fruit, vegetables, whole grains and beans, which are also high in various types of carbohydrates, are some of the healthiest foods you can eat. This is because they come packaged with fibre and an array of vitamins, minerals and other phytonutrients that are associated with better physical and mental health and a reduced risk of chronic conditions.

When diets composed of different macronutrient ratios have been compared, such as low-fat versus low-carb diets, the data consistently show that diet quality matters more. Diets lower in fat or lower in carbohydrates can both support better cardiovascular health, weight loss and prevention and treatment of type 2 diabetes.

Health impacts of a low-carb, animal-based diet

In the short term, low-carb diets have been shown to result in weight loss and improve blood sugar regulation, in part, because there is reduced consumption of ultra-processed foods high in free sugars and refined grains. However, when compared to high quality low-fat diets with a balanced range of carbohydrates, there does not appear to be any special advantage for weight loss in people with or without type 2 diabetes.

Concerns arise when carbohydrates are replaced by animal sources of protein and fat. This can result in nutritional deficiencies due to the lower intake of plant-based foods, including folate, vitamins C and K, magnesium and fibre deficiency.

In addition, numerous studies have shown that when low-carb diets result in higher intakes of saturated fat, found predominantly in animal-sourced foods, this leads to elevated blood LDL-cholesterol levels. Elevated LDL-cholesterol is a major risk factor for atherosclerotic cardiovascular disease, including heart attacks and strokes. This is likely to be why some studies have reported greater evidence of coronary artery atherosclerosis in people following a low-carb diet.

Long-term concerns from observational studies include higher rates of all-cause, cardiovascular and cancer-related mortality with animal-based low-carb diets – that means, a higher chance of premature death.

Animal-based low-carb diet versus plant-based diet

An important metabolic ward study tested a low-fat plant-based diet head-to-head with a low-carb animal-based diet. The 20 participants could eat as much as they wanted during the two week period, with each participant trialling both diets.

On the plant-based diet, participants consumed significantly less calories. Both diets led to improvements in fasting glucose and insulin levels, but the plant-based diet resulted in greater weight and body fat loss and improvements in cholesterol levels. The low-carb group lost mainly water weight and muscle mass, developed a degree of insulin resistance, had higher postprandial triglyceride levels and a rise in LDL-cholesterol levels. The low-carb diet did improve fasting triglyceride levels, which worsened on the plant-based diet.

A healthy low-carb diet

For some people, there may be advantages to adopting a low-carb plant-based diet. Higher intakes of plant sources of fat, particularly polyunsaturated fats such as omega-3 and omega-6 fatty acids can result in lower triglyceride and LDL-cholesterol levels. Additionally, higher protein intakes may help with satiety, which may support weight management. Higher protein intakes may be especially useful for individuals using GLP-1 medications for weight loss, and this can help to prevent muscle loss when combined with regular strength training.

Low-carb plant-based diets have been coined and studied under the name Eco-Atkins, a diet that contains increased protein and fat from gluten and soya products, nuts and vegetable oil. In both a 4 week and a 6-month randomised controlled trial, the Eco-Atkins diet resulted in greater lowering of triglycerides and LDL-cholesterol when compared to a high-carb lacto-ovo vegetarian diet. However, it’s worth noting that these studies, albeit randomised, are small, with the longer-term one having a high drop-out rate.

As mentioned previously, lowering carbohydrates, even in the context of a plant-based diet does not appear to have additional benefits for weight loss if the diet is focussed on minimally processed plant-based foods.

Long-term health outcomes of a plant-based diet

Observational studies have consistently shown that populations consuming a mostly or exclusively plant-based diet have better health outcomes, including lower rates of coronary heart disease, overweight and obesity, type 2 diabetes, certain cancers and a reduced risk of early death. This is regardless of the macronutrient ratio of the diet.

A good example comes from the Blue Zones, regions around the world where people live the longest and healthiest lives. People in Ikaria, Greece tend to eat a higher fat diet, specifically high in extra virgin olive oil. In contrast, people in Okinawa, Japan, eat a very high carbohydrate diet with the purple sweet potato being a major source of energy. What the diet of the Blue Zones have in common is that they are predominantly or entirely based around fruit, vegetables, whole grains, beans, nuts and seeds.

Summary

• Diet quality remains more important than macronutrient ratios.
• Low-carb diets are currently recognised by UK guidelines as one evidence-based option for the management of type 2 diabetes and for supporting weight management in people living with overweight or obesity.
• Some people may find that a low-carb diet helps them to achieve their health goals.
• Diets high in animal-sourced fats and protein are associated with poorer health outcomes in the longer-term.
• If lowering carbs in the diet, they should be replaced by plant sources of protein and fat.
• It is best to first discuss with a registered dietitian or healthcare professional before changing your diet.

How to adopt a healthy low-carb diet

Healthy low-carb foods

• Vegetables: artichokes, asparagus, aubergine, broccoli, brussels sprouts, cabbage, cauliflower, celery, courgettes, cucumber, garlic, green beans, kale, leeks, lettuce, mushrooms, onions, peppers, pumpkin, radishes, soya beans, spinach, tomatoes
• Fruits: avocado, blackberries, olives, raspberries, strawberries
• Protein/fat: almonds, almond milk, brazil nuts, chia seeds, flax seeds, hazelnuts, hemp seeds, macadamia nuts, pecans, pine nuts, pumpkin seeds, sesame seeds, soya milk, sunflower seeds, tempeh, tofu, walnuts, yoghurt, nut butters
• Pasta: made from edamame, lentils, chickpeas, beans or pea protein
• Flours: made from naturally low carb food sources such as lupin or almond flour
• Dips: hummus, bean salsa, guacamole
• Condiments/flavouring: chilli powder, cinnamon, cocoa, herbs, mustard, pesto (vegan version), spices, tomato puree, vinegar, vanilla extract

Coconut is low carbohydrate but should be consumed in moderation as it contains saturated fat. A small amount of oil occasionally for a particular favourite recipe probably does no harm for most people.

Plant-based low-carb breakfast ideas

• Smoothies – start with a base of fortified soya milk, soya yoghurt, or silken tofu and water, then add your preferred fruits and veggies such as berries, spinach, kale, cucumber or avocado, and add flaxseeds, chia seeds, or hempseeds for unsaturated fats. A squeeze of lemon or vanilla extract can also add extra flavour!
• Chia seed pudding – soak chia seeds overnight in fortified soya milk and top with berries, nuts, seeds, or nut butter. Optionally add vanilla extract and/or cocoa powder to taste. A great option for meal prepping in advance.
• Tofu scramble – lightly fry some crumbled tofu with veggies such as spinach, mushrooms, tomatoes, and avocado.
• Soya yoghurt bowl – top soya yoghurt with nuts, seeds, and fruit
• If you’ve got a bit longer to make breakfast, try a tofu shakshuka recipe or chickpea flour omelet

Plant-based low-carb main meal ideas

• Salads – start with a base of dark leafy greens, top with a quality protein source such as marinated tempeh or tofu, add your preferred veggies, nuts, and seeds, and top with some hummus, guacamole, or dressing
• Soups – start with a base of non-starchy vegetables (e.g. cauliflower, courgette, spinach or broccoli) blended with vegetable stock, then blend in protein such as silken tofu, and flavour with herbs, spices, and healthy fats like olive oil or seeds.
• Bean-free chilli made with soya mince, mushrooms, peppers, and a side of avocado
• Baked tofu with roasted low-carb vegetables such as asparagus, broccoli and cauliflower and tahini dressing
• Tofu satay made with firm tofu and a sauce of peanut butter, garlic, lime juice, and water, served with a stir-fry of non-starchy vegetables.
• Thai-style vegetable and tofu curry with a small portion of brown rice

These are just some ideas to get you started with finding plenty of free recipes online!

Low-carb snacks

• Nuts and seeds
• Protein balls
• Olives
• Edamame beans
• Nut butter with celery sticks
• Hummus, guacamole or salsa with low carb veggie sticks
• Unsweetened soya yoghurt topped with berries
• Berries with chocolate dipping sauce (made from a combination of peanut butter, cocoa powder, vanilla extract and a splash of water)
• 70% plus dark chocolate

Low-carb plant-based meal plan example^*

*Portions based on a standard 2000Kcal daily intake designed by Carbs & Cal app. This low-carb plant-based meal plan is intended for educational purposes only.

Resources

• SACN report: Lower carbohydrate diets for type 2 diabetes (2021)
• A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force on low-carbohydrate diets.
• Aktins for healthcare professionals

Iodine for babies and children: how much do they need?

by Dr Miriam Martinez-Biarge

Iodine is a vital nutrient at all ages.

Our thyroid gland takes iodine from the blood, combines it with the amino acid tyrosine and makes thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid hormones control cardiac, muscle and digestive functions, body temperature, menstrual cycles, cholesterol levels and body weight.

Thyroid hormones also regulate bone growth and brain development, and that is why a normal thyroid function is essential during pregnancy and the first years of life: iodine deficiency or insufficient thyroid function (hypothyroidism) can cause poor growth and impaired intellectual function in babies and children. Iodine deficiency during pregnancy increases the risk of congenital anomalies and miscarriage.

The iodine content of land plant foods depends on the iodine present in the soil. This varies considerably by country, region and agricultural practices and is generally low in the UK and much of Europe. As a result, fruits, vegetables, grains, legumes and nuts usually provide relatively small amounts of iodine and are unlikely to meet requirements on their own. People following plant-based diets therefore need to ensure they have a reliable source of iodine through fortified foods, supplements or both.How much iodine do babies and children need?

The recommended daily intakes in the UK are: 70 micrograms (mcg) for 1-3 year old children, 100 mcg for 4-6 year olds, 110 mcg for 7-10 year olds and 130 / 140 mcg for 11-18 year old girls and boys respectively.  Pregnant and breastfeeding women should ensure an iodine intake of around 200 mcg per day from diet and/or supplements.

Where is iodine found?

Iodine is naturally abundant in the oceans. Sea vegetables and fish have the largest concentrations of iodine. Dairy products are one of the main sources of iodine in the UK’s diet, because cows’ feed is fortified with iodine and because of the use of iodine-containing disinfectants during milking. Unlike many other countries, iodised salt is rarely used in the UK and therefore cannot be considered as a source of iodine.

The iodine content of land plant foods depends on the iodine present in the soil. This varies considerably by country, region and agricultural practices and is generally low in the UK and much of Europe. As a result, fruits, vegetables, grains, legumes and nuts usually provide relatively small amounts of iodine and are unlikely to meet requirements on their own. People following plant-based diets therefore need to ensure they have a reliable source of iodine through fortified foods, supplements or both.

Babies under 1 year

During the first year iodine requirements are well covered with breastmilk or formula milk and babies do not need to take supplements. For breastfed babies, iodine intake depends on maternal iodine status, so breastfeeding mothers should ensure that their own iodine intake is adequate.

Children over 1 year

From one year of age, vegan children should obtain iodine regularly from fortified foods, supplements, or a combination of both. Many children’s multivitamins contain iodine, although the amount varies considerably between products. Families should check labels carefully. Some vegan-specific supplements, for example, The Vegan Society’s VEG 1 Baby and Toddler (for children 6 months-5 years) and VEG 1 tablets (for older children), are now available and provide the right amount of iodine alongside other nutrients of importance in plant-based diets, such as vitamin B12, vitamin D and selenium.

Many plant milks are now fortified with iodine, typically providing around 20–30 micrograms (mcg) per 100 ml, similar to the amount present in cow’s milk. A child drinking 250–300 ml of an iodine-fortified plant milk daily may obtain a substantial proportion of their iodine requirements from this source (60–75 mcg).

However, iodine fortification remains inconsistent between brands and many plant milks still contain little or no iodine. Families should therefore check labels carefully rather than assuming that a product contains iodine. Organic plant milks are generally not fortified with iodine.

It is also important not to assume that other plant-based dairy alternatives provide the same amount of iodine as fortified milk. Plant yoghurts are often not fortified with iodine, and most vegan cheeses contain little or no iodine. When assessing iodine intake, check the nutrition information for each product individually.

As a general guide, children up to 10 years of age who drink 250–300 ml of an iodine-fortified plant milk every day may not require an iodine supplement, whereas those who drink little or no fortified milk should consider one. Children over 10 years need two glasses of iodine-fortified milk a day to meet most of their requirements; if they don’t drink this amount, they should take a supplement.

What about sea vegetables?

Sea vegetables can contain significant amounts of iodine, but the iodine content varies enormously between species and even between batches of the same product. For this reason, seaweeds are not a reliable way to estimate iodine intake.

Small amounts of lower-iodine seaweeds such as nori can be enjoyed as part of a healthy diet and may be used in dishes such as sushi, rice balls or vegetable wraps. Occasional consumption of wakame, for example in miso soup or seaweed salads, is also unlikely to be a concern in older children.

However, some seaweeds, particularly kombu (kelp), arame and hijiki, can contain extremely high amounts of iodine and are not recommended for children or for pregnant and breastfeeding women because even occasional consumption may result in iodine intakes well above recommended levels and could affect thyroid function. In addition, hijiki may contain significant amounts of inorganic arsenic and is generally best avoided.

Because of the variability in iodine content, seaweeds should not be relied upon as the main source of iodine for vegan children. Babies and toddlers under 2 years of age are best offered alternative sources of iodine, such as breastmilk, formula, fortified foods or supplements where appropriate.

Families who consume seaweeds regularly, particularly as part of a cultural or traditional dietary pattern, may benefit from reviewing their overall iodine intake with a dietitian.

The health benefits of nuts and seeds

By Isabelle Sadler, PBHP UK Research Assistant and MSc Nutrition Student

Nuts and seeds are a fundamental part of a plant-based diet, providing a rich source of protein, unsaturated fats and several micronutrients. They’re also a great way to increase fibre intake, which is associated with a decreased incidence in mortality from several common chronic diseases.

There is growing evidence for the beneficial and protective effects of consuming nuts and seeds regularly, especially for cardiovascular health. Studies have demonstrated that eating a handful of nuts at least 5 days a week can increase lifespan by around 2 years. However, there is a global underconsumption of nuts, and this food group represents one of the largest gaps between recommended intake and current consumption levels. Not eating enough nuts and seeds is also one of the leading dietary risk factors for disease burden globally.

Nuts and seeds in healthy dietary patterns

Various dietary patterns have been developed to promote good health, such as the Planetary Health, Mediterranean, Portfolio, Dietary Approaches to Stop Hypertension (DASH), and Whole-Food Plant-Based (WFPB) dietary patterns. These diets share several core, healthy components, one of these being nuts and seeds!

The Portfolio diet is a plant-based eating pattern that is designed to lower cholesterol. It includes nuts and seeds as one of several cholesterol lowering foods, alongside plant protein, viscous fibre sources, phytosterols, and plant unsaturated fat sources. A higher plant-based Portfolio Diet Score has been associated with a 14% lower risk of cardiovascular disease, coronary heart disease, and stroke in 3 prospective cohort studies, as well as a more favourable blood lipid and inflammatory profile.

Similarly, regular nut consumption is a key component of the Mediterranean-style dietary pattern. In a randomised trial in people with raised cardiovascular disease risk, a Mediterranean diet with added nuts, compared to control diet, reduced the risk of cardiovascular disease, type 2 diabetes, cognitive decline, and other adverse health outcomes.

The EAT-Lancet Commission Planetary Health Diet also recommends consuming 50g of nuts per day (tree nuts and peanuts). In a systematic review and meta analysis including a total of over 2.21 million participants, this dietary pattern was associated with a significantly reduced odds of diabetes, CVD, cancer and mortality.

Cardiovascular health

Some of the strongest evidence for the health benefits of nuts and seeds is related to a reduced risk of cardiovascular disease and its risk factors.

In a systematic review and meta-analysis, consuming the high versus lowest quantity of nuts and seeds was associated with a reduced risk of cardiovascular disease, cardiovascular mortality, coronary heart disease, and coronary heart disease mortality. A smaller, but still relevant, risk reduction was also seen for stroke.

The reduction in risk of cardiovascular disease could, in part, be due to the impact that consuming nuts and seeds can have on blood lipids. In the same meta-analysis as above, intake of nuts (median ~50 g/day) lowered total cholesterol by 0.15 mmol/L and LDL-cholesterol by 0.13 mmol/L. These findings are supported by a comprehensive review of the literature, which studied 19 systematic reviews and meta-analyses of randomised controlled trials. Across the trials, there was a consistent beneficial effect of total nuts and tree nuts, including walnuts, almonds, cashews, peanuts, and pistachios, for decreasing total cholesterol by 0.09 to 0.28 mmol/L, LDL-cholesterol by 0.09 to 0.26 mmol/L, and triglycerides by 0.05 to 0.17 mmol/L. One of the included reviews also examined the effect of nuts on apolipoproteins and found a significant reduction in apolipoprotein B of 0.042 g/L, across 13 trials.

Nuts and seeds can also lower the risk of high blood pressure, a leading driver of cardiovascular disease. Flaxseeds are particularly notable for their blood pressure lowering effect, with an effect size worthy of use in people with hypertension.

Why are nuts and seeds so good for us?

Nuts and seeds are a rich source of monounsaturated and polyunsaturated fats, as well as plant protein, dietary fibre, phytosterols and polyphenols. Individually, these nutrients are beneficial for health and may, for example, have modest cholesterol-lowering effects. However, when they are combined within the natural matrix of a nut or seed, their effects appear to be even greater, contributing to the reductions in LDL-cholesterol observed in studies of regular nut consumption.

We know that the favourable fatty acid profile of nuts contributes to improvements in blood lipids, particularly when nuts replace foods high in saturated fat. Evidence has also demonstrated that phytosterols contribute to the cholesterol-lowering effects of nuts and seeds. Phytosterols interfere with cholesterol absorption in the intestinal lumen, helping to lower blood cholesterol levels. The phytosterol content of nuts varies, with pistachios, almonds, and walnuts containing some of the highest amounts.

Nuts and seeds also provide important micronutrients, including magnesium, zinc, iron, calcium, copper, phosphorus, potassium, selenium, vitamin E, and B vitamins. Together, these nutrients support several aspects of health, including cardiovascular function, immune health, bone health, and protection against oxidative stress. Nuts also contain a relatively high amount of L-arginine, which has cardiovascular health benefits.

The array of healthy nutrients in nuts together with the fact that they are likely to be replacing less healthy foods in the diet results in reduced mortality from all causes and from cardiovascular diseases, cancer, respiratory diseases and infectious diseases.

Are nuts associated with weight gain?

Despite the mounting evidence for the health benefits of nuts, concerns persist that they may contribute to weight gain due to their high energy density. Nuts are known to have a high fat content, making up at least 40% of their total energy content, ranging from around 44% in pistachios and cashews to 76% in macadamia nuts.

This may be a barrier for increasing the consumption levels of nuts in line with healthy eating recommendations, as they are seen as more energy dense and more likely to contribute to weight gain compared to other healthy foods.

Despite this concern, robust evidence from a systematic review and meta-analysis suggests that the opposite might even be true. Across six cohort studies, nuts were associated with lower incidence of overweight/obesity and across 86 randomised controlled trials, researchers found no adverse effect of nuts on body weight.

There are a number of reasons why nuts are not associated with weight gain. The high protein and fibre content and the need for prolonged chewing may contribute to an increased feeling of fullness. Not all of the fat in nuts is absorbed and unsaturated fats may result in a greater thermogenic effect (the increase in the metabolic rate that occurs after eating a meal/food) than saturated fats.

Best nuts and seeds to include in a plant-based diet

All nuts and seeds can contribute to a healthy dietary pattern and provide a wide range of beneficial nutrients. Including a variety is likely to provide the greatest nutritional benefit, as different nuts and seeds contain different combinations of unsaturated fats, fibre, vitamins, minerals, and phytochemicals.

For individuals following a plant-based diet, flaxseeds, chia seeds, hemp seeds, and walnuts are particularly valuable additions due to their content of alpha-linolenic acid (ALA), an essential omega-3 fatty acid. ALA is essential because we must obtain it from our diet. Daily requirements of ALA can be met by eating a tablespoon of chia seeds or ground flaxseeds (linseeds), two tablespoons of hemp seeds or six walnut halves.

Sesame seeds and tahini provide a useful source of calcium and zinc, while pumpkin seeds are rich in iron and zinc. Brazil nuts are notable for their selenium content, with just two nuts often providing enough selenium to meet daily requirements, though content can vary depending on where they’re grown. Almonds and hazelnuts are rich in vitamin E, and pistachios and walnuts provide particularly high levels of phytosterols, which may contribute to cholesterol lowering.

Nut and sesame allergy

Tree nut and peanut allergies are among the most common food allergies and can range from mild to severe. Individuals with a diagnosed allergy should continue to avoid the foods they are allergic to and seek guidance from their healthcare professionals regarding safe food choices.

For information on introducing peanuts safely to infants and children, please refer to the factsheet on our website.

Allergy to sesame is also increasing and is one of the 14 allergens that are mandated to be listed on food products when present.

Top tips for incorporating nuts and seeds into the diet

• Enjoy a handful of your favourite nuts as a quick and delicious snack, choosing mostly unsalted and minimally processed nuts and seeds is recommended where possible.
• Making your own homemade trail mix using unsalted nuts, seeds, and dried fruit can be a simple way to have a ready-to-go snack
• Sprinkle nuts and seeds on top of soups, salads, stir-fries, oatmeal and cereal. For example, sesame seeds on stir fries and curries, pumpkin seeds on salads.
• Blend seeds such as flax, chia, or hemp into smoothies
• Use nut butters to top off a snack, such as peanut butter with apple slices, almond butter on whole grain toast, or a tahini sauce drizzled over roasted vegetables
• Incorporate nuts into savoury meals. For example, walnuts can be added to lentil bolognese, cashews can create creamy sauces, and mixed nuts can be used in nut roasts or veggie burgers.
• Use nuts and seeds such as pistachios and pine nuts to make homemade pestos, dips, and salad dressings
• Add nuts and seeds to home baking, such as breads, muffins, flapjacks, and granola, or experiment with nut flours in baking recipes

Benefits of a Plant-Based Diet

By Dr Shireen Kassam, Director of Plant-Based Health Professionals UK

A plant-based diet is one that focuses on the consumption of fruit, vegetables, whole grains, beans, nuts and seeds, whilst minimising or avoiding animal-derived and processed foods. There is no precise medical definition of a ‘plant-based diet’, and it includes vegan (100% plant-based), vegetarian and flexitarian diet patterns. Most people consider a plant-based diet one where at least 85% of calories are derived from plant foods. There are numerous benefits to this way of eating and it is healthy and safe to do so at all stages of life.

So, what are some of the expected benefits?

Maintaining a healthy weight

A healthy diet is the main way to maintain a healthy weight. A plant-based diet consists predominantly of foods which are lower in energy density, yet packed full of essential nutrients. People following a 100% plant-based or vegan diet tend to have an overall lower body mass index when compared to people following non-vegan dietary patterns.

One of the most important nutrients for maintaining a healthy weight is fibre and this is only found in plant foods. Fibre not only keeps you feeling full for longer, but it also promotes a healthy gut microbiome, which in turn positively impacts body weight.

On a plant-based diet, you can usually eat to fullness without overly worrying about portion control or calorie counting. You are also less likely to gain weight over time. This is certainly true when you concentrate on eating minimally processed plant foods, as close to nature as possible.

Reducing the risk of high blood pressure

High blood pressure or hypertension is a leading cause of illness, especially heart disease, a major cause of death in the UK. Yet for most people it is possible to maintain a normal blood pressure throughout life by adopting healthy lifestyle habits. These include regular physical activity, avoiding tobacco smoking and alcohol consumption, sleeping well and managing stress.

When it comes to diet, plant-based diets are best for maintaining a healthy blood pressure and can have a similar blood pressure lowering effect to medications. A vegan diet may have the greatest beneficial impact on blood pressure, in part due to the association with lower body weight.

There are certain foods and nutrients within a plant-based diet that stand out in their ability to reduce blood pressure. These include whole grains, legumes and nuts and seeds. Nitrate-rich vegetables, such as leafy greens and beetroot, including beetroot juice, dilate the blood vessels and reduce blood pressure. Flaxseed and hibiscus tea are also useful additions.

Minimising salt / sodium consumption is essential for maintaining a healthy blood pressure although it is worth noting that most salt in the diet comes from ultra-processed foods rather than the salt used in cooking or for flavouring. Increasing the intake of potassium by eating more fruit and vegetables benefits blood pressure control. For those trying to cut down on salt (sodium chloride), switching to potassium chloride salt, may be beneficial, although caution is required for people with chronic kidney disease and those taking medications that elevate blood potassium levels.

Reducing the risk of high cholesterol

As animal-sourced foods are progressively removed from the diet, blood cholesterol levels fall. People who eat a vegan or 100% plant-based diet, tend to have the lowest cholesterol levels of all diet patterns. This is because a plant-based diet avoids or minimises ‘nutrients’ that increase blood cholesterol, namely saturated fat, and to a lesser extent dietary cholesterol. It also emphasises nutrients that naturally keep blood cholesterol low, such as fibre and unsaturated fatty acids.

Some standout foods for lowering cholesterol that are part of the Portfolio diet are nuts and seeds, plant protein (chickpeas, soya, beans), foods high in viscous fibre, plant sterols and oils high in monounsaturated fatty acids, such as extra virgin olive oil.

Reducing the risk of type 2 diabetes

Type 2 diabetes is driven by insulin resistance, a condition caused by the abnormal accumulation of fat inside the muscle, liver and pancreatic cells. This fat accumulation inhibits the action of insulin and thus leads to elevated blood glucose levels.

Plant-based diets, including vegetarian and vegan diets, are associated with a significantly lower risk of type 2 diabetes, in part, but not exclusively due to the beneficial impact on body weight. Plant-based diets are also central to the treatment of type 2 diabetes, and in some can induce remission.

Reducing the risk of heart disease

The main risk factors for heart disease are being an unhealthy weight, high blood pressure, high cholesterol and type 2 diabetes. Avoiding these conditions significantly reduces the risk of heart disease. So it is not surprising that plant-based diets, including vegetarian and vegan diets, are associated with lower rates of heart disease.

It is worth noting that not all plant-based diets are created equal. To optimise health outcomes, a plant-based diet needs to be composed mainly of minimally processed, whole foods. A plant-based diet that is high in refined grains, free sugar and ultra-processed foods can be as bad as a meat-heavy diet and does not benefit health.

Reducing the risk of cancer

The causes of cancer are varied and complex. Eating a plant-based diet is one of several healthy habits that is associated with a lower risk of cancer. This is because you avoid foods associated with a higher risk of cancer, such as processed and red meat, and instead focus on foods and nutrients that reduce cancer risk. These include fibre, whole grains, fruit and vegetables and soya foods.

In general, meat-free diets, both vegetarian and vegan, have been associated with a lower overall risk of cancer of around 15%. In part, because of the association with a healthier body weight, but also because of the associations with lower inflammation and a healthier gut microbiome.

Surprising benefits

There is a long list of health benefits of plant-based eating that may surprise you. Some are listed below:

• Lower risk of urinary tract infections, as most infections are derived from bacteria carried in meat.
• Improvements in menstrual pain in women.
• Improvements in menopausal symptoms, especially when emphasising soya foods.
• Lower risk of fatty liver disease because it is naturally low in saturated fat and high in fibre-rich foods.
• Lower use of insulin in people with type 1 diabetes.
• Lower in cost by a third, compared to the typical Western diet.
• Lower medical costs and lower use of prescribed medications.

Best for planetary health

Without a healthy planet there are no healthy people.

The climate and ecological crises are now directly affecting human health globally. One of the main drivers is our food system. Animal agriculture is a major cause of greenhouse gas emissions, biodiversity loss, land, water and air pollution, land use change and more. The most impactful action we can take as individuals is to remove animal-sourced foods from the diet and instead eat a plant-based diet. Without exception, the production of all plant foods has significantly less impact on the environment than animal-sourced foods. There is now international consensus that if we want to meet our climate and nature goals, we need a global transition to a plant-based food system.

The Planetary Health Diet, devised by the Eat-Lancet Commission, provides a global framework for a healthy diet that will keep the food system within planetary boundaries. It is a diet that is composed of more than 85% plant-based foods, with animal-sourced foods greatly limited and not considered essential.

Concluding remarks

The positive impacts of a plant-based diet far outweigh any perceived downsides. There are additional huge benefits to our animal kin who find themselves living their entire lives in factory farms. Like with all diet patterns, a plant-based diet needs to be appropriately planned. If adopting a vegetarian or vegan diet, supplementation with vitamin B12 is essential.

Plant-based diets are full of abundance and flavour, can be adapted to all traditional and cultural diet patterns, and are a joy to adopt.

Resources

Plant-Based Eatwell Guide

Plant-Based on a Budget

Plant-based diets for the prevention and treatment of cardiovascular diseases

By Michael Metoudi, RD

What is cardiovascular disease?

Cardiovascular disease (CVD) defines a group of disorders affecting the heart and blood vessels. The most common type is coronary heart disease (CHD), characterised by the narrowing of blood vessels and reduced blood flow to the heart. If left untreated, it develops into other serious types of CVDs such as arrhythmias (irregular heartbeats), angina (chest pain), and eventually leading to myocardial infarction (heart attack) and heart failure. Other major types of CVDs include hypertension and cerebrovascular disease, such as stroke, both of which have significantly increased in the UK during the past two decades.

CVDs remain the commonest cause of illness and death worldwide. Alarmingly, the overall rates of heart disease have dramatically increased in younger people, suggesting that it is not just a disease confined to old age.

Risk factors for cardiovascular diseases

 The main drivers of CVD are lifestyle-related and are mostly modifiable. These include:

 1) Behaviour or lifestyle risks: such as poor dietary patterns, high in salt and low in whole plant foods; smoking; physical inactivity; and alcohol use.

 2) Metabolic risks: such as high systolic blood pressure, obesity, high LDL-cholesterol and fasting blood glucose and diabetes.

 3) Environmental risk: including air pollution.

Other emerging modifiable lifestyle factors include high stress levels, poor sleep and social isolation and loneliness.  Genetics appear to be responsible for 40-60% of the risk for CVD. However, diet and lifestyle interventions can offset genetic risk for CVD by almost one half in susceptible individuals.

Cardiovascular disease risk factors

The evidence for whole-food plant-based diets in cardiovascular diseases

Prevention and Treatment

Poor diet quality represents the number one lifestyle risk factor for CVD, responsible for up to half of all cardiometabolic disease-related deaths.

Some of the strongest evidence supporting a whole food plant-based diet (WFPBD) for CVD relates to the prevention and treatment of CHD. Studies as far back as the 1950s have shown that predominantly and exclusively plant-based diets reduce CVD risk.

Two landmark cohort studies include the Framingham Heart study and the Seven Countries study, first linking diet quality (plant vs. animal fat) to CHD risk. Fast forward and we have over 75 years of data from meta-analyses of large prospective cohort studies consistently showing a reduced risk of CHD, overall CVD, their primary risk factors and CVD mortality in those following a plant-based diet. These studies include data from participants that follow vegetarian or vegan diets such as the EPIC-Oxford and Adventist Health studies showing just under 30% reduction for CHD.

For Intervention studies involving the primary prevention of CVD, the PREDIMED study showed that a Mediterranean diet pattern, supplemented with olive oil or nuts in those at high risk, reduced stroke and overall CVD events by at least one third. The more recent OMNIVEG study showed even greater benefits for heart disease risk factors for those following a vegan Mediterranean-style diet compared to the traditional Mediterranean diet.

When it comes to the treatment of established heart disease (secondary prevention), there are consistent and significant improvements in CVD risk factors including reduced blood lipids levels, blood pressure and markers of glycaemic control in people following a vegan or vegetarian diet.

The Lifestyle Heart Study, a randomised lifestyle intervention trial involved 48 patients with established CAD. This study showed that a predominantly WFPBD, low in fat, together with other lifestyle interventions (exercise, smoking cessation and stress management) resulted in 82% of patients showing regression of their arterial CHD in the intervention arm of the study, after 5 years of follow-up.

Importance of diet quality

Studies that consider diet quality, using the plant-based diet index, such as the Nurses’ Health Study and the Health Professionals Follow-up study, also find a similar risk reduction in CVD in those eating the highest portions of whole plant foods.

High adherence to a healthy plant-based diet is associated with a 14% reduction in CHD and a 10% reduction in overall CVD risk. Conversely, following an unhealthy plant-based diet, high in ultra-processed foods, refined grains, free sugars, unhealthy fats, and salt, can increase the risk of CVD and CVD Mortality.

When substituting animal foods for plant foods, such as nuts, legumes or whole grains, there is a significant reduction in CVD risk by as much as 30%. Fish consumption has also shown to reduce CVD risk up to 8%, but only in types with a high omega-3 fat content, suggesting this to be the primary cardioprotective factor. Adequate sources of omega-3 can be obtained in whole plant foods such as flaxseeds, chia seeds, walnuts, hemp hearts and soya.

Mechanisms that drive cardiovascular diseases

 At the core (or heart!) of CVD is the development of atherosclerosis, the build up of plaque inside the arteries. These plaques are made up of predominantly fat, cholesterol, calcium and debris of cells from the immune system. Over time, these plaques harden, narrow the arteries, limit blood flow to the heart and organs and give rise to the collective symptoms of CVD. Plaque rupture leads to the formation of a blood clot, resulting in a myocardial infarction and/or stroke.

Atherosclerosis begins when specific lipoproteins, that transport lipids in the circulation (e.g cholesterol), become trapped beneath the endothelium that lines the blood vessels. Lipoproteins linked to this process include ApoB-containing lipoproteins, particularly LDL-cholesterol. Their retention within the arterial wall leads to an inflammatory reaction which drives the formation and growth of atherosclerotic plaques.

It is of great concern that the development of these plaques does not just occur later in life but appears to form even from early childhood.

Atherosclerosis development in Cardiovascular Disease

How whole-food plant-based diets reduce cardiovascular diseases

Lowering blood pressure

High blood pressure, or hypertension, is the biggest risk factor for CVD. Several studies demonstrate the benefits of plant-predominant diets in reducing hypertension, with the DASH diet (Dietary Approaches to Stop Hypertension) most extensively studied. The core components of the DASH diet are fibre-rich plant foods and thus following a vegan or 100% plant-based diet has well-established benefits for lowering blood pressure. As the intake of animal-sourced foods are lowered and plant-based foods are increased, the greater the benefits for blood pressure lowering. Specific beneficial foods include  whole grains foods, fruit and vegetables, and legumes.

WFPBDs are beneficial because of the abundance of dietary potassium, a mineral that is necessary for maintaining muscle function but also relaxing blood vessels, thereby reducing blood pressure. WFPBDs are naturally lower in salt, a major risk factor for hypertension. They are also higher in fibre, a nutrient consistently associated with blood-pressure lowering effects

Reducing blood and dietary lipids

Elevated blood lipids, especially LDL cholesterol, Lipoprotein (a)(LP(a)), a genetically-determined lipoprotein, and triglycerides are major risk factors for CVD. In general, the lower the levels of these lipids, the better for prevention and managing CVD. Saturated fat intake is the main determinant of LDL-cholesterol levels, with dietary cholesterol having a smaller, but still an important impact.

Vegetarians and vegans consistently have lower LDL-cholesterol levels than omnivores. There is a great deal of evidence based on the Portfolio diet, a combination of five plant-based food groups designed to lower cholesterol. These include plant sources of protein, nuts and seeds, sources of soluble fibre (oats, barley, psyllium), plant sterols and oils high in monounsaturated fats, such as extra virgin olive oil. (see our factsheet here). Despite  Lp(a) being genetically determined, plant-based diets have also shown to reduce levels by as much as 16% in 4 weeks.

WFPBDs have a variable impact on blood triglycerides. However, fibre-rich plant foods have shown to significantly reduce levels, particularly nuts (rich in omega-3 fats) and whole grains. Minimising intake of free sugars and refined grains is also important.

Reducing inflammation and improving endothelial function

Plant-based diets lower the risk of CVD by reducing inflammation.  Vegan and vegetarian diets as well as the Mediterranean diet were ranked highest for reducing C-reactive protein (hsCRP), a primary marker of inflammation that is linked to CVD by promoting atherosclerosis and endothelial dysfunction. Vegan and vegetarian diets appear to reduce other important circulating biomarkers of inflammation linked to CVD.

Whole plant foods have also directly been shown to improve endothelial function, especially through foods such as fruits, vegetables, soya, nuts and seeds, cocoa, and tea.

Blood glucose control and diabetes

Elevated blood glucose and type 2 diabetes almost doubles the risk of CVD, especially heart failure, heart attack and stroke. WFPBDs have shown to significantly reduce the risk of type 2 diabetes as well as having a role in the clinical treatment of type 2 diabetes. Emerging evidence also shows their role in the management of type 1 diabetes.

Modulating the microbiome

The gut microbiome is linked to a host of different diseases, with CVD being no exception. Specific species of gut bacteria appear to be responsible for an increased or decreased risk of CVD. Certain bacteria that metabolize compounds from carnitine, found in red meat and eggs produce trimethylamine (TMA), a molecule which gets converted to trimethylamine N-oxide (TMAO) within the liver. TMAO is linked to CVD risk. It can alter how cholesterol is metabolised by the body by disrupting reverse cholesterol transport and reducing its excretion, promoting lipid deposition, which accelerates atherosclerosis. Predominantly plant-based diets have shown to directly shift populations of gut bacteria from TMAO producers to beneficial bacteria that metabolise fibre and produce short chain fatty acids (SCFAs) that regulate blood pressure and reduce inflammation. Vegan diets in particular have gut microbiome signatures that are associated with improved cardiometabolic health.

Consensus Guidelines for reducing Cardiovascular disease

Conclusion

There is an abundance of high quality evidence supporting a WFPBD  for the prevention and treatment of CVDs. It addresses the root causes, whilst simultaneously providing the core nutrients that not only protect the heart and blood vessels, but do not contain the dietary components from animal foods that are directly linked to CVD risk, development and progression.