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.

Heart to Heart with Sundhya

Tuesday 14th July 2026 12:00 – 1:00pm BST

Dr Sundhya Raman is a lifestyle medicine doctor with a special interest in cardiometabolic risk. She is part of the university education team at PBHP UK delivering special study modules on lifestyle medicine and sustainability. She is also the lifestyle medicine lead on the council of the Primary Care Cardiovascular society and co-opted council member of the British Association for Cardiovascular Prevention and Rehabilitation. Please join her on July 14th 12-1pm at the PBHP UK members meeting to chat about anything regarding PBHP education, or lifestyle in cardiometabolic disease

Not a member? Please join us here.

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

Review of the plant-based nutrition and lifestyle medicine news June 2026

Three important reports, more evidence on plant-rich diets, huge benefits from Food as Medicine initiative and healthy habits improve cancer outcomes.

Three important reports on food, health and climate

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

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

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

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

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

Some of the headline findings include:

• Healthier food remains nearly twice as expensive per calorie as less healthy food, and the gap is widening
• Households in the lowest income fifth of the population would need to spend 85% on food to afford the government-recommended healthy diet
• The price gap between healthier and less healthy food is increasing and is now the widest it has been in over a decade
• 40% of food and non-alcoholic drink promotions are on foods high in fat, salt or sugar.
• Fruit and vegetables only account for 3% of traditional advertising food and non-alcoholic drink expenditure, compared to at least 29% for unhealthy foods

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

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

More evidence supporting plant-rich diets

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

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

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

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

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

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

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

Vegan versus Med diet for fibromyalgia

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

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

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

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

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

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

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

Food is medicine

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

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

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

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

The results were remarkable:

• 31% fewer hospitalisations among participants receiving medically tailored meals
• 20% fewer emergency department visits
• US$3,433 lower healthcare costs per person during the intervention period
• Healthcare savings offset 98% of the program costs within a 7-month period
• No reduction in primary care visits, suggesting participants remained engaged with routine healthcare while requiring less acute care
• The greatest benefits were seen among those with the highest disease burden
• Cardiovascular disease: healthcare costs reduced by US$10,450 per person
• Chronic kidney disease: healthcare costs reduced by US$12,312 per person
• Healthcare costs fell by nearly US$9,700 per person amongst the most medical complex patients

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

Healthy lifestyle habits after a cancer diagnosis.

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

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

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

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

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

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

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

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

Slovenia’s new dietary guideline and the ensuing controversy

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

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

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

See you back in July.

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Monthly member online meet-up with the PBHP UK team

IBLM Certification Information Session

Are you planning to sit the International Board of Lifestyle Medicine (IBLM) certification exam this year, or considering certification in the future?

Join Claire Lynch for an informal online information session on Monday 27 July, 7–8pm (Google Meet).

This session is particularly relevant for those already registered for the 2026 certification pathway, but anyone interested in learning more about certification is welcome to attend.

We’ll cover:

• What to expect over the coming months
• Key deadlines and requirements
• CME and case study requirements
• Exam preparation and study support
• Common questions and practical tips

Whether you’re already registered or simply exploring whether certification might be right for you, this session is an opportunity to ask questions, meet other candidates, and gain a clearer understanding of what the certification journey looks like in practice.

📅 Monday 27 July
🕖 7:00–8:00pm
💻 Google Meet

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.

Global Healthy Hospital Network webinar

June 10th 4pm BST/5pm CEST

Healthy food alone is not enough. It also has to look good, taste good, and feel meaningful to the people eating it.

Our next Healthy Hospital Food Network webinar brings together two inspiring speakers to explore how taste can support the transformation of food in hospitals and other care settings. From whole-food approaches and chef education to taste architecture and cooking techniques, the session will showcase concrete ideas for making nutritious meals more appealing and more successful in practice.

🔹Bettina Campolucci is a plant-based chef and wellness educator. She will share insights from the Chefs’ Manifesto, highlighting the power of whole foods, humble vegetables, legumes, chef training, and recipe development to improve menus and strengthen food quality in institutional settings.

🔹Jaroslav Guzanic is a Research & Private Chef, Founder of Taste of Central Europe, Swiss Network for Food Education and Co-Lead of the NNEdPro Europe Regional Network. He will focus on answering “how can we cultivate taste’ and share practical solutions for hospital kitchens that connect flavour, appearance, food bioactives, cooking methods, and multisensory experiences.

Following the two speaker inputs, participants are invited to join a 25-minute discussion on what it takes to implement these ideas in real kitchen environments.

Join us for an exchange on how healthier food can become more attractive, more delicious, and more feasible in healthcare.

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