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

PBHP UK Members book club

Sunday 27th September ​2026, 7pm BST

Our next book club discussion will be about:

What Your Doctor Isn’t Telling You About Food by Dr Alan Desmond.

Alan will also be attending.

Not a member? Please join us here.

PBHP Members book club

Sunday 12th July 2026, 7pm BST

Our next book club discussion will be about:

Food Intelligence by Kevin Hall.

Please join us as a member to access similar events.

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

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.

Please follow my organisation ‘plant-based health professionals UK’ on Instagram @plantbasedhealthprofessionals and facebook. You can support our work by joining as a member or making a donation via the website.

Monthly member online meet-up with the PBHP UK team

Lifestyle Medicine 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