Review of the plant-based nutrition and lifestyle medicine news April 2025
A little late for April as I was focussing my attention on writing an article about industry influence on the food we eat. I highlight some new studies and resources on food and health.
My selection of papers this month demonstrate we have reached a level of consensus when it comes to diet and health. A healthy diet is one which prioritises whole plant foods and may or may not contain small amounts of animal-sourced foods. Ultra-processed foods (UPFs) in general should be minimised, whilst remembering that the NOVA UPF category is quite heterogenous and that some UPFs, such as whole grain breads and cereals and fortified plant-based milks and meat alternatives, may actually be a useful source of nutrients and not inherently unhealthy.
My conclusion is based in part on the results of a new study from the Harvard School of Public Health that assessed the impact of eight dietary patterns on healthy ageing amongst the 105,015 participants of the Nurses’ Health Study and the Health Professionals Follow-up study. The eight dietary patterns analysed were those known to be associated with a reduced risk of major chronic non-communicable diseases (the Alternative Healthy Eating Index, Mediterranean diet and healthful plant-based diet), hypertension (Dietary Approaches to Stop Hypertension diet), cognitive decline (the Mediterranean-DASH Intervention for Neurodegenerative Delay diet), hyperinsulinaemia (reverse empirical dietary index for hyperinsulinaemia score), inflammation (reverse empirical dietary inflammatory pattern score) and planetary health (planetary health diet index). In addition, the impact of UPF consumption was assessed.
The results showed that only 9.3% of the participants achieved healthy ageing, defined by the lack of 11 major chronic diseases and no impairment in cognitive, physical or mental function by the age of 70 years. Adherence to all of the dietary patterns mentioned was associated with a higher odds of healthy ageing, whilst a higher consumption of UPFs was associated with a lower likelihood of healthy ageing. The foods most associated with healthy ageing were fruits, vegetables, whole grains, beans, nuts, seeds and low-fat dairy. Interestingly fish did not stand out as a food that was associated with better health.
It should be noted that the population studied were mostly of White ethnicity and therefore more likely to be able to digest lactose in cow’s dairy. In non-White populations, lactose intolerance is more prevalent and thus cow’s dairy would not be an appropriate food to have in the diet. For this reason, the 2025 Dietary Guidelines Advisory Committee in the US considered fortified soya alternatives alongside and equivalent to low-fat dairy beverages and recognises in its new ‘Eat healthy your way’ framework, that dietary guidelines can be adapted to suit cultural and traditional preferences as long as the key components are included. The committee recommended prioritising plant sources of protein over animal-sourced foods for better individual and planetary health outcomes.
The DGAC was criticised by some for not making specific recommendations on UPFs, due to insufficient evidence and inconsistencies in defining and classifying UPFs in the scientific literature. Here in the UK, the Scientific Advisory Committee on Nutrition, an independent body that advises the Government, has just released an updated report on processed food and health. As expected, their conclusions are very sensible and based on the available evidence. They state, ‘not all UPFs affect health in the same way. The categories of UPF consistently associated with adverse health outcomes were those including meat and animal products and sweetened drinks.’ They also reported ‘UPF categories including vegetarian alternatives were not associated with adverse health outcomes.’
I was interested to read the Lancet Commission on rethinking coronary artery disease. The commission recommends reclassifying the condition as atherosclerotic coronary artery disease (ACAD) and to move away from focussing only on ischaemia and acute cardiac events and instead to focus on the development of atheroma and atherosclerosis. The intention is to shift emphasis away from end stages of the disease and instead to prioritise prevention and early detection. ACAD can start in utero and hence a life course approach is needed if we are to truly impact prevention and prevent premature mortality.
This is where healthy diets and lifestyle medicine come to the forefront. Ninety percent of coronary heart disease could be prevented by addressing modifiable risk factors. We already have a large body of evidence to support dietary interventions for preventing and managing atherosclerotic cardiovascular disease. Most data point towards a diet pattern centred around fruit, vegetables, whole grains, legumes, nuts, seeds and fish akin to the Mediterranean-style diet, which has been extensively studied. This type of diet is rich in fibre and micronutrients, whilst being lower in saturated fat. The requirement for fish in the diet remains debated. The study on optimal diets for healthy aging highlighted above does not find an essential role for fish and vegetarian/plant-based dietary patterns are part of evidence-based recommendations within chronic disease guidelines. This new review outlines where we are with dietary evidence for ACAD, the limitations of the data and the need for implementation science i.e. getting this knowledge into the real world and clinical practice.
Despite the potential limitations and criticisms of nutrition studies, in my view, we know enough to devise recommendations that will serve to improve the diet quality of most individuals and significantly improve population health. Of course there continues to be interest in precision nutrition approaches, which consider differences in responses to foods and nutrients between and within individuals. This reflects a general trend in medicine for personalised approaches, but cynically I feel the movement is being driven, in part, by commercial interests. Precision nutrition companies make strong health claims that are not always supported by the available evidence and may serve to widen health inequalities given the associated costs. This new review on the topic of precision nutrition in cardiometabolic diseases is worth reading. Take home message is that precision nutrition is not ready for prime time but is worth studying if this is done using robust research approaches and driven by clinical need rather than profit.
Unhealthy diets continue to cost society enormously as dietary risk factors are the leading cause of chronic ill health and premature mortality. This study aimed to comprehensively assess the macroeconomic burden of 15 dietary risk factors for 204 countries and territories from 2020 to 2050. The dietary risk factors considered were those identified from the 2019 GBD study. These were diets high in processed meats, high in red meat, high in sodium, high in sugar-sweetened beverages, high in trans fatty acids, low in calcium, low in fibre, low in fruits, low in legumes, low in milk, low in nuts and seeds, low in polyunsaturated fatty acids, low in seafood omega-3 fatty acids, low in vegetables and low in whole grains.
The analysis found that these dietary risk factors would result in an estimated global macroeconomic burden of INT $15.5 trillion from 2020 to 2050, equivalent to 0.34% of the total GDP. This economic burden was mostly related to three conditions: ischaemic heart disease (60.6%), type 2 diabetes (15.4%) and stroke (12.6%). Among all dietary factors, a diet low in whole grains incurred the largest economic burden and was the leading dietary risk factor in most countries and regions. For the UK, the estimated cost of unhealthy diets from 2020 to 2050 was INT $8.1 billion.
Dietary risk factors also contribute to significant numbers of preventable cancers, mainly from insufficient consumption of fibre-rich plant foods and overconsumption of processed and red meat and alcohol. What is not often discussed is the impact of other chronic conditions on cancer risk. A secondary analysis of a cancer screening study from the US found that the presence of chronic conditions in midlife, including cardiometabolic, respiratory and gastrointestinal conditions, significantly increased the risk of various types of cancer over a 20 year follow up period. This points towards shared mechanisms of disease development and highlights opportunities for prevention.
What we eat needs to be sustainable for the planet. This month has seen a number of misleading reports, including a new one from the AHDB that tries to persuade us that red meat should be part of our diet, provides essential nutrients and can be sustainable from an environmental perspective. This goes against all the available science. For health, the evidence supports limiting or avoiding red meat for prevention of chronic conditions. For planetary health, red meat production, especially from ruminant animals such as cows and sheep, is hugely damaging. Another paper examines the environmental impact of grass-fed beef production in the US. The analysis finds that grass-fed beef production produces significantly more greenhouse gas emissions than cows raised in factory farms and also much more compared to meat from other animals and plant sources of protein. A great article by George Monbiot for the Guardian clarifies why farming cows and sheep can never be considered sustainable.
As usual, the right wing media continue to undermine efforts to transition to a plant-based diet. The Times ran a headline suggesting vegans can’t build muscle. This was based on a new study from New Zealand that analysed protein intake in long-term vegans and found that lysine and leucine intakes fell short of recommended intakes. I was able to bring some balance to the conversation with my interview for BBC Science Focus. The paper did not assess health outcomes, let alone ability to build muscle. In fact, a few days later mainstream media reported on a randomised controlled study that found that a vegan diet matched for protein intake was equivalent to an omnivorous diet for building muscle in young, healthy men and women.
With all this misinformation circulating about the role of meat in healthy and sustainable diets, we need to change food culture and environments to support behaviour change. This qualitative study revisits public awareness and attitudes toward sustainable diets in the UK, a decade after a similar investigation in 2013/14. The researchers conducted nine focus groups with 60 adults across different rural/urban and deprivation settings in Scotland, aiming to determine whether understanding of the environmental impact of food, particularly meat consumption, had improved. The study found that while awareness of the environmental implications of food choices, including meat, has increased, especially among more affluent groups, significant barriers to reducing meat consumption remain. These include taste preferences, cultural attachments to meat, cost concerns, and scepticism about meat alternatives and conflicting dietary messages.
What remains clear is that in food service, swapping meat-based meals to equivalent whole food plant-based versions can provide nutritional, environmental and cost benefits. A new policy report published jointly by The Food Foundation, Green Alliance and The Good Food Institute provides recommendations for Government on how to support the transition towards plant-rich diets. This needs a farm to fork approach with the UK producing and eating more plant-based foods. This would bring an array of health, environmental and economic benefits.
Read my article on food industry influence and see you later in May for my next review of the plant-based and lifestyle medicine news.
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