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

This month sees an update to several national guidelines, all emphasising plant-rich diets and exercise, plus lifestyle interventions for Parkinson’s, diet and cancer and fasting for Crohn’s disease.

New lipid guidelines and dietary guidelines to improve cardiovascular health

The new dyslipidaemia guideline from the American College of Cardiology, American Heart Association, and nine other medical associations that replaces the 2018 guide, places renewed emphasis on lifestyle practices as the foundation of cardiovascular disease prevention, while recognising that pharmacotherapy is often required to reach increasingly stringent lipid targets.

A key message is the importance of a life-course approach. Elevated atherogenic lipoproteins over time drive cardiovascular risk, so early intervention, particularly through healthy behaviours, is essential. These include heart-healthy eating, regular physical activity, maintaining a healthy weight, good sleep, stress management, and avoidance of tobacco.

A heart-healthy diet is recommended to reduce cardiovascular events, while dietary supplements are not advised due to limited and inconsistent evidence of benefit. Physical activity is also emphasised, both for modest lipid improvements and broader cardiovascular protection.

The guideline recognises that behaviour change requires support. Referral to dietitians and use of multidisciplinary care are encouraged, particularly in higher-risk individuals such as those with severe hypertriglyceridaemia.

Despite this strong focus on lifestyle practices, drug therapy, especially statins, remains central. Lower LDL-cholesterol targets, particularly in secondary prevention, mean that many patients will require combination therapy alongside lifestyle measures. It also includes lowering the screening and treatment age from 40 to 30.

The American Heart Association (AHA) has also updated its dietary guidance for cardiovascular health and is notably different from the recently released Dietary Guidelines for Americans. The AHA reinforces that overall dietary patterns, rather than individual nutrients, are central to cardiovascular health. Poor diet quality remains a leading contributor to cardiovascular disease, and the guideline emphasises that adopting and sustaining a heart-healthy dietary pattern across the life course is fundamental to prevention.

At its core, the guidance promotes a predominantly plant-based, minimally processed way of eating. This includes a high intake of vegetables and fruits, whole grains, legumes, nuts, and seeds, alongside healthy sources of protein, whilst limiting red and especially processed meat. There is a clear emphasis on replacing saturated fats, found in animal fats and tropical oils, with unsaturated fats from plant oils and whole foods, reflecting strong evidence for improvements in LDL-cholesterol and cardiovascular risk. Healthy protein sources mainly focus on beans and pulses and also include fish.

A major focus is the quality of foods rather than just macronutrient composition. The guideline strongly encourages shifting away from ultraprocessed foods, and towards minimally processed foods that retain their natural structure and nutrient profile. Similarly, it highlights the importance of reducing added sugars, particularly from sugar-sweetened beverages, and lowering sodium intake, both of which have well-established links to cardiovascular risk.

Energy balance is also central, with maintaining a healthy body weight through alignment of diet and physical activity identified as a key determinant of cardiometabolic health. Physical activity is therefore integrated into the dietary framework rather than treated separately.

Importantly, the guidance challenges common misconceptions around supplements and single “superfoods.” Nutritional needs should be met primarily through whole dietary patterns, which provide fibre, micronutrients, and bioactive compounds that work synergistically. In most individuals, a high-quality diet removes the need for supplementation. The exception being a meat-free diet that requires supplementation with vitamin B12 (through fortified foods or supplements).

Alcohol guidance is rightly more cautious than in previous iterations. The statement advises against initiating alcohol consumption for health reasons and recommends limiting intake due to uncertain cardiovascular benefit and clear risks across a range of health outcomes.

A useful article on trending cardiovascular nutritional controversies covers evidence for and against beef tallow, ultraprocessed foods, full-fat dairy, seed oils, medium chain triglyceride (MCT) oils, seafood, and alternative sweeteners. In short, the paper concludes that beef tallow is harmful to health as it raises LDL-cholesterol levels. There is insufficient evidence to choose high-fat over low-fat dairy (remembering that dairy is not required in the diet). Ultraprocessed foods should be limited in the diet, favouring minimally processed, whole foods instead. Seed oils benefit cardiometabolic health and can be part of a heart-healthy diet, but they should not be heated to excessive temperatures or repeatedly heated. MCT oils may have a role in certain rare medical conditions, but the evidence does not support promotion in the general population. It reminds us that coconut oil is not an MCT and is not considered heart healthy. Seafood (or should we say sea animals) are considered a beneficial component of the diet, but there are increasing concerns around environmental contamination of these foods. Articifical sweetners (aspartame, advantame, acesulfame potassium, neotame, saccharin, and sucralose), natural sweeteners (monk fruit extract and stevia) and sugar alcohols (erythritol, mannitol, sorbitol, and xylitol) have an overall negative impact on health, although they may be healthier to consume that sugar-sweetened beverages. The healthiest choices is to stick to consuming water, tea and coffee.

Vegetarian and vegan diets and cancer incidence

This 2026 systematic review and meta-analysis provides a comprehensive assessment of vegetarian and vegan diets in relation to cancer risk, drawing on prospective cohort studies across multiple populations and cancer types.

Overall, vegetarian diets are associated with a modest but consistent reduction in total cancer incidence, with around a 13% lower risk compared to non-vegetarian diets. This reduction extends across several specific cancers, with the strongest associations seen for cancers of the digestive system, particularly stomach and colorectal cancers, as well as pancreatic cancer. There are also smaller but statistically significant reductions in breast cancer, especially postmenopausal breast cancer, alongside bladder cancer, melanoma, and non-Hodgkin lymphoma.

For vegan diets, the evidence base is more limited but broadly consistent in direction. Vegan diets are associated with a larger reduction in total cancer risk, in the range of around 20–25%, and a reduced risk of breast cancer. However, findings for colorectal and prostate cancer are less clear, reflecting the smaller number of studies available.

The authors conclude that the evidence linking vegetarian diets to lower risk of total cancer, colorectal cancer, colon cancer, and breast cancer is “probable,” while for other cancers it is considered suggestive but less certain due to limited data. For vegan diets, the evidence is currently more limited overall.

The paper also explores potential mechanisms. Part of the observed benefit appears to be mediated through lower body weight, as vegetarian and vegan diets are associated with reduced adiposity, an established risk factor for several cancers. However, this explains only part of the effect. Independent dietary factors are likely important, including higher intakes of fibre, whole grains, fruits, and vegetables, and lower consumption of red and processed meat. These dietary differences may influence cancer risk through effects on inflammation, insulin resistance, hormonal pathways, and the gut microbiome.

Overall, the findings support the conclusion that more plant-based dietary patterns, including vegetarian and vegan diets, are associated with a lower risk of several cancers. While further research is needed, particularly in vegan populations and across a wider range of cancers, the evidence adds to the growing case for plant-based diets as a central component of cancer prevention.

Fasting mimicking diet in Crohn’s disease

The fasting-mimicking diet (FMD) is a short, periodic, plant-based dietary intervention designed to reproduce the metabolic effects of prolonged fasting while still providing limited nourishment. Typically followed for five consecutive days each month, it is plant-based, low in calories, protein and sugars, and relatively higher in unsaturated fats. Developed and extensively studied by Dr Valter Longo and colleagues, earlier work has shown that FMD can reduce systemic inflammation, improve metabolic health, and promote cellular repair processes. Preclinical studies have also demonstrated effects on gut microbiota, immune regulation, and intestinal regeneration, providing a strong rationale for testing this approach in inflammatory bowel disease.

This 2026 randomised controlled trial evaluates the effects of FMD in adults with mild-to-moderate Crohn’s disease. Participants were assigned either to continue their usual diet or to undertake three monthly cycles of a 5-day FMD, returning to their habitual diet between cycles. 60-70% of participants were also receiving medications for Crohn’s disease.

The findings are notable. Around 70% of participants in the FMD group achieved a clinical response, compared with approximately 44% in the control group, and nearly two-thirds achieved clinical remission. These improvements were seen early, with benefits emerging after just a single 5-day cycle. Alongside symptomatic improvement, there were reductions in objective markers of inflammation, particularly faecal calprotectin, supporting a genuine anti-inflammatory effect.

The intervention also led to improvements in patient-reported outcomes and quality of life, suggesting that the clinical benefits translated into meaningful day-to-day improvements for patients. Although endoscopic data were limited, early signals pointed towards possible improvements in mucosal healing.

Mechanistically, the study provides insight into how FMD may work. The diet was associated with reductions in pro-inflammatory lipid mediators and downregulation of key inflammatory cytokines, including TNF, IL-1β and IL-18. These findings are consistent with earlier research showing that fasting-like states can suppress inflammatory pathways, enhance autophagy, and promote tissue repair. Additional mechanisms may include beneficial shifts in the gut microbiome and increased production of ketone bodies, which have anti-inflammatory effects.

From a practical perspective, the appeal of FMD lies in its feasibility. Unlike many dietary interventions that require continuous restriction, FMD involves only five days of dietary change per month, allowing individuals to maintain their usual eating pattern for the remainder of the time. Adherence in the study was relatively high, and the intervention was generally well tolerated, with mild symptoms such as fatigue and headache being the most common side effects.

There are, however, important limitations. The study was relatively small and open-label, and most participants had mild disease, which may limit generalisability. The benefits also appeared to diminish after a washout period, suggesting that ongoing cycles may be needed to sustain the effect.

Overall, this trial adds to a growing body of evidence that dietary interventions can have clinically meaningful effects in inflammatory conditions.

Updated guidelines on resistance training for adults

This 2026 American College of Sports Medicine position stand makes a compelling case that resistance training should be considered a fundamental component of health for all adults, not just those interested in fitness or performance. Drawing on a large body of evidence (130 systematic reviews and data from more than 30,000 people), it shows that resistance training improves muscle strength, muscle mass, power, endurance, balance, and overall physical function. These changes translate into meaningful real-world benefits, including improved ability to perform daily activities, maintain independence with ageing, and reduce the risk of falls. Beyond musculoskeletal health, resistance training is also associated with reduced mortality and lower risk of cardiovascular disease, cancer, and type 2 diabetes, alongside benefits for mental health and sleep.

A key message is that resistance training does not need to be complex to be effective. Many different approaches can deliver similar benefits, and the most important factor is consistency over time. The guideline emphasises that programmes should be tailored to the individual to support adherence, taking into account preferences, confidence, and practical barriers. This represents a shift away from rigid, highly structured prescriptions towards a more flexible and inclusive approach.

For most adults, a practical starting point is to engage in resistance training at least twice per week, targeting all major muscle groups. Exercises can be performed using free weights, machines, resistance bands, or body weight, making the approach accessible in a range of settings, including at home. A small number of sets per exercise is sufficient to begin with, and intensity can be progressed gradually as confidence and strength improve. For those aiming to build strength, using relatively heavier loads and focusing on controlled movements through a full range of motion is effective. For improving muscle mass, increasing overall training volume over time is important, while for enhancing power and functional performance, incorporating faster, more dynamic movements with moderate loads can be beneficial.

Importantly, the guideline challenges several common misconceptions. Training to exhaustion is not necessary to achieve results, and no single type of equipment or programme is superior for all individuals. Complex programming strategies offer little additional benefit for most people compared with simpler approaches. Resistance training is also considered safe for healthy adults across the lifespan when introduced progressively, countering the perception that it is inherently risky or only suitable for younger individuals.

Read this short summary, including advice from the lead author.

Physical activity for public health in the 21st century

This 2026 Nature Medicine paper reframes physical activity as a central pillar of public health while challenging the persistent assumption that it is simply a matter of individual choice. It highlights that despite overwhelming evidence of benefit, global levels of physical activity have not meaningfully improved, with a substantial proportion of adults still failing to meet recommended levels. The authors argue that this stagnation reflects not a lack of awareness, but deeper structural and societal barriers.

A key contribution of the paper is its focus on inequality. Patterns of physical activity vary markedly across countries, genders, and socioeconomic groups, with the greatest disparities seen between wealthier men in high-income settings and poorer women in low-income settings. These differences are not incidental; they reflect unequal access to safe environments, time, cultural acceptance, and financial resources. In this context, physical activity is better understood as something shaped by opportunity rather than simply motivation.

The paper also broadens the scope of why physical activity matters. While traditionally emphasised for cardiovascular and metabolic health, it is shown to have wide-ranging effects across physical and mental health, including immune function, mental wellbeing, and cancer outcomes. This reinforces its role as a foundational determinant of overall health, rather than a niche behavioural factor.

One of the most important insights is the distinction between different domains of physical activity, particularly between leisure-time activity and work- or place-based activity. Leisure-time activity, such as walking, cycling, sport, or exercise, is typically performed by choice, in safer environments, and at intensities and durations that are more consistently associated with health benefits. In contrast, work-related or necessity-based activity, such as manual labour, domestic work, or physically demanding jobs, is often repetitive, prolonged, and performed under conditions of low autonomy, limited recovery, and sometimes physical risk. The paper highlights that these forms of activity do not confer the same health benefits and may, in some cases, be associated with adverse outcomes, a phenomenon sometimes referred to as the “physical activity paradox.”

This distinction has important implications. Public health messaging that treats all movement as equivalent risks obscuring the lived realities of those whose physical activity is driven by necessity rather than choice. For individuals in physically demanding occupations, the issue is not insufficient activity but rather the quality, context, and physiological burden of that activity. Conversely, those with sedentary occupations may have the time and resources to engage in beneficial leisure-time activity, reinforcing health inequalities.

In response, the authors propose a shift towards a systems-based model of “physical activity for health and wellbeing.” This approach recognises that activity patterns are shaped by the environments in which people live and work. Factors such as urban design, transport systems, workplace structures, safety, and social norms all influence whether individuals are able to engage in health-promoting activity.

The practical implication is that improving population health will require more than advising individuals to exercise. It will depend on creating conditions that make beneficial forms of physical activity accessible, safe, and integrated into daily life. This includes designing cities that support walking and cycling, ensuring equitable access to green space, addressing gender and socioeconomic barriers, and rethinking workplace environments to reduce harmful physical demands while enabling healthier movement patterns.

A case for lifestyle interventions in Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder characterised by motor symptoms such as tremor, rigidity, and slowed movement, alongside a wide range of non-motor features including cognitive impairment, sleep disturbance, depression, and autonomic dysfunction. While traditionally managed with pharmacological therapies, there is growing recognition that lifestyle factors play a central role in influencing symptoms, quality of life, and potentially disease progression.

This paper presents a comprehensive review of a “wellness prescription” for Parkinson’s disease, advocating a shift from a reactive, medicalised model of care to a proactive, patient-centred approach grounded in lifestyle medicine. It adopts a biopsychosocial framework, placing the individual at the centre and emphasising that everyday behaviours, particularly exercise, diet, sleep, mental health, and social engagement, are integral to outcomes.

Among lifestyle interventions, physical activity has the strongest evidence base. Regular exercise improves core motor symptoms such as mobility, balance, strength, and gait, and also benefits non-motor symptoms including sleep, pain, cognition, anxiety, and depression. There is emerging evidence that it may influence disease progression. Current guidance supports early and sustained engagement in a combination of aerobic, resistance, balance, and flexibility training. Importantly, enjoyment and adherence are key, with activities such as dance, tai chi, and group exercise offering both physical and psychosocial benefits.

Diet is increasingly recognised as an important modifiable factor in both the risk and progression of Parkinson’s disease. Nutritional challenges are common, with a substantial proportion of individuals at risk of malnutrition due to motor difficulties, gastrointestinal dysfunction, reduced appetite, and interactions with medications such as levodopa. Beyond these practical considerations, dietary patterns appear to influence disease biology. Mediterranean-style and plant-rich diets, high in fruits, vegetables, whole grains, legumes, nuts, seeds, and olive oil, are associated with a lower risk of developing Parkinson’s disease, a later age of onset, slower progression, and reduced mortality. Diet may also exert effects through the gut microbiome, with higher-quality diets linked to increased production of anti-inflammatory metabolites. Although randomised trial data remain limited, current evidence supports a predominantly plant-based, Mediterranean-style dietary pattern as the most beneficial approach.

Other aspects of lifestyle are also critical. Sleep disturbance is common and contributes to poorer cognitive and mental health outcomes, with interventions such as sleep hygiene, light exposure, and behavioural therapies offering benefit. Mental health is central to overall wellbeing, with proactive strategies, including exercise, mindfulness, and social engagement, helping to reduce depression and anxiety, which are highly prevalent in Parkinson’s disease. Mind–body approaches such as yoga, meditation, and tai chi show evidence of improving both motor and non-motor symptoms, as well as reducing stress and inflammation.

The paper also highlights the importance of social connection and a sense of purpose. Social isolation is common and associated with worse outcomes, while engagement in meaningful activities and supportive communities can improve quality of life and potentially influence disease trajectory. Broader aspects of wellbeing, including sexual health, general medical care, and self-management skills, are also emphasised as essential components of a holistic approach.

Overall, the review argues that lifestyle interventions should be considered core to the management of Parkinson’s disease rather than optional adjuncts. It calls for a fundamental shift towards integrating exercise, diet, and other lifestyle strategies into routine care from diagnosis, empowering individuals to take an active role in their health and supporting a more holistic approach to living well with Parkinson’s disease.

Half the calories from crops lost in feeding farm animals

The global food system is a major driver of climate change, biodiversity loss, and water use, yet it fails to deliver equitable nutrition. As highlighted in UK government food security reports, rising food insecurity alongside diet-related disease reflects systemic inefficiency rather than a lack of production. This paper examines how effectively global croplands are used to produce food for human consumption.

The central finding is that only around half of the calories grown on croplands are ultimately available to feed people. While global crop production increased significantly between 2010 and 2020, much of this growth was diverted towards feeding farm animals and non-food uses such as biofuels, rather than direct human consumption. As a result, gains in food availability have lagged behind increases in production.

A major source of inefficiency is the conversion of crops into animal products, particularly beef. Large quantities of feed are required to produce relatively small amounts of meat, meaning most of the original calories are lost from the food system. The greatest loss of calories (39.7%) is through production of beef, which only provides 9% of animal-sourced calories (excluding fish).

The scale of this loss is substantial. Croplands produce enough calories to feed far more people than the current global population, yet nearly half of this potential is lost through inefficient use. Shifting towards more plant-based diets or even replacing beef could significantly increase the number of people that could be fed.

Overall, the paper argues that the challenge is not producing more food, but using what we already produce more effectively. We have the ability to ensure every person on this planet has sufficient calories and nutrients to live healthy lives, we just need to ensure there is equitable distribution of food.

Plant-based alternatives to animals foods to improve planetary health

This new paper, Novel Plant and fungi-based Alternatives Support Nutritional Adequacy of Diets and Reduce Their Environmental Impacts, provides important evidence that plant-based meat and dairy alternatives can play a practical and effective role in supporting a shift away from animal-sourced foods, without compromising overall diet quality.

Using a realistic UK “basic basket” that reflects how people actually eat, the authors modelled small, achievable changes, replacing processed meats, milk, or yogurt with plant-based alternatives, and assessed the impact on nutrition, environmental outcomes, and cost.

A key finding is that targeted substitutions with plant-based alternatives can maintain nutritional adequacy across the whole diet. Despite concerns about these foods being ultra-processed, most products assessed were classified as “healthy” using nutrient profiling models, and overall diets continued to meet recommended nutrient intakes in most scenarios . In some cases, nutritional quality even improved, with increases in fibre and reductions in energy intake and saturated fat, particularly when replacing processed meats. While certain micronutrients such as iodine or vitamin B12 may be lower in some products, these differences had minimal impact when considered within the context of the whole diet.

The environmental benefits were consistent and meaningful. Across all substitution scenarios, greenhouse gas emissions, land use, and water use decreased, even with relatively small dietary changes . This reinforces the idea that shifting away from animal products, even partially, can contribute significantly to climate and sustainability goals.

Importantly, the study highlights that plant-based alternatives offer a realistic pathway for change. Unlike whole food plant-based diets, these products are designed to mimic the taste, texture, and convenience of meat and dairy, helping to overcome common behavioural barriers such as familiarity, cooking skills, and social norms. The modelling approach, focusing on single, incremental substitutions, reflects how people actually change their diets, rather than assuming complete dietary overhauls.

Cost remains a key limitation. While plant-based dairy alternatives were often comparable or cheaper, plant-based meat alternatives were consistently more expensive, which may limit accessibility and uptake, particularly among lower-income groups. The authors emphasise that without policy action to improve affordability, the full public health and environmental potential of these foods may not be realised.

Overall, this study makes a strong case that plant-based meat and dairy alternatives can serve as a useful and pragmatic bridge in dietary transition. When carefully selected, they enable reductions in animal food consumption while maintaining nutritional adequacy and delivering environmental benefits, supporting a gradual and achievable move towards more sustainable, plant-forward diets.

Read this article for more information about plant-based meat alternatives.

Updated food-based dietary guidelines from the Netherlands

The new Dutch dietary guidelines are bold, taking both health and planetary sustainability into consideration.

The core of the “Wheel of Five” remains unchanged but there has been an update to quantities of various food groups. The recommendations include:

• Eating Plenty of vegetables, fruit, legumes, and whole grains
• Limiting intake of salt, saturated fat, and sugar
• Increasing legumes intake to 250g per week
• Reducing meat consumption from a maximum of. 500g to 300g/week (with ≤100g red meat). This is less red meat than recommended in the Eat-Lancet Planetary Health Diet.
• Halving cheese intake from 40g to 20g per day
• Whilst still including dairy, encouraging alternating with fortified plant-based alternatives.

These guidelines demonstrate real leadership from the Dutch Government, helping to put scientific evidence into action. We hope the UK Government follow suit.

See you back in May.

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