Review of the plant-based nutrition and lifestyle medicine news August 2025
This month I cover lifestyle strategies for mental health, interventions to prevent cognitive decline, omega-3 fats, the huge benefits of physical activity, UPFs and thumbs up to eating potatoes.
Lifestyle Medicine in Mental Health Care
People living with mental illness face profound health inequalities, dying 13–15 years earlier on average than the general population. Most of this gap is not due to suicide but to preventable physical diseases such as heart disease, diabetes, and cancer, conditions strongly shaped by diet, physical activity, sleep, and smoking.
The Lancet Psychiatry Commission’s 2025 report makes a compelling case for embedding lifestyle interventions into mental health care as core clinical practice rather than optional extras. Diet quality is consistently lower in people with mental illness, and nutrition-focused programmes, particularly those based on a Mediterranean-style eating pattern rich in whole plant foods, have been shown to improve both mental health symptoms and physical outcomes. In some trials, these dietary changes even reduced overall health service costs, highlighting that food can be both therapeutic and economical. Exercise, too, emerges as a powerful form of medicine: structured programmes improve mood, support recovery, and lower cardiometabolic risk while building quality of life and resilience. Better sleep hygiene plays an equally important role, and smoking cessation remains one of the most effective and cost-saving interventions available. Importantly, the report emphasises that multi-component programmes that bring these elements together are the most effective of all.
Yet, lifestyle medicine remains poorly integrated into routine psychiatric care. The barriers are familiar: under-resourced services, lack of specialist training for clinicians, persistent stigma, and a default reliance on medication alone. The Commission calls for a paradigm shift, one that involves employing dietitians and exercise professionals within mental health teams, supporting peer-led initiatives, tailoring programmes to cultural and personal needs, and addressing the wider determinants of health such as poverty, housing, and food insecurity.
This is more than a matter of physical health. It is about re-imagining mental health care as holistic, humane, and preventive. The evidence is clear: food, movement, sleep, and social connection are not “nice add-ons” but evidence-based therapies that can transform outcomes when given the priority they deserve.
Lifestyle First in Preventing and Treating High Blood Pressure
High blood pressure remains the most common, preventable risk factor for heart disease, stroke, dementia, kidney disease, and premature death. The 2025 American Heart Association and American College of Cardiology guideline underlines what we already know but too often fail to act upon: diet and lifestyle must be the first-line treatment for raised blood pressure.
The evidence is unequivocal. Weight gain, poor diet quality, lack of physical activity, disrupted sleep, alcohol use, and stress are the drivers of hypertension across the lifespan. Conversely, a shift toward healthier behaviours can both prevent blood pressure from rising and bring it down once elevated. A diet based on whole plant foods, rich in fruits, vegetables, whole grains, beans, nuts, and seeds, naturally lowers sodium intake while providing abundant potassium, fibre, magnesium, and plant protein, all of which help reduce blood pressure. The DASH (Dietary Approaches to Stop Hypertension) diet, itself rich in plant foods, remains the most effective eating pattern studied, but Mediterranean and vegetarian diets also consistently improve outcomes. Don’t forget that the DASH diet was modelled on the blood pressure lowering effects of the vegetarian diet, but researchers added animal-sourced foods to make it ‘more acceptable’.
Lifestyle is powerful medicine. On average, dietary change can reduce systolic blood pressure by 5–8 mmHg, while regular physical activity contributes similar reductions. Weight loss, even as little as 5% of body weight, can lower blood pressure further. Salt reduction, particularly when combined with a potassium-rich diet, has profound effects, with trials showing meaningful drops in blood pressure and even fewer strokes and heart events at the population level. Stress-reduction practices such as meditation and yoga add additional benefit. Together, these approaches rival or exceed the effect of a single antihypertensive drug, but without side effects, and with wide-ranging benefits for overall health.
Despite this, medication continues to dominate hypertension management, often prescribed before people are given the tools and support to make meaningful lifestyle changes. The new guideline recognises that in lower-risk adults, medication should only be considered after a 3–6 month trial of lifestyle modification, if blood pressure remains elevated. This reflects a crucial shift: acknowledging that lifestyle is not a soft option, but an evidence-based therapy that should form the cornerstone of care.
The challenge is implementation. Achieving healthier lifestyles requires more than just individual willpower. It demands supportive environments, affordable access to healthy food, opportunities for movement, and culturally tailored interventions. Clinicians have a central role in advocating for these changes, but policy, community, and public health action are equally vital.
Preventing Cognitive Decline with Lifestyle
The search for effective ways to slow or prevent dementia has often focused on drugs. Yet lifestyle medicine is proving to be just as important, if not more so. The US POINTER trial, just published in JAMA, provides some of the strongest evidence yet that multi-domain lifestyle interventions can protect brain health in later life.
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.
This study is unique in its scale, diversity, and length of follow-up, and it reinforces the lesson from the landmark Finnish FINGER study: targeting multiple risk factors through diet, movement, social connection, and vascular health can slow cognitive decline. Unlike pharmaceuticals that act on a single pathway, lifestyle interventions address the full spectrum of risks, offering safe, affordable, and broadly effective protection for brain health.
Plant-Based Diets and Mental Health and Neurocognitive Outcomes
The role of diet in mental and cognitive health has been controversial, with mixed results from past studies on vegetarian and vegan diets. This new systematic review and meta-analysis, including over 700,000 adults worldwide, helps clarify the picture: the quality of the plant-based diet is key.
High adherence to healthy plant-based diets, those rich in whole fruits, vegetables, whole grains, legumes, nuts, and tea/coffee, and low in refined or ultra-processed plant foods, was associated with better mental and cognitive outcomes. People eating this way had significantly lower odds of anxiety, depression, and psychological distress in cross-sectional studies, and reduced risk of depression, cognitive decline, and dementia in long-term cohort studies. In contrast, unhealthy plant-based diets high in refined grains, sugary drinks, sweets, and processed plant foods were linked with higher rates of depression and anxiety.
This is an important corrective to the narrative that meat-free or plant-based diets might harm mental health. Past studies often grouped all plant-based diets together, failing to distinguish between minimally processed whole plant foods and heavily processed plant-based options. The new findings reinforce that a whole food, plant-based pattern supports brain health while a diet built on refined, processed foods, even if technically “plant-based”, may be detrimental.
The mechanisms make sense: fibre, polyphenols, antioxidants, and unsaturated fats in healthy plant foods reduce inflammation, support vascular and gut health, and thus promote mental well-being. Meanwhile, ultra-processed foods, whether animal or plant-based, destabilise glucose regulation, disrupt the gut microbiota, and contribute to inflammation, all of which can undermine mood and cognition.
Ultra-Processed vs Minimally Processed: Same Guidelines, Different Outcomes
Ultra-processed foods (UPFs) now make up more than half of daily calories for people in the UK, and similar levels are seen worldwide. While observational studies have long linked UPFs with obesity and chronic disease, critics argued the evidence was only correlational. The new UPDATE trial, published in Nature Medicine, is the first to directly compare ultra-processed and minimally processed diets while ensuring both met official UK dietary guidelines. The results confirm that processing may matter more, over and above nutrients alone.
In this crossover trial, adults living with overweight or obesity ate two different diets for eight weeks each: one based on minimally processed foods and the other on ultra-processed products, both meeting the Eatwell Guide targets for nutrients and food groups. Despite similar nutrient profiles, outcomes diverged. Participants lost significantly more weight and body fat on the minimally processed diet, along with better control of food cravings and improved triglyceride levels. By contrast, the ultra-processed diet led to smaller weight losses, less fat reduction, and more fatigue, constipation, and reflux.
It is important to note, however, that the difference in weight loss between the two diets was modest, about 1 kilogram over 8 weeks, and both groups lost weight and improved some health markers when following the Eatwell Guide. We do not yet know whether the benefits of minimising ultra-processed foods would widen, persist, or diminish over longer periods. Participants also reported preferring the ultra-processed diet for taste and convenience, and fewer dropped out during that arm. This underscores that sustainability and acceptability of a diet are equally crucial for long-term outcomes. Importantly, the study also demonstrates that adhering to dietary guidelines, even when some processing is involved, can still promote health improvements (UPF group had greater LDL-cholesterol lowering for example).
The UPDATE trial strengthens the case for looking beyond nutrients to the degree of processing, but it also reminds us that dietary change must be both effective and sustainable if it is to make a lasting difference.
The American Heart Association Calls Time on Ultra-Processed Foods
The American Heart Association (AHA) has now weighed in on one of the most urgent nutrition issues of our time: the dominance of ultra-processed foods in the modern diet. Their new 2025 science advisory reviews the evidence and issues a clear message: excess intake of UPFs is a major driver of cardiometabolic disease, and policies must move beyond nutrients to address processing itself.
UPFs, as defined by the Nova system, are industrial formulations made with additives, refined ingredients, and processes not used in home cooking. Observational studies consistently show that high UPF intake raises the risk of heart disease, type 2 diabetes, obesity, and premature death, with risks rising by 25–60% in the highest consumers. Importantly, these associations persist even after adjusting for fat, sugar, and salt, suggesting that the harms of UPFs cannot be explained by nutrients alone.
The advisory notes several pathways: UPFs tend to be hyper-palatable, calorie dense, and easy to overeat; they disrupt appetite regulation and the gut microbiome; and packaging introduces contaminants such as bisphenols and microplastics. At the population level, they displace healthier foods, entrench poor diet quality, and are aggressively marketed to children and vulnerable communities.
The advisory clearer notes that not all UPFs are equal. Some fortified products like whole grain breads or unsweetened soya milks can play a useful role in an otherwise whole food diet. Most UPFs associated with poor health outcomes are HFSS foods i.e high in saturated fat, salt and sugar. The AHA calls for a multi-pronged strategy including front-of-pack labelling, taxes on HFSS UPFs, stricter regulation of food additives, and action on marketing. Importantly, they stress that UPFs are not just a matter of personal choice but of food environments shaped by industry and policy.
This advisory represents a turning point. Just as trans fats were once ubiquitous before regulation, UPFs are now recognised as a systemic health threat. The next step is embedding this understanding into dietary guidelines and creating food systems that make minimally processed, whole foods the affordable, easy choice.
Potatoes, Diabetes, and Diet Quality
Potatoes receive a less favourable score in plant-based diet indices, largely because some studies have linked high potato intake, especially white potatoes, to weight gain, high blood pressure, and type 2 diabetes. But this new analysis from three major US cohorts, with over 200,000 participants and decades of follow-up, offers a more nuanced picture.
The study found that French fries were consistently associated with a higher risk of type 2 diabetes: people eating three extra servings of fries per week had about a 20% higher risk. In contrast, baked, boiled, or mashed potatoes were not linked to increased risk after accounting for lifestyle and dietary factors. In other words, the cooking method matters. Frying potatoes, especially in oils that generate harmful compounds at high temperatures, appears to drive the association with diabetes, not the potato itself.
The researchers also modelled dietary substitutions. Replacing potatoes, particularly fries, with whole grains was associated with a lower risk of diabetes, while replacing them with white rice slightly increased risk. This reinforces a central principle: the health impact of any food depends not just on its own qualities but on what it displaces in the diet. Whole grains, rich in fibre and micronutrients, remain a more protective staple, but potatoes can still play a role in a balanced diet.
These findings suggest that potatoes have been unfairly maligned in some diet scoring systems. When prepared without excess fat or salt and eaten as part of a varied, predominantly plant-based diet, they can provide valuable nutrients such as vitamin C, potassium, fibre, and polyphenols. The real risks come from processing and preparation methods that strip away these benefits and add harmful compounds.
Omega-3 Fats: Rethinking DHA and EPA for a Sustainable Future
For over 50 years, the long-chain omega-3 fatty acids EPA and DHA have been linked to heart, brain, and eye health. Higher intakes are associated with reduced risk of heart disease, dementia, and premature death, with emerging benefits for conditions such as fatty liver disease and obesity. Yet despite their importance, most people in the UK and globally consume far less than recommended, with average intakes under 250 mg per day compared to guidance of 450–500 mg. For vegans and many vegetarians, intakes are close to zero given the absence of fish from the diet.
This new review highlights two important realities. First, relying on oily fish is neither sustainable nor sufficient. Farmed salmon today contains about half the omega-3 it did 20 years ago, while global demand for fish far exceeds supply, contributing to overfishing and environmental damage. Second, even for those who do eat fish, intake levels remain too low to reach optimal blood levels of omega-3, suggesting the need for broader strategies.
What does this mean for people on a plant-based diet? While the body can convert some alpha-linolenic acid (ALA, found in flax, chia, and walnuts) into EPA and DHA, conversion to DHA is limited. This raises ongoing questions about whether direct supplementation with algal oil, the only reliable vegan source of EPA and DHA, should be recommended. Evidence from trials shows algal oil raises blood omega-3 levels just as effectively as fish oil, supporting its role as a sustainable alternative. The review also explores promising innovations such as bioengineered oilseeds (like Camelina and canola) and fortified plant foods, which could help close the global supply gap.
Importantly, the review suggests that current recommendations may actually be too low. While 450–500 mg per day is advised, cardiovascular and anti-inflammatory benefits often require intakes closer to 1–1.5 g daily, especially if we consider omega-3 index of greater than 8% as optimal for cardiovascular health outcomes. Cognitive benefits may also depend on higher intakes, with EPA showing particular promise for supporting brain function.
For those on a plant-based diet, the jury is out with regards the need for DHA/EPA supplementation. For certain life stages such as pregnancy and lactation and in babies and young children up to the age of two years, it is considered essential. The updated guidance from the Academy of Nutrition and Dietetics in the US does not consider DHA/EPA supplements essential for adults on a vegan or vegetarian diet. There are some intervention studies in the pipeline that will hopefully answer some of these outstanding questions in the near future.
Physical Activity Across Life: How Much, How Long, and Why It Matters
Physical inactivity is one of the leading global risk factors for death, yet much of the evidence linking activity to health outcomes comes from studies that measured it at just one point in time. A major new systematic review and meta-analysis, covering 85 prospective studies and millions of participants, has now looked at how physical activity patterns over the life course shape health and survival.
The findings are striking. Adults who were consistently active throughout life had about a 30–40% lower risk of dying from any cause, and a similar reduction in cardiovascular mortality, compared with those who remained inactive. Encouragingly, people who increased their activity later in adulthood still gained substantial benefits, with around 20–25% lower risk of premature death. In contrast, people who reduced their activity over time lost much of this protection, highlighting the importance of maintaining movement throughout life.
The analysis also confirmed the dose-response relationship: meeting the current World Health Organization guidelines of at least 150 minutes of moderate activity per week (or 75 minutes of vigorous activity) was enough to cut the risk of early death by about one third. Even activity levels below these recommendations provided measurable benefits, reminding us that some movement is always better than none. Beyond the guideline range, however, additional benefits were smaller, suggesting that the biggest gains come from moving inactive people into the “guideline zone.”
This life course approach underscores an important message: it is never too late to start, but consistency matters most. Activity patterns that persist into older age bring the greatest protection, particularly against cardiovascular disease. The study also suggests that leisure-time activity, walking, cycling, sports, confers stronger benefits than occupational or incidental movement, likely because it is more sustained and intentional.
Taken together, these studies show that the building blocks of health are the same across conditions and across the life course: a diet based on whole plant foods, limited ultra-processed foods, regular physical activity, restorative sleep, meaningful social connection, and attention to environmental and social determinants. The evidence is not only strong but increasingly precise, with long-term, randomised, and meta-analytic data showing the same consistent patterns.
The challenge now is not a lack of knowledge but a lack of implementation. Lifestyle medicine must become central to routine care, backed by supportive policies and food environments that make the healthy choice the easy choice. As health professionals, advocates, and community members, we have the opportunity to ensure that the science of prevention becomes the practice of everyday health.
See you back in September!
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