Review of the plant-based nutrition and lifestyle medicine news July 2025
This month I cover cardiovascular disease, rheumatoid arthritis, inflammatory bowel disease, diverticular disease and wider issues relating to food system transition for addressing climate change.
Photo by Jannis Brandt on Unsplash
Cardiovascular disease (CVD) remains the leading cause of death globally, yet substantial gains in health and longevity are possible through addressing modifiable lifestyle factors. A large international pooled analysis, with data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents, published in The New England Journal of Medicine, has quantified this potential. Individuals free from five classic risk factors – hypertension, high cholesterol, smoking, obesity, and diabetes – at age 50 gained over a decade of life free from CVD compared to those with all five risks. Women gained 13.3 additional CVD-free years and 14.5 years free from all-cause mortality, while men gained 10.6 and 11.8 years, respectively. Importantly, modifying hypertension and smoking in midlife was associated with the greatest gains in disease-free life expectancy, underscoring the value of preventive strategies and risk factor modification. It is worth noting however that these risk factors only explain 50% of the risk of CVD. Other risk factors such underlying inflammation and genetically determined risk factors such as LP(a) are likely to be important.
The Role of Diet in Cardiovascular Risk
Diet quality is a crucial lever in modifying multiple risk pathways, including hypertension. Diet patterns known to reduce the risk of hypertension are ones that emphasise healthy plant foods i.e. Stop Hypertension (DASH) diet, Mediterranean diet, and vegetarian diet. A complementary analysis from the US National Health and Nutrition Examination Survey (NHANES) evaluated the link between plant-based dietary patterns and subclinical cardiovascular disease i.e. in the absence of symptoms. Using biomarkers like cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)], the study found that higher adherence to a healthy plant-based diet (rich in whole grains, fruits, vegetables, and legumes) was associated with a significantly lower likelihood of elevated cTnI, indicating reduced subclinical myocardial damage. Conversely, higher intake of unhealthy plant-based foods (e.g., refined grains, sugary drinks) was associated with greater cTnI elevation. This association persisted after adjustment for sociodemographic characteristics, lifestyle behaviours, and health status. There were no significant associations between plant-based diet indices and cTnT or NT- proBNP.
The study findings reiterate the importance of diet quality when consuming a plant-based dietary pattern. It should be noted though that the paper does not provide information on the exact quantities of food consumed. But given that this is a representative US cohort, it can be assumed that in general, consumption of healthy plant foods was not terribly high. The research conclude ‘Encouraging healthcare providers, policymakers, and other health authorities to recommend and support access to and adoption of healthy plant-based diets may be beneficial for promoting cardiovascular health in both individuals and communities.’
In addition, a new report has demonstrated that a healthy plant-based diet, low in animals foods, can support better health in Black and low income Americans, as evidenced by lower all-cause and CVD mortality. This suggests that different ethnicities and socioeconomic groups can benefit from eating more plants.
Diet vs. Physical Activity in Body Weight Management
With the advent and availability of effective weight loss medication, there has been a lot of discussion about the best methods for maintaining a healthy body weight. The relative contributions of diet and physical activity is often discussed. A comprehensive global analysis reported in Nature Metabolism challenges assumptions around energy expenditure. The study examined energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialised populations.
The study showed that with economic development is associated with increased prevalence of obesity but also energy expenditure and activity-related energy expenditure is higher in more developed populations. This is related to larger body size. Variations in total energy expenditure across economic strata are relatively modest. In contrast, rising obesity rates correlate more strongly with increasing caloric intake, suggesting diet plays a far larger role in body weight regulation than physical activity alone. The study concludes ‘Regulating food environments to maximise the benefits of increased calorie availability without promoting a nutrient-poor, obesogenic diet remains a crucial challenge in public health that will only become more acute as economic development continues globally.’ There is plenty of evidence that a dietary pattern high in whole plant foods and low/absent in animal food and ultra-processed foods, helps to support a health body weight.
Lifestyle Factors Remain Crucial with GLP-1 Agonists
The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide has revolutionized obesity and diabetes management by delivering weight loss of 15–21%. However, a recent clinical review in JAMA Internal Medicine stresses that these pharmacologic tools do not eliminate the need for dietary quality or physical activity. We know that dietary quality remains poor in most people using weight loss medication. Muscle loss remains a concern since up to 40% of lost mass with GLP-1 RAs may be lean tissue. This necessitates adequate protein intake and resistance training. The authors propose a “MEAL” framework: Muscle maintenance, Energy balance, Avoid side effects, and Liquid intake. Diets should prioritise nutrient density over calorie restriction, with Mediterranean, DASH, or plant-based patterns recommended for their cardiometabolic benefits. Protein recommendations are 1.0-1.5 g/kg and >1.5 g/kg for older or people post-bariatric surgery. Protein meal replacements are recommended for those with smaller appetites. Physical activity, particularly strength training, is also recommended to help mitigate lean tissue loss and supports long-term success.
Plant-Based Protein and Muscle Strength
A frequent concern about plant-based diets is their adequacy for maintaining muscle mass and function. A new systematic review and meta-analysis of eight randomised controlled trials provides reassuring evidence: plant-based protein interventions are not detrimental to muscle strength. In fact, across multiple studies in varied populations, including older adults, plant protein intake was associated with comparable gains in strength relative to animal protein, provided protein intake met recommended thresholds. This evidence supports the inclusion of plant-based sources in muscle maintenance strategies, particularly for populations using GLP-1 therapies or engaging in resistance training
Chronic Disease Prevention: Beyond Cardiometabolic Health
While cardiovascular disease remains a dominant global health burden, chronic inflammatory conditions such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and diverticulitis also carry substantial morbidity and cost. Diet and lifestyle factors plays an increasingly recognised role in modulating risk for these diseases, offering new avenues for prevention.
Dietary Patterns and Risk of Rheumatoid Arthritis and Inflammatory Bowel Disease
Evidence from a nested case–control study within the Malmö Diet and Cancer Study (MDCS) in Sweden has provided new insights into the link between diet and incident RA. This analysis focused on components of the 2015 Swedish food-based dietary guidelines, including fruit and vegetable intake, red and processed meat consumption, and fibre intake. Two key dietary factors stood out. First, consumption of at least 400g/day of fruits and vegetables was associated with a 36% reduced risk of developing RA. Second, adherence to a red and processed meat intake below 500 g/week was associated with a 40% lower risk. Importantly, the association between meat consumption and RA risk was primarily observed in seropositive RA, a more severe form of the disease. These findings suggest that plant-forward, low-meat dietary patterns may reduce systemic inflammation and autoimmune risk.
There is now also convincing evidence on the benefits of diet and lifestyle interventions for people living with RA. The Plants for Joints study demonstrated that a whole food plant-based diet, physical activity and stress management was effective at alleviating symptoms of arthritis, improving cardiometabolic health and supported some people to reduce their reliance on medications.
A growing body of research links dietary patterns to the risk of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). A large-scale prospective study using data from 143, 434 participants of the UK Biobank study found that adherence to a healthy plant-based diet (hPDI) was significantly associated with a reduced risk of both UC and CD. Specifically, each standard deviation increase in hPDI was associated with an 8% reduction in UC risk and a 14% reduction in CD risk. Conversely, higher scores on the unhealthy plant-based diet index (uPDI), characterised by high intakes of refined grains, sweets, and sugary beverages, were associated with increased CD risk.
Mediation analyses suggested that the protective effects of a healthy plant-based diet were partially explained by reductions in systemic inflammation, as measured by C-reactive protein, white blood cells, and neutrophils, and by improved metabolic and liver function markers. These findings highlight the anti-inflammatory potential of whole-food plant-based diets and their role in preventing chronic gastrointestinal inflammation.
Similarly, another analysis using data from the UK Biobank study and the EPIC study, including more than 500,000 participants, also showed that a healthy plant-based diet was associated with a lower risk of IBD. In addition, it was able to show that a healthy plant-based diet resulted in fewer complications and less requirement for surgery in people with an established diagnosis of IBD. The authors conclude ‘We show that adherence to a healthy plant-based dietary index might be a strategy to alter the natural history of IBD, especially in individuals with moderate or high genetic risk’.
A prior study demonstrated that healthier lifestyles, that included maintaining a healthy body weight, regular physicial activity, eating sufficient fibre and fruits and vegetables and not smoking, could reduce the burden of inflammatory bowel disease by up to 60%. This suggests that a large proportion of cases are preventable.
Inflammatory diets are typically high in red and processed meat, refined grains and free sugars, whilst being low in healthy whole plant foods. Recent additional studies include one that suggests inflammatory diets during pregnancy may increase the risk of type 1 diabetes in children and that inflammatory diets may also increase the risk of developing osteoporosis.
Lifestyle and Genetic Risk in Diverticulitis
Diverticulitis, a common gastrointestinal condition, has traditionally been attributed to ageing and structural factors. However, a recent integrated analysis of four large US cohort studies (including the Nurses’ Health Studies and the Health Professionals Follow-Up Study) and validation in the Mass General Brigham Biobank challenges this notion. Researchers developed a “healthy lifestyle score” based on five modifiable factors: body mass index <25, regular physical activity, non-smoking status, high fiber intake, and low red meat consumption. Each point increase in this score was associated with a significantly lower risk of diverticulitis, independent of genetic risk. Even among individuals with a high polygenic risk score, adherence to a healthy lifestyle reduced the likelihood of developing diverticulitis. These results highlight the power of lifestyle intervention to mitigate genetic susceptibility and suggest that public health strategies should prioritise fibre-rich, plant-based diets alongside other modifiable behaviours.
One of the key beneficial impacts of a full plant-based or vegan diet is a significant reduction in the risk of diverticular disease as demonstrated by the results of the EPIC-Oxford study. This is at least in part due to the higher fibre intakes associated with plant-based diets.
Food, Health, and Planetary Boundaries: Aligning Nutrition and Sustainability
As the climate crisis intensifies, the intersection of diet, health, and environmental impact demands urgent attention. Food systems contribute approximately one-third of global greenhouse gas (GHG) emissions, with the production of animal-based foods, especially red and processed meats, disproportionately responsible for emissions, land use, and biodiversity loss.
From Fuel to Fork: The Fossil Fuel Footprint of Modern Diets
The IPES-Food report Fuel to Fork draws attention to the deep entanglement of food systems with fossil fuel dependency. Approximately 15% of all fossil fuels globally are consumed by food systems. Fertilizers alone, mostly derived from fossil gas, account for one-third of global petrochemical use. Additionally, plastic packaging for food and drink represents a major source of pollution and carbon emissions. The report calls out industrial agriculture for its reliance on energy-intensive inputs – fossil-based agrochemicals, plastic films, and synthetic nitrogen fertilisers – which not only harm the environment but also exacerbate health disparities and food insecurity. Transitioning to agroecological farming, local supply chains, and dietary patterns rich in minimally processed plant-based foods is a critical pathway to a more sustainable and just food.
Protein Quality and the Shift to Plant-Based Meat Alternatives
Reducing meat consumption is widely recognised as beneficial for the environment, but concerns remain about nutritional adequacy, particularly protein quality. A new Dutch modelling study addressed this by evaluating the impact of replacing animal meat with plant-based meat alternatives (PBMAs) on dietary protein adequacy. The study found that while total and utilizable protein intake declined modestly with a full replacement scenario, 86% of the adult population would still meet protein adequacy thresholds. Ensuring variety and sufficient total intake, particularly of high-quality plant proteins like soya and mycoprotein, was key to maintaining nutritional balance. These findings support broader adoption of PBMAs in national dietary strategies, provided that formulation and fortification support essential amino acid requirements.
A new review article from the UK summarises the evidence on PBMAs for health and the environment. There clearly is a role for these products to support reduction in meat consumption, but the food industry needs to ensure they are formulated to provide essential nutrients, cost needs to come down to encourage more widespread uptake and consistent education of consumers is needed to facilitate less meat consumption.
UK Food Production: A Systemic Mismatch
Despite clear evidence of the health and environmental benefits of plant-based diets, food production in the UK remains misaligned with dietary guidelines. A dietary gap analysis found that only 7% of UK-produced food in 2022 was fruit and vegetables compared to the recommended ~40% share in the Eatwell Guide. Instead, disproportionately high production of dairy, oils, and sugar beets reflects entrenched agricultural subsidies and market structures. The report argues for reorienting food policy to better match national dietary and environmental targets, including through investment in horticulture and plant protein crops. Aligning food production with health needs is not only a matter of agricultural reform, it is a matter of public health equity and ecological resilience.
Let’s hope that the National Food Strategy delivers on this. So far the Government have set out their ten priority outcomes for the new food strategy and are now engaging various stakeholders, including citizens. Let’s hope the final strategy is one that aligns food production with both health and sustainability goals.
See you back in August!
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