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

This month I cover a new report on obesity and the food environment, guidance on prevention of dementia, physical activity recommendations, plus more evidence for eating plants and drinking coffee!

Food and Weight Management: Fixing the food environment

To address overweight and obesity in the UK, we must address the unhealthy food environment, according to this new report from the Health and Social Care Committee. Obesity is not a personal failure but is a consequence of many factors that are usually outside the control of the individual. There is plenty of evidence to show that food environments, including supermarkets, fast food outlets and advertising, influence are dietary behaviours. In addition, calorie for calorie, unhealthy foods are cheaper than healthy ones.

The report makes a number of recommendations to encourage healthier diets.

• Implementation of the 2018 nutrient profiling model to support people to identify less healthy foods and drinks. You can learn more about this by listening to the In a Nutshell Podcast.
• Mandatory healthy sales reporting with target set for supermarkets. We would also add that reporting of plant versus animal protein sales should be included as recommended in the 10 Point Plan policy briefing.
• Requirement for large businesses to report on the price promotions it offers, specifically the percentage of such promotions on healthier foods like fruits and vegetables.
• Update and promote the healthy start scheme to ensure all children benefit.
• Support more community projects to support access and uptake of healthier diets. The work of the Alexandra Rose Charity is an example of the positive impact that making fruit and vegetables accessible to those most in need can have on health.
• Introduce mandatory front-of-pack labelling.
• Incentivise reformulation of products to remove sugar, salt and fat and increase fibre.
• Support local authorities to use planning systems to improve local food environments, including refusing planning permission to fast food outlets that serve unhealthy meals.
• Overhaul advertising to promote healthy foods.
• Prioritise health in food policy and ensure that the enforcement of healthy food environments is properly resourced.
• Address the oversized influence of the food industry. Read my article on this topic here.

The document provides a blueprint for Government on evidence-based action it can take to support healthier diets for all. The question now is, will they listen and will they act.

In my view, healthcare should be leading by example. At the moment, hospital food environments are no different to the high street, with retail outlets and staff canteens selling foods high in sugar, salt and saturated fat. Hospitals serve meals with processed meat and there is little to no promotion of healthier, fibre-rich meals.

A reminder of why the work of the Plants First Healthcare Coalition is so important.

Modifiable risk factors for ischaemic heart disease in the US

Cardiovascular diseases remain the main cause of ill health and death globally. This updated analysis from the GBD provides data on modifiable risk factors that are responsible for ischaemic heart disease (IHD) in the US in 2023. These data are also relevant for other high-income countries. Although deaths from IHD have decreased, people are living longer in ill health.

High systolic blood pressure (SBP), dietary risks, and high low-density lipoprotein cholesterol (LDL-C) were the leading risk factors for IHD, accounting for 47.2%, 38.6% and 28.5% of IHD deaths, respectively. Elevated fasting glucose and high body mass index continue to rise in prevalence as risk factors for IHD. Smoking and air pollution have decreased as in their impact on IHD mortality.

We have known for a long time now that ischaemic heart disease is preventable in the majority of people and can be significantly reduced even in people at higher genetic risk. The direct cause of IHD relates to elevated blood cholesterol and high circulating levels of atherogenic lipoproteins. These lipoproteins penetrate the wall of the coronary arteries and lead to atherosclerosis. This process is exacerbated by high blood pressure and high blood glucose, which both act to damage the endothelial lining of the coronary arteries.

Plant-rich diets (with or without fish) are an essential part of IHD prevention strategies as outlined in the 2026 dietary guidance from the American Heart Association. Read more about prevention of cardiovascular disease and about our research on diet and hypertension.

Dietary approaches for lipid management

During some informal conversations with colleagues, I learnt that many are not familiar with the Portfolio diet. Given its decades of robust evidence in cholesterol lowering and improving cardiovascular outcomes, it seems that we are missing a big opportunity in the UK. We know that one of the huge benefits of eating more plants and less animals is a healthier blood lipid profile.

Yet even I was surprised to see there were significant benefits for people with genetic hypercholesterolaemia

A new study reported in Nature tested the impact of a whole food plant-based (WFPB) diet in people with heterozygous familial hypercholesterolaemia, a genetic disorder that leads to elevated blood cholesterol and increasing the risk of atherosclerotic cardiovascular disease.

The study was a two-period, two-treatment, crossover, controlled feeding trial in 50 participants who were not on cholesterol-lowering medications. Each participants ate a standard American diet (SAD) or a WFPB diet separated by a wash out period. A WFPB diet was defined based on the 2019 Canadian dietary guidelines. All meals and drinks were provided and the diets were designed to be isocaloric and intended to maintain current participant weight. Of note, no phytosterols-fortified foods were included.

Compared to the SAD, the WFPB diet phase resulted in an 18% decrease in LDL-C, 15% reduction in ApoB, reductions in blood pressure and an overall 11.9% relative reduction in the estimated 10-year risk of CVD event. Compared to the SAD, the WFPB diet reduced intestinal cholesterol absorption, and improved perceived appetite sensations, meaning greater feelings of fullness and reduced appetite.

It’s worth noting that there was significant heterogeneity in response to the WFPB diet. Five participants achieved a greater than 30% reduction in LDL-C, whilst five had an increase in LDL-C levels on the WFPB compared to the SAD.

Overall, this study confirms that dietary approaches are an important tool for managing genetic hypercholesterolaemia and likely to have additional benefits for overall health.

Processed plant-based meat versus red meat.

There remains concern about plant-based diets being too ‘processed’ and therefore worsening health outcomes compared to a ‘natural’ meat-based diet. This narrative has been perpetuated by the meat industry, without scientific proof to support the claims.

Studies have actually shown the opposite. For example, the SWAP-Meat study from Stanford University compared Beyond meat products to organic, grass-fed meat from cows. The results showed that despite being classified as ultra-processed, the Beyond substitution led to a lowering of TMAO levels, the primary outcome, alongside reductions in LDL-C and body weight and without any negative impacts.

Of course this study was small and short, but it does suggest that processed plant-based meat alternatives could have benefits for health when compared to eating red meat

It is good to see this new study – the FOOD-1 trial – which replicates some of the previous findings. Forty-one participants were randomly assigned to a plant-based meat-supplemented, fully plant-based diet, with two portions of Beyond patties per day or a red-meat supplemented diet for 6 days and subsequently underwent cross-over. The primary end-point again was TMAO with a number of secondary end-points relating to cardiometabolic health.

The results showed that participants on the plant-based meat diet reduced TMAO and LDL-cholesterol levels, whilst there was a small but significant increase in body weight (0.6kg) and NTproBNP. The authors propose the rise in weight and NT-proBNP may have been due to the salt content of the Beyond products since the participants had a higher prevalence of CVD risk factors, compared to the SWAP-MEAT study.

Other things to note are that during the plant-based phase, participants were not meant to consume any other animal-derived foods, but some still did. The patties were well tolerated but more participants reported abdominal pain and diarrhea with the plant-based patties.

The overall take away is that plant-based meat alternatives may be better for health than red meat, however, there are always trade offs to consider. Ideally, red meat should be replaced by minimally processed plant protein sources such as legumes.

Read more about plant-based meat alternatives.

New WHO guidelines on reducing the risk of dementia

Dementia is a huge personal, community and societal issue with 57 million people globally living with dementia, 60% of whom are in low and middle-income countries. Pharmaceutical interventions have not lived up to their promise. The good news though is that 45% of dementia cases could be prevented or delayed by addressing modifiable risk factors.

This updated WHO guidance puts the evidence into action. Recommendations are essential the tenants of healthy living and include promoting healthy behaviours, preventing and managing chronic conditions and reducing exposure to environmental hazard. These include the following;

• Equitable access to lifestyle eduction and prioritising cognitive training and stimulation – meaning engaging in activities that use and stimulate the brain.
• Social activity and participation to prevent loneliness and isolation.
• Regular physical activity.
• Avoidance of alcohol and tobacco.
• Healthy diet.
• Prevention of overweight and obesity.
• Prevention and management of type 2 diabetes.
• Prevention and management of hypertension.
• Prevention and management of hearing loss and visual loss.
• Reduction in exposure to household and outdoor air pollution.

Specific dietary recommendations are centred round evidence-based dietary patterns include the Mediterranean, DASH (Dietary Approaches to Stop Hypertension) and MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) diets. The guideline states ‘These diets emphasize fruits, vegetables, whole grains, nuts and legumes, while limiting red meat, saturated fats and sugary foods’. Dietary supplementation is discouraged, rather a food-first approach encouraged.

Further support for eating more fibre-rich foods comes from an updated meta-analysis of observational studies including 222,108 participants from 16 cohorts and 10 countries. It finds that higher intakes of fruit and vegetables lowers the risk of dementia by 20%. Vegetable consumption had a slightly greater impact than fruit.

The WHO report is a very useful document for empowering healthcare providers and clinicians to embed lifestyle medicine into routine practice. Read our article on diet, lifestyle and brain health and use our factsheet on Alzheimer’s disease.

Plant-based meals in hospitals

This is a highly practical study that moves the discussion on plant-based hospital food from aspiration to implementation. Using a multidisciplinary co-creative process involving chefs, dietitians, clinicians, facilities teams and industry partners, the researchers developed 30 fully plant-based recipes combined into seven daily hospital menus. The aim was to produce meals that were nutritionally adequate, palatable, affordable, appropriately portioned and operationally feasible. The menus provided 90–97 g of protein per day, with all meals meeting the study’s threshold for essential amino-acid adequacy and estimated protein quality. Soya, lentils, oats, grains, nuts and seeds were the main protein sources, with soya drinks and pea-protein isolate used where needed to increase protein density without substantially increasing food volume.

The study offers a useful blueprint for hospitals because it brings together six essential criteria: protein quantity, protein quality, palatability, portion size, cost and feasibility. It also shows that plant-based hospital meals can be delivered within a realistic food budget, with daily ingredient costs of €10.50–€12.30. This creates opportunities for hospitals to introduce plant-based defaults, expand plant-rich menus and reduce reliance on animal protein without compromising clinical standards. The meals were also high in fibre, low in saturated fat and based largely on legumes, whole grains, fruits, vegetables, nuts and seeds, offering wider health and sustainability benefits.

However, there were important barriers. Breakfast and lunch were particularly difficult to make sufficiently high in protein without using fortified drinks or protein isolates. Larger portions may be poorly tolerated by patients with reduced appetite, nausea, fatigue or treatment-related symptoms, while some protein isolates had an unpleasant taste. The menus also relied heavily on soya, which is nutritionally useful but may be unsuitable for some patients and limits diversity. Importantly, the tasting was carried out by the expert group rather than by patients, so real-world acceptability and actual intake remain uncertain. The reported costs also excluded labour, preparation time, training and food waste.

The main nutritional concerns were calcium and vitamin B12. None of the menus met the calcium target and only one met the vitamin B12 target, highlighting the need for fortified products or supplementation. It is worth mentioning that the calcium target aimed for was more than 950mg per day, whereas in the UK, 700mg/day is considered adequate. Total protein intake was adequate, but some individual meals provided less than the intended 20 g, which may be relevant for older patients with anabolic resistance. Fibre intake was high at 39–54 g per day, which is beneficial for many people but may worsen satiety, bloating or gastrointestinal symptoms in acutely unwell patients.

Overall, this study should give hospitals confidence that high-protein plant-based meals are achievable, but success depends on dietetic oversight, culinary expertise, careful fortification and real-world testing of intake, acceptability and clinical outcomes.

New physical activity guidelines UK

The UK has updated its physical activity guidelines. We know that regular physical activity (PA) is essential for optimising both physical and mental health and wellbeing. PA is associated with lower risks of chronic conditions, including cardiovascular diseases, type 2 diabetes, cancer, dementia, depression and more.

The fundamentals of the guidance remain the same – 150 minutes of moderately intensity or 75 minutes of vigorous activity per week and strength training twice per week for adults and at least 60 minutes per week for children.

The key updated guidance for all stages of life are: stronger recommendations for strength exercises throughout the life course, including for those on GLP-1 medications; warnings about prolonged periods of sitting / sedentary behaviours; benefits of light activities, including everyday tasks such as gardening, shopping, housework; additional recommendations for balance exercises for prevention of falls and frailty in older adults.

There are some useful infographics to use in teaching and practice.

An interesting, large scale, pragmatic study enrolling 19,234 people found that five minute exercise snacks every hour during the working day is not only feasible and acceptable but improved psychosocial outcomes. So this may be a useful way to reduce sedentary behaviours.

Physical activity guidance also ties in nicely with a report from London School of Economics that presents their impact assessment of the Dose of Nature (DoN) Prescription randomised controlled study with data collected over 2.5 years and responses from 375+ participants. The study run by the charity DoN involved patients with a range of mental health conditions, referred by their GPs. The 8-week intervention involved an assessment with a DoN psychologist, who then matched the participant with a DoN guide. The intervention group were supported to participate in nature-based activities.

The results showed that the programme resulted in significant improvements in mental health and wellbeing, with reduction in anxiety and depression. There was significantly increased life satisfaction and the perceived worthwhileness of daily activities. Further analysis showed that improvements in social connectedness, belonging, and reduced loneliness partially explain the mental health benefits.

Importantly, the benefit-cost ratio was calculated at 8.3, meaning that the benefits of a DoN prescription are more than eight times greater than its costs. This suggests a high value-for-money.

Sustainable diets do not increase costs

This new study examined how Scotland could meet UK Climate Change Committee recommendations to achieve a 20% reduction in meat and dairy consumption by 2030 and a 35% reduction in meat by 2050 while maintaining nutrient sufficiency, supporting health and ensuring affordability.

The researchers used nationally representative dietary and health data from 3,447 Scottish adults aged 16 years and older, combined with data from foodDB, which contains price and environmental information for around 70,000 UK supermarket products. They modelled 33 different ways of achieving meat and dairy consumption and outcomes included intake of 54 nutrients, obesity, type 2 diabetes, cardiovascular disease, all-cause mortality, food costs, greenhouse-gas emissions, land and water use, and eutrophication.

The most effective strategy was not a uniform reduction across the population, but targeting people with the highest intake of red and processed meat. Reducing red meat to no more than 60g per day among high consumers could achieve the 2030 target, while a maximum of 31g per day could achieve the 2050 target. This approach generated greater health and environmental benefits than reducing all types of meat equally, with similar cost savings.

The modelled pathway with the greatest combined benefits reduced red meat to a maximum of 31 grams per day and dairy by 20%, without replacing the removed foods. Over ten years, this was estimated to prevent around 59,248 cases of type 2 diabetes, 18,595 cases of cardiovascular disease and 2,240 deaths, while reducing average BMI by 2.09 kg/m².

Environmental benefits were consistent. In the most effective pathway, greenhouse-gas emissions fell by 0.91 kgCO₂e per person per day, alongside reductions in land use, water use and eutrophication. Targeting high red-meat consumers was slightly more effective than applying a general reduction across all meat consumption.

Importantly, healthier and more sustainable diets were not more expensive. The most effective pathway reduced average food costs by around 41p per person per day, approximately £150 per year. Replacing meat with vegetables, beans or pulses retained modest savings, whereas oily fish was the only replacement associated with a significant increase in cost. Savings were similar in the most and least deprived groups.

The main nutritional concern related to reducing animal-sourced foods without appropriate replacement. Average intakes of protein, zinc, calcium, iodine and selenium fell, with dairy reduction particularly affecting calcium and iodine. However, in reality, when people remove foods from the diet this is usually replaced by something else. So swapping dairy with fortified plant-based alternatives can easily address concerns about nutrients such as calcium and iodine.

For those in clinical practice this is a useful study that allays fears about diet change not being possible in lower income households due to cost barriers. Modest changes can lead to both climate and health benefits. Replacing meat with beans is the best option for health and swapping dairy products for fortified soya drinks and foods can be affordable when choosing supermarket own brands.

It seems from another study in Nature Food, which analysed dietary intakes in 165 countries and across 72 socio-economic groups, that diets of highly educated urban men aged 15-34 is having the greatest environment impact. In contrast, rural women aged 35-54 with lower educational attainment are eating diets with the lowest environmental impact – half that of the highest impact group. The analysis also showed that higher quality, healthier diets consistently had a lower environmental impact. No surprises there since eating more plants and less animal-sourced foods is win win for people and planet.

Dr Marco Springmann has created a free online database that provided information on what people around the World are actually eating. The interactive tool will allow researchers to more accurately evaluate the health, environmental and economic impacts of global diets.

Thumbs up to coffee from the American Heart Association

A good news story to end. The American Heart Association has published a new scientific statement on caffeine and cardiovascular disease. Most of the studies on caffeine are in the context of drinking coffee. Different people metabolise caffeine at different speeds, so at an individual level, caffeine can have variable acute effects.

There is clear heterogeneity in the data on caffeine/coffee consumption and health outcomes. The overall conclusion of this review is that moderate caffeine or coffee consumption (up to 400 mg/d caffeine or ≈3–5 cups of coffee at 8 oz per cup) is safe for most adults and is associated with a lower risk of cardiovascular disease, including coronary heart disease, stroke, heart failure, and atrial fibrillation, as well as hypertension and type 2 diabetes. Habitual coffee consumption may also be linked with a reduction in premature mortality, with the lowest mortality risk observed at moderate levels of intake (2–4 cups/d). Similar benefits have been seen with consumption of decaffeinated coffee suggesting benefits of non-caffeine bioactive compounds in coffee.

Of course, coffee is not an essential component of a healthy diet, but if you enjoy it and you don’t get acute side effects, then you can be reassured that it does not cause harm and may even afford some health benefits.

See you back in August.

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