Review of the plant-based nutrition and lifestyle medicine news March 2026
Cancer and brain health are the main themes of this month’s review. Plus a reminder that genetics are not our destiny and that diets can be healthy AND sustainable.
Healthy lifestyles can improve heart health even when high genetic
Heart disease remains the top killer of men and women globally, yet 90% of cases could be prevented if we addressed modifiable risk factors.
This new study investigated the combined impact of diet and lifestyle on the risk of coronary heart disease. While we know that both genetics and lifestyle influence cardiovascular risk, fewer studies have looked at how these factors interact, particularly in the context of plant-based dietary patterns.
Researchers analysed data from 7,764 participants in the long-running Rotterdam Study, following them prospectively for several decades to track the development of coronary heart disease. The investigators applyed a validated lifestyle score that incorporated a healthy plant-based diet in combination with non-smoking, adequate physical activity and moderate sleep duration, alongside polygenetic risk score.
The results showed that higher adherence to this healthy plant-based lifestyle was associated with a significantly lower risk of developing coronary heart disease. For every increase in the score reflecting healthier behaviours, the risk of coronary heart disease fell. Participants with the highest adherence to the healthy plant-based lifestyle had a 22% lower risk of developing coronary heart disease compared with those with the poorest adherence.
Importantly, adherence to a healthy plant-based lifestyle benefited all genetic risk groups. However, participants with a high genetic risk benefited the most with a 44% reduction in risk compared to participants with a low or intermediate genetic risk who showed a 20% reduction in risk. Once again, these data confirm that genes are not our destiny.
The accompanying editorial highlights an important point. Lifestyle behaviours rarely occur in isolation. People who follow a healthier diet are also more likely to be physically active, avoid smoking and maintain good sleep patterns. Looking at these behaviours together therefore provides a more realistic picture of how lifestyle influences cardiovascular health.
Taken together, these findings reinforce a powerful public health message. A diet rich in whole plant foods, combined with other healthy lifestyle habits, can substantially reduce the risk of coronary heart disease. Even for individuals with an unfavourable genetic profile, lifestyle choices remain a powerful tool for protecting long-term health. This is of particular importance for South Asian. New data from the MASALA study in the US show that South Asians have a significantly higher risk of heart disease and type 2 diabetes, which also occur much earlier in life, compared to all other ethnicities. Thus, tailored and earlier prevention strategies are required with intensive risk factor management.
Do vegan diets increase the risk of colorectal cancer?
One of the largest studies of its kind on diet and cancer saw a hugh amount of media attention. The analysis brings together data from nine different studies, 3 different continents and includes 1,645,555 meat eaters; 57,016 poultry eaters; 42,910 pescatarians; 63,147 vegetarians; and 8,849 vegans. Participants were followed for a median of 16 years.
Although the results support prior literature and shows that vegetarian diets lower the risk of five different cancer type, there are also some surprising results.
Vegetarians in this cohort had a reduced risk of pancreatic, breast, prostate, and kidney cancers, and multiple myeloma. This lower risk was explained, in part, by lower body weight. However, they also had a higher risk of squamous cell oesophageal cancer, which is not easily explained, but could be due to lower intakes of B vitamins. Prior studies have identified B vitamins to be important for preventing oesophageal cancer
For those following a vegan diet, there were just too few numbers of each cancer type to draw firm conclusions. However a surprising finding was that vegans had an increased risk of colorectal cancer.
As the authors themselves point out, this should be interpreted with caution since the results for vegans were based on just 93 cases across all the studies with some studies having fewer than 10 cases. When the first 4 years of follow-up were excluded, the higher risk of colorectal cancer was no longer significant. This suggests that some people already had the early stages of cancer present prior to entry into the study as there is a long lead time prior to cancers becoming clinically apparent. In addition, as pointed out in this excellent video by Mic the Vegan, the models reported adjusted for body mass index (BMI). If you accept that a lower BMI is a result of the vegan diet rather than a confounder then this association with colorectal cancer disappears. In addition, when BMI was not adjusted for, vegans also had a lower risk of prostate and breast cancers.
However, it is worth noting that a very plausible reason for the higher risk of colorectal cancer in vegans is the low calcium intakes across most of the cohorts analysed. Adequate calcium intake has long been known to protect against colorectal cancer.
The lower calcium intake in vegans is likely a reflection of the fact that these studies were from the 1990’s and 2000’s when fortified vegan products were not widely available. Modern day analysis of vegans shows that calcium intakes are now adequate.
Another points to note are that this study did not report on total cancer risk, only site specific risk. Prior analyses, including from the EPIC-Oxford study and Adventist Health Study-2, have clearly shown a reduced risk of total cancer in both vegetarian and vegans, with a greater reduction in vegans. In addition, omnivores in the current analysis had relatively low intakes of meat compared to current typical Western diets. The study did not consider diet quality and vegans were identified based on what they do not eat (animal-sourced foods), rather than what they were eating – which of course is not always healthy.
The take home message remains unchanged. Diets high in fruit, vegetables, whole grains, beans, nuts and seeds are best for cancer prevention. Vegan diets need to be appropriately supplemented with vitamin B12 and certain nutrients need extra focus such as calcium, vitamin D, iodine, selenium and zinc.
Physical activity in cancer survivors
This study examines the impact of physical activity in cancer survival. While there is strong evidence that regular exercise reduces the risk of developing cancer, there has been less research on whether physical activity improves survival after a diagnosis, particularly for cancers other than breast, prostate and colorectal cancer.
Researchers analysed data from six large cohort studies involving more than 17,000 cancer survivors diagnosed with bladder, endometrial, kidney, lung, oral, ovarian or rectal cancer. Participants were followed for an average of almost 11 years after diagnosis, allowing the researchers to examine how levels of leisure-time physical activity related to the risk of dying from cancer.
The findings were striking. Even small amounts of moderate to vigorous physical activity after a cancer diagnosis were associated with a lower risk of cancer mortality for bladder, endometrial and lung cancer. Higher levels of activity, double or triple the recommended amount, were associated with reductions in mortality for oral cancers.
Perhaps the most encouraging finding was that becoming active after diagnosis appeared to be beneficial even for people who had previously been inactive. Lung and rectal cancer survivors who met physical activity guidelines after diagnosis had a lower risk of cancer mortality regardless of their activity levels before diagnosis. This reinforces an important message for patients: it is never too late to start moving.
As with most observational studies, the findings cannot prove cause and effect. People who are able to be physically active may already be healthier than those who are not. However, the results remained broadly consistent even after accounting for factors such as smoking, cancer stage and treatment.
Overall, this research strengthens the case for physical activity as an important component of cancer survivorship care. Alongside good nutrition and other lifestyle measures, regular movement may play a meaningful role in improving long-term outcomes for people living with and beyond cancer.
An opportunity for breast cancer prevention
A major new analysis from the Global Burden of Disease Study provides a stark reminder of the growing global impact of breast cancer and the urgent need to prioritise prevention. The study analysed trends from 1990 to 2023 across 204 countries and territories, making it one of the most comprehensive assessments of breast cancer worldwide.
Breast cancer remains the most commonly diagnosed cancer among women globally and a leading cause of cancer death. Although survival has improved in many high-income countries due to earlier detection and better treatment, the overall number of cases continues to rise as populations grow and age.
What is often overlooked is the extent to which breast cancer is preventable. The study estimates that around 28% of the global burden of breast cancer is attributable to modifiable risk factors. The largest contributors include dietary risks, tobacco exposure, high blood glucose, excess body weight, alcohol consumption and low levels of physical activity.
Looking ahead, the projections are concerning. By 2050, the number of new breast cancer cases each year is expected to increase to around 3.5 million globally, with deaths rising substantially as well. Much of this increase will occur in low- and middle-income countries where access to screening, diagnosis and treatment remains limited.
These findings highlight an uncomfortable truth. While advances in treatment are improving survival, far less attention is given to preventing cancer in the first place. Policies that support healthier diets, increased physical activity and reduced alcohol consumption could prevent a significant proportion of cases.
Diet and brain health
Interest in how diet influences brain health continues to grow, and several new papers this month add to the evidence that what we eat may play an important role in the risk of cognitive decline and dementia.
A systematic review and dose–response meta-analysis examined the relationship between plant-based dietary patterns and the risk of cognitive impairment and dementia across seven prospective studies involving more than 220,000 participants. The overall findings suggested that people who followed plant-based diets more closely tended to have a lower risk of cognitive impairment and dementia. However, the most important message from this analysis was that diet quality matters. Healthy plant-based diets rich in vegetables, fruits, whole grains, legumes and nuts were associated with a lower risk, while plant-based diets high in refined grains, sugary foods and ultra-processed products were associated with a higher risk. In other words, simply eating “more plant foods” does not guarantee protection if those foods are heavily processed.
A second study combined analyses from large prospective cohorts in the United States and the United Kingdom with a broader meta-analysis of cohort studies examining plant-based diets and dementia risk. Once again, the results highlighted the importance of diet quality. Participants with the highest adherence to healthy plant-based diets had a substantially lower risk of developing dementia, while those with diets characterised by less healthy plant foods had a higher risk. Foods most strongly associated with lower dementia risk included vegetables, legumes, nuts and beverages such as tea and coffee. In the pooled analysis, those most closely following a healthy plant-based dietary pattern had around a 21% lower risk of dementia compared with those with the lowest adherence, while unhealthy plant-based diets were associated with a 24% higher risk.
A third paper offered a more cautionary perspective. Using data from cohorts in China, Europe and the United States, researchers reported that more restrictive vegetarian diets in older adults, particularly vegan diets, were associated with a higher risk of cognitive impairment, while pescatarian diets appeared to be associated with lower risk. The authors suggested that nutritional inadequacy could partly explain these findings, particularly with respect to nutrients such as vitamin B12, vitamin D, iron and long-chain omega-3 fats. Importantly, however, the study did not directly measure nutrient status and did not distinguish clearly between healthy and unhealthy plant-based dietary patterns, meaning the findings need to be interpreted carefully.
Taken together, these studies reinforce a key point that is often lost in discussions about plant-based diets. The question is not simply whether a diet is vegetarian, vegan or plant-based in name, but whether it is a high-quality dietary pattern centred on minimally processed plant foods. The strongest evidence continues to suggest that diets rich in vegetables, fruits, legumes, whole grains, nuts and other whole plant foods are associated with better cardiometabolic health and, increasingly, with better brain health as well. At the same time, the more cautionary findings remind us that plant-based diets need to be well planned, particularly in older adults, to ensure adequate intake of key nutrients such as vitamin B12.
Parkinson’s disease and dairy – is there a link?
A new systematic review and meta-analysis has examined whether dairy consumption is associated with the risk of Parkinson’s disease. Parkinson’s disease is a progressive neurodegenerative condition affecting almost 12 million people worldwide, and the number is expected to more than double by 2050. Identifying modifiable lifestyle factors that influence risk is therefore an important public health priority.
This review analysed nine observational studies from the United States, Europe and Asia, including more than 630,000 participants and over 4,000 cases of Parkinson’s disease. The researchers found that people with the highest intake of dairy had a 21% higher risk of developing Parkinson’s disease compared with those consuming the least dairy. When milk alone was examined, the association remained significant, with a 13% higher risk among those with higher milk consumption. Interestingly, the relationship appeared stronger in men than in women.
Not all dairy products were associated with risk. The analysis did not find a significant link between Parkinson’s disease and fermented dairy products such as yoghurt, or with cheese, butter or ice cream. This suggests that the type of dairy consumed may be important, with the strongest signal seen for plain milk.
The reasons for this association are not yet fully understood, but several explanations have been proposed. One possibility relates to the gut–brain axis. Changes in the gut microbiome may influence the misfolding and spread of alpha-synuclein, a protein that accumulates in the brains of people with Parkinson’s disease. Another theory is that milk may lower levels of uric acid in the blood. Uric acid acts as a natural antioxidant, and lower levels have been linked to greater vulnerability to neurodegeneration. Environmental contaminants such as pesticide residues in dairy products have also been suggested as a possible contributor.
It is important to interpret these findings cautiously. The evidence comes from observational studies, which means the research can identify associations but cannot prove cause and effect. Dietary intake was also typically measured only once and relied on self-reported food questionnaires, which can introduce error. Nevertheless, the consistency of the findings across multiple large studies means the potential link between milk intake and Parkinson’s disease warrants further investigation. It is worth noting that prior studies using Mendelian randomisation and the lactase gene variant to predict for intakes of dairy have found that higher intakes are associated with an increased risk of Parkinson’s disease. This suggests that a causal relationship is indeed possible.
Taken together, this research adds to a growing body of evidence suggesting that dietary patterns may influence the risk of neurodegenerative disease. While more research is needed to clarify mechanisms and causality, it highlights the importance of considering diet as part of a broader strategy to reduce the burden of chronic disease.
When it comes to dairy, we know it is not required in the diet, 75% of the worlds population is lactose intolerant (the natural state in humans), dairy may increase the risk of prostate cancer and of course its production is terrible for the environment and the animals. If we apply the precautionary principle we should be moving away from consuming dairy, especially when we have healthier alternatives in the form of plant drinks.
European diets and sustainability
A new paper examined how closely European diets align with the planetary health diet, a framework designed to support both human health and environmental sustainability. The researchers analysed dietary data from nine European countries, comparing current eating patterns with the dietary targets proposed by the EAT–Lancet Commission.
The study included 16,083 adults with sample sizes ranging from 519 in the UK to 3703 in Portugal. Across all countries studied, the findings showed a clear gap between current diets and what would be considered both healthy and environmentally sustainable. In general, people consumed far more red and processed meat, dairy and added sugars than recommended, while intake of whole grains, legumes, nuts, fruits and vegetables fell well below suggested levels. These patterns were consistent across much of Europe, highlighting how deeply entrenched animal-based and ultra-processed food consumption remains in modern diets.
More specific quantification of food groups showed average intakes of 189.6 ± 24.6 g/d for vegetables and 177.1 ± 47.7 g/d for fruits, followed by 66.2 ± 13.6 g/d for tubers, 31.5 ± 19.5 g/d for whole grains, 27.5 ± 12.8 g/d for legumes, 5.2 ± 3.2 g/d for nuts, and 14.0 ± 7.4 g/d for unsaturated oils. For animal-based foods, mean intakes were 263.8 ± 85.6 g/d for dairy, 82.5 ± 10.5 g/d for total red meat (40.4 g/d from beef and lamb and 42.0 g/d from pork), 49.9 ± 17.8 g/d for poultry, 22.8 ± 7.0 g/d for eggs, 38.6 ± 17.4 g/d for fish and seafood, and 28.2 ± 9.3 g/d for saturated fats. The mean intake of added sugars was 54.6 ± 9.5 g/d.
The UK data reflected this broader pattern and showed some of the lowest scores for adherence to the planetary health diet. Compared with the planetary health diet targets, UK diets were characterised by excessive intake of red and processed meat, poultry, eggs, sugar and saturated fat and insufficient consumption of plant foods such as legumes, nuts and whole grains. Fruit and vegetable intake also remained below optimal levels.
The overall message from the study is clear: achieving diets that are both healthy and environmentally sustainable will require substantial shifts in food consumption across Europe. This requires joined up policy and regulation across farming, healthcare, retail and public sector catering. We are still hopefully that the National Food Strategy for the UK, likely due for publication in the summer, will address these key issues. Read our collaborative Ten Point Plan recommendations for the National Food Strategy team.
Micronutrient adequacy of plant-based meat alternatives
Concerns are often raised about the nutritional adequacy of plant-based diets, particularly with respect to micronutrients such as iron, zinc, vitamin B12 and iodine. At the same time, plant-based meat alternatives have attracted criticism because they are often classified as ultra-processed foods. Critics argue that replacing animal products with these alternatives could worsen diet quality or increase the risk of nutrient deficiencies. A new randomised controlled trial helps address some of these concerns by directly comparing micronutrient intake and status in people consuming plant-based meat alternatives with those eating animal-based meats.
In this eight-week trial, 89 adults were randomly assigned to consume either plant-based meat analogues or animal-based meat as their primary protein source while otherwise maintaining their usual diet. Researchers assessed both dietary intake and blood markers of micronutrient status before and after the intervention. Overall, the study found that replacing animal meat with plant-based meat alternatives did not lead to clinically meaningful declines in micronutrient status. Key nutrients often highlighted as potential concerns in plant-based diets, including iron and zinc, remained within normal ranges, and there were no significant differences between the groups at the end of the study. Some nutrients, including dietary fibre, were higher in the plant-based meat group, reflecting the plant ingredients used in these products.
A remaining concern about plant-based meat alternatives is the higher sodium content. Of course, when people eat meat they tend to add salt when cooking for added flavour, so the differences may not be as wide as expected. Interestingly, the SWAP-Meat study comparing beef with Beyond meat products did not find a detrimental effect on blood pressure from the potential higher sodium intake, at least in the short term.
While the current study was relatively short and cannot address long-term health effects, it provides useful evidence that plant-based meat alternatives, if used as part of a varied diet, may offer a practical way for people to reduce their intake of animal products without increasing the risk of nutrient deficiencies. Read our article on plant-based meat alternatives.
See you back in April!
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