Review of the plant-based nutrition and lifestyle medicine news November 2025
This month I cover the social and environmental determinants of health, evidence on sustainable diets, physical activity, cognitive resilience and even the safety of drinking coffee.
Updated Lifestyle Medicine Core Competencies
The 2025 update to the Lifestyle Medicine Core Competencies marks an important step in the evolution of the field. It reflects a growing recognition that health is determined not only by individual behaviours, but also by social, environmental and structural factors that shape people’s daily lives. Building on the substantial 2022 revision, this latest update introduces one new competency and refines two others, bringing the total to 89 competencies guiding lifestyle medicine education, certification and practice worldwide.
The most notable addition is a new competency on applying lifestyle medicine within the context of the social determinants of health. Factors such as income, housing, education, access to healthy food and neighbourhood environment drive a large proportion of health outcomes, yet remain under-recognised in routine care. This new competency asks clinicians to integrate an understanding of these determinants into assessment, intervention and follow-up, pairing lifestyle prescriptions with culturally relevant strategies, community partnerships and support in navigating systems and resources. The direction of travel is clear: lifestyle medicine must be not only evidence-based but equity-focused, working to remove the structural barriers that prevent people from making healthy choices.
The planetary health competency has been strengthened to emphasise more clearly the bidirectional relationship between human health and the health of the planet. The update highlights mounting evidence that climate change, air pollution, biodiversity loss and environmental degradation are driving rising rates of chronic disease, respiratory and cardiovascular pathology, allergies and the health consequences of extreme weather. At the same time, it underlines that our food system, especially the high consumption of animal-based foods, is a major driver of greenhouse gas emissions, whereas predominantly plant-based dietary patterns support both human and planetary wellbeing. Planetary health is therefore positioned not as an optional extra, but as a core concern for preventive and therapeutic care.
The competency on food processing has also been updated to reflect rapidly expanding evidence linking ultra-processed foods to poor health outcomes. Rather than focusing solely on classification systems, clinicians are asked to understand how different types and degrees of processing affect physiology and disease risk. Ultra-processed foods are now strongly associated with obesity, metabolic disease, cardiovascular disease, kidney disease, adverse perinatal outcomes, mental health problems, systemic inflammation and higher all-cause mortality. At the same time, the revised competency acknowledges that not all processing is harmful; freezing fruit and vegetables or milling whole grains, for example, can preserve nutrients and improve access. This nuance is essential for patient-centred advice that goes beyond simplistic “processed versus unprocessed” messages. Relevant to this is a new review paper on ultra-processed plant foods such as meat and dairy alternatives. The review concludes that although whole plant foods are healthier, ultra-processed plant foods result in improved cardiometabolic outcomes when compared to unprocessed animal-based products. Therefore, plant-based meat and dairy alternatives provide useful options to support people to transition away from animal-sourced foods.
Overall, the 2025 update reflects an increasingly interconnected view of health: the social and economic conditions that shape choice, the planetary systems that sustain life and the industrial food environment that drives risk. For clinicians, it signals a shift towards a more holistic, justice-oriented and environmentally aware practice that places whole food plant-based nutrition, equitable access and supportive environments at the centre of chronic disease prevention and care.
2025 Lancet Countdown: Diet, Food Systems and Modifiable Risk Factors
The 2025 Lancet Countdown report makes it painfully clear that our food systems and dietary patterns are now among the most important modifiable drivers of both climate breakdown and premature mortality. Agricultural greenhouse gas emissions have risen by 36% since 2000, reaching their highest level to date, with red meat and dairy alone responsible for more than half of these emissions. Despite improvements in efficiency, growth in the production and consumption of animal-source foods has more than offset any gains. Per capita agricultural emissions in very high HDI (human development index) countries are now nearly three-quarters higher than in low HDI settings, illustrating the disproportionate contribution of affluent populations.
The health consequences of this food system are stark. Diet-related mortality increased to an estimated 11.8 million preventable deaths, including 1.9 million attributable specifically to excessive red meat and dairy intake. Diet-related deaths are rising fastest in high HDI countries, where high intakes of meat and refined grains remain dominant risk factors for non-communicable disease. The report underlines that diet is now one of the most powerful levers we have for improving global health, and that the window for action is narrowing.
Climate change is already undermining food security. Heatwaves and drought, now more frequent due to human-driven warming, were associated with an additional 123.7 million people experiencing moderate or severe food insecurity across 124 countries in 2023. Warming oceans, acidification and declining marine productivity threaten nutrition for communities dependent on fisheries, often those who have contributed least to the crisis. Almost one-third of the world’s population cannot afford a healthy diet, and hundreds of millions remain undernourished. Climate impacts are compounding existing inequities in food access, nutrition and health.
Dietary choices therefore represent a rare domain where individual, clinical and policy actions can deliver simultaneous benefits for people and planet. Yet the report stresses that the potential health co-benefits of adopting predominantly plant-based, low-carbon diets remain largely unrealised. Mortality linked to high-carbon diets continues to rise, reflecting political inaction, industry influence and the absence of coherent food and agricultural policy reform. The Countdown identifies a shift towards plant-rich diets, reduced red and processed meat, and resilient, sustainable food systems as essential to reducing mortality, closing health inequities, stabilising the climate and protecting future generations.
The report also links food systems to air pollution. Agricultural emissions, notably ammonia from intensive livestock production, contributed to almost one-fifth of all anthropogenic PM₂.₅-related deaths in 2022, driving cardiovascular and respiratory disease. Land degradation, deforestation and rising wildfire risk, much of it linked to the expansion of livestock and feed crops, intensify respiratory health threats and increase the risk of zoonotic spillover. Taken together, the findings show that high-income countries and wealthy populations remain disproportionately responsible for both food-system emissions and diet-related disease, while low-income populations bear the greatest burden of climate-amplified food insecurity and malnutrition.
The overarching message is that transforming our food system is no longer an optional add-on to climate policy; it is a central public health intervention. A shift towards predominantly or exclusively plant-based diets, embedded within broader policies that support sustainable agriculture and equitable access to healthy foods, is one of the most effective actions we can take to protect health and the climate simultaneously. The Eat Lancet commission, covered in my October review, provides us with the knowledge on how this can be achieved.
Physical Activity: Steps, Cancer Risk and Brain Health
A series of new studies provide further clarity on the health benefits of everyday movement, especially simple walking.
A comprehensive systematic review and meta-analysis of 57 prospective studies, including more than 160,000 adults with device-measured steps, has provided the clearest picture yet of how daily steps relate to long-term health. Risk reductions were seen across a range of outcomes, including cardiovascular disease, type 2 diabetes, cancer mortality, dementia, depression and all-cause mortality, as people moved from very low step counts upwards. The largest proportional gains occurred when individuals increased their steps from sedentary levels to around 7000 per day. At this level, the risk of early death fell by nearly half compared with 2000 steps, with substantial reductions in major cardiovascular events and cancer deaths. Although benefits continued to accrue at higher step counts, the curve flattened for several outcomes beyond 7000 steps. The authors conclude that around 7000 steps per day is a realistic and clinically meaningful target, particularly for those who find traditional “minutes of moderate-to-vigorous activity” targets off-putting. The message is simple: every additional step counts, and modest increases in walking can deliver substantial physical and mental health benefits.
A large US cohort analysis, following over 230,000 adults for more than three decades, examined how long-term adherence to physical activity recommendations affects the risk of digestive system cancers. Those who consistently met the recommended activity threshold, roughly 17 MET-hours per week, equivalent to about five hours of brisk walking, had substantially lower risks of both developing and dying from cancers of the bowel, pancreas, liver and gallbladder. Notably, doing far more than this, up to 40 MET-hours per week, did not further reduce risk, suggesting that long-term consistency matters more than high intensity or volume. This reinforces the importance of embedding manageable levels of movement into daily life rather than relying on intermittent bursts of exercise.
A third study, in individuals with biomarker evidence of preclinical Alzheimer’s disease, provides further insight into the neuroprotective effects of physical activity. Among participants with amyloid pathology but no cognitive symptoms, higher habitual activity was associated with slower accumulation of tau pathology and better preservation of brain network integrity in regions vulnerable to early Alzheimer’s changes. The levels of activity associated with these benefits were modest and comparable to those observed in the step-count meta-analysis – 5000-7500 steps per day. This reinforces a consistent theme: moderate, achievable increases in movement support both physical and cognitive health, even before disease is clinically apparent. For clinicians, it strengthens the case for framing physical activity as a core component of dementia prevention as well as cardiometabolic and cancer risk reduction.
Lifestyle Interventions and Cognitive Decline
A large network meta-analysis of 109 randomised controlled trials involving over 23,000 cognitively unimpaired older adults has clarified which lifestyle interventions most reliably preserve cognitive function. The authors compared a range of single-domain interventions, that is, physical exercise, dietary changes, cognitive training, social activity, with increasingly complex multidomain programmes combining several of these elements. Outcomes focused on global cognition, using tools such as the MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment).
Two approaches stood out consistently. Structured cognitive training alone and physical exercise alone each produced meaningful improvements in global cognition compared with health education, no intervention or active control conditions. When combined, cognitive training plus regular physical exercise produced the largest effect on cognitive outcomes. Multidomain programmes that added diet, social activity and health education did show benefits, but these were modest and did not exceed the gains from the simpler exercise-plus-cognitive-training combination. The analysis suggests that “more” is not always “better”; highly complex programmes may dilute adherence and intensity without delivering additional benefit.
Subgroup analyses suggested that cognitive training, alone or with exercise, was particularly effective in adults younger than 70 years, whereas multidomain interventions including health education appeared more beneficial in those aged 70 and older, albeit with wider confidence intervals due to smaller numbers. Interventions lasting longer than three months tended to produce more stable benefits, particularly when exercise and cognitive training were combined.
Although the effect sizes were generally small to moderate, they are clinically meaningful in a context where pharmacological options remain limited and pathological changes begin decades before symptoms. The findings are broadly consistent with landmark trials such as the FINGER trial, but refine the message: the most reproducible cognitive benefits come from targeted interventions that directly stimulate neuroplasticity and build cognitive reserve, namely physical activity and cognitive training.
Nutrient Adequacy and Environmental Footprint of Vegan vs Other Menus
A detailed modelling study comparing Mediterranean omnivorous, pesco-vegetarian, ovo-lacto-vegetarian and vegan menus under strictly isocaloric conditions provides robust evidence that a well-planned vegan diet is both nutritionally adequate and environmentally superior. The authors constructed seven-day menus for each pattern, all providing 2000 kcal per day and consistent with national dietary guidelines, allowing a like-for-like assessment of nutrient density and environmental impact.
Across all four dietary patterns, protein requirements were fully met, including in the vegan menu, dispelling the persistent myth that plant-based diets are inherently protein deficient. The vegan pattern delivered the highest fibre intake, the lowest saturated fat and the lowest dietary cholesterol. It also provided the greatest coverage of several key micronutrients, including folate, vitamin C, vitamin E, magnesium, potassium and iron, reflecting the nutrient richness of whole plant foods.
Nutrient shortfalls in the vegan menu were limited to a small, predictable set. Vitamin B12 intake was very low in the absence of fortified foods or supplements, reaffirming standard guidance that supplementation or regular consumption of B12-fortified foods is essential for vegans. Vitamin D intake was inadequate across all four dietary patterns, a reminder that diet alone is rarely sufficient to meet vitamin D needs in the UK and many other countries. Iodine intake fell short of recommendations in all diets except the pescatarian pattern, though iodised salt, commonly used in real-world settings, was not included and would likely correct much of this deficit. Long-chain omega-3 fatty acids (EPA and DHA) were below recommended levels in the vegan and vegetarian menus, though alpha-linolenic acid (ALA) intake was high. The authors therefore suggest considering algal DHA supplementation for those not consuming fish, a simple step that preserves the benefits of a fully plant-based diet.
Overall micronutrient adequacy was excellent in all four models, with the vegan pattern performing particularly well aside from the small group of nutrients that are already routinely flagged for attention in plant-based practice: vitamin B₁₂, vitamin D, iodine and long-chain omega-3 fats. When those are addressed through fortified foods or supplements, the vegan diet emerges as nutritionally complete.
The environmental analysis was equally striking. Greenhouse gas emissions decreased progressively as animal products were reduced, reaching their lowest levels in the vegan menus, which cut emissions by nearly half compared with the Mediterranean omnivorous diet. Measures of land use and ecosystem impact showed the same pattern. Even a healthful omnivorous diet emphasising fruit, vegetables and whole grains carried a substantially higher environmental burden than the vegan dietary pattern. The conclusion is clear: a well-planned vegan diet can deliver high nutritional adequacy without compromising health, while simultaneously offering the greatest benefits for planetary health.
From Hamburgers to Holidays: The Impact of Reduced Meat Intake
A UK-focused modelling study from Imperial College London complements these findings by showing how powerful even modest reductions in meat intake can be when scaled across populations. Using global food system emissions data combined with UK consumer survey responses, the authors estimated that reducing meat consumption to three portions per week, especially by limiting ruminant meat, could almost halve production-related greenhouse gas emissions from food in high- and middle-income settings.
Crucially, the study frames changes in terms that feel concrete and achievable for the public. For an individual consumer, the emissions saved by cutting down to three weekly meat servings (92 kcal per day) were equivalent to avoiding six short-haul return flights per year. While the study did not model fully vegan diets, it reinforces a consistent message that shifts towards plant-rich, and ideally fully plant-based, eating patterns deliver large and rapid climate benefits, whilst preserving nutritional adequacy. They also align with public preferences for simple, meaningful climate actions, offering people something positive and practical they can do every day.
Nudging Meat Off the Plate: Real-World Behaviour Change
A large systematic review and meta-analysis of real-world “nudge” interventions in food-service settings offers practical insight into how institutions can help people choose more plant-based meals. Drawing on 33 field experiments and 78 effect sizes, the analysis found that not all nudges are equal. The most effective strategies were those that changed the choice architecture itself rather than simply providing more information.
In particular, making vegetarian or vegan dishes the default option, while still allowing people to choose meat if they wished, reduced meat selection by an average of 54%. This represents one of the strongest behaviour-change effects documented in nutrition research. By contrast, simpler informational approaches such as labels, health messages or environmental signage had little measurable impact and, in about a third of poorly designed interventions, even backfired.
For hospitals, schools, workplaces and other large caterers, these findings are highly relevant. When plant-based options are made the easy, convenient and attractive default, people tend to choose them without feeling coerced. Coupled with evidence that well-planned vegan and planetary health diets are nutritionally adequate and environmentally beneficial, this behavioural science offers a powerful lever for institutions to reduce emissions and improve public health at scale. This reinforces the evidence supporting our own approach in the UK through our Plants First Healthcare initiative.
Nutritional Adequacy of the EAT-Lancet Planetary Health Diet: UK Evidence
Debate around the EAT-Lancet Planetary Health Diet (PHD) has often centred on a perceived risk of nutritional inadequacy, particularly when animal-source foods are reduced. A new analysis from the MRC Epidemiology Unit in Cambridge provides robust, UK-specific evidence to address these concerns.
Using 11 years of data from the nationally representative UK National Diet and Nutrition Survey, the researchers analysed detailed 4-day food diaries from nearly 10,000 individuals aged 15 and over, alongside biomarker data from over 4,600 participants. They assessed alignment with the PHD using a 14-component score and examined both nutrient intakes and objective nutritional status.
Higher adherence to the PHD was consistently associated with better, not worse, nutritional adequacy for most vitamins and minerals. Individuals with higher PHD scores were more likely to meet reference intakes for folate, vitamin C, magnesium, potassium, fibre, iron and many other nutrients. Importantly, there was no evidence that closer adherence increased the risk of inadequacy for any nutrient.
The study paid particular attention to nutrients often cited as problematic in more plant-based patterns, such as iron, zinc, calcium, vitamin D and vitamin B12. In the general diet, iron adequacy was low among women of reproductive age and adolescents. However, within these groups, those whose diets were more closely aligned with the PHD were more likely to achieve adequate iron intake. Ferritin levels did not differ by PHD alignment, suggesting no adverse effect on iron stores. Zinc and calcium adequacy likewise improved with higher PHD scores, supporting the capacity of plant-rich diets, built on whole grains, legumes, nuts, seeds, fruits and vegetables, to cover these key minerals.
Vitamin D intake was inadequate across the board, both in the average UK diet and in diets more consistent with the PHD, which is unsurprising given limited food sources and UK latitude. This reinforces existing guidance that supplementation is generally required at the population level, regardless of dietary pattern. Vitamin B12 intake did not rise with greater PHD adherence, as expected, but there were no differences in B₁₂ status measured by serum B₁₂ or holotranscobalamin. This likely reflects the use of fortified foods and supplements among those with the highest PHD scores, and underscores the point that B12 is a nutrient requiring explicit attention in plant-based diets, but one that is easily and safely managed.
A direct comparison with a Mediterranean diet score showed similar improvements in nutritional adequacy for iron, zinc, calcium and vitamin D with higher adherence to either dietary pattern. This places the PHD on equal footing with the Mediterranean diet in terms of nutrient adequacy, while offering greater potential environmental benefits.
The key message is reassuring: for the UK population, greater adherence to the Planetary Health Diet does not compromise nutritional adequacy. On the contrary, it is associated with better intake and status for many nutrients of concern. For policymakers, clinicians and the public, this study strengthens the case that shifting towards sustainable dietary patterns is entirely compatible with, and indeed supportive of, nutrition security.
Coffee and Arrhythmias: The DECAF Trial
A small but highly practical update on a question many patients ask: does coffee worsen atrial fibrillation? The DECAF randomised clinical trial provides reassuring evidence that, for most people living with atrial fibrillation, moderate coffee consumption is not harmful and may even be beneficial.
In this six-month study of 200 regular coffee drinkers undergoing cardioversion for persistent atrial fibrillation, participants were randomised either to continue drinking at least one cup of caffeinated coffee per day or to abstain completely. Recurrence of atrial fibrillation or flutter occurred in 47% of those continuing coffee, compared with 64% in the abstinence group, corresponding to a 39% lower hazard of recurrence in the coffee arm. There was no signal of increased adverse events.
These findings challenge the long-standing dogma of advising patients with atrial fibrillation to avoid caffeine altogether and are consistent with observational studies suggesting neutral or even protective associations between coffee and cardiovascular outcomes. For individuals who enjoy coffee, this trial offers welcome reassurance within the context of a healthy lifestyle. Moderate caffeinated coffee intake appears safe and may confer a small additional benefit for rhythm stability.
See you back in December !
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