Review of the plant-based nutrition and lifestyle medicine news October 2024
A busy month with the launch of our Plants First Healthcare campaign and Food in Healthcare report. New national and international reports continue to support the power of a plant-based lifestyle.
Read our new report on Food in Healthcare, which documents the evidence for implementing plant-based meals as the default option in healthcare. We summarise new data from survey’s and research conducted by PBHP UK, along with best practice examples from around the world.
Report: Recipe for health:a plan to fix our broken food system (PDF)
This month, a new report has been published by the House of Lords Food, Diet and Obesity Committee. It once again describes the consequences of our broken food system, which is leading to rising rates of obesity and chronic ill health. The authors describe obesity and its consequences as a ‘public health emergency’.
The report outlines the failure of successive governments to tackle this crisis, despite nearly 700 wide-ranging policy proposals over the last few decades. The result of inaction is an annual societal cost of obesity of at least 1–2% of UK GDP. Two-thirds of adults are overweight with unhealthy diets being the main driver. After tobacco, this makes diet-related risks the biggest contributor to years of life with all income groups now failing to meet dietary recommendations. The report reiterates the continued misplaced focus on individual responsibility rather than tackling the underlying drivers of unhealthy diets.
The key recommendations include:
- Government Strategy: Establish a cohesive food policy, shifting from individual responsibility to regulatory approaches.
- Industry Accountability: Mandate healthy food sales targets and implement taxes on high-fat, salt, and sugar (HFSS) foods.
- Reduce Ultra-Processed Foods (UPFs): Tighten regulations on UPFs and research health impacts.
- Youth Health Initiatives: Strengthen school meal standards and improve nutrition for children.
- Accessibility: Expand subsidies for nutritious foods to make them affordable for low-income families.
We all hope that this is not another report that falls on deaf ears and gathers dust.
An unbiased, sustainable, evidence-informed Universal Food Guide: a timely template for national food guides
It is timely to read this new review, which brings together the evidence on the impact of diet on health and sustainability outcomes and provides a template to inform national food-based dietary guidelines. The authors critique national food guides for corporate and political influences that prioritise animal-sourced and ultra-processed foods, often contrary to health evidence. The proposed guide champions a whole food, plant-based diet, given that this has been shown to reduce non-communicable diseases like cardiovascular diseases and type 2 diabetes and has the lowest environmental impact. It advocates for clear, sustainable guidelines, emphasising foods rich in fibre, legumes, whole grains, fruits, and vegetables while limiting processed foods.
Key sections include:
- Food Guides and Conflicts of Interest: The paper highlights how corporate influence affects national dietary recommendations, especially regarding animal products and processed foods, often conflicting with scientific evidence on health risks.
- The Healthiest Evidence-Based Diet: A whole food, plant-based diet with no animal products or processed foods is identified as optimal for preventing and managing chronic diseases and lowering the environmental impact.
- Constituents of the Universal Food Guide Template: The guide prioritises nutrient-dense, plant-based foods (e.g., legumes, whole grains, berries, and leafy greens) for their health benefits. It aligns closely with the nutritional needs throughout life stages, focusing on whole foods high in vitamins, minerals, and fibre.
- Policy and Practical Implications: Recommendations include the implementation of food policies that are free from commercial interests, aiming to foster population health and planetary sustainability. The guide’s universal nature is intended to serve as a model adaptable to various cultural and geographic contexts.
- Environmental and Ethical Considerations: The diet model supports ethical food production practices that lower greenhouse gas emissions and biodiversity loss, with the guide aiming to aid in achieving international climate goals through sustainable eating patterns.
The authors have translated the science into a proposal for a Universal Food Guide to serve as a template for national food guides, acknowledging that these recommendations need to be adapted across geographic regions. The following is the proposed daily intake:
- ≥ 3 servings of legumes (beans, peas, and lentils) e.g. 1–2 cup cooked beans/peas/lentils; 1⁄4 cup hummus (chickpeas)
- 1 serving of berries e.g. 1⁄2 cup fresh or frozen; 1⁄4 cup dried
- 3 servings of other fruits e.g. 1 medium fruit; 1⁄4 dried fruit
- 1 serving of cruciferous vegetables e.g. 1⁄2 cup chopped
- 2 servings of greens e.g. 1 cup raw; 1⁄2 cup cooked
- 2 servings of other vegetables e.g. 1⁄2 cup non‐leafy vegetables
- 3 servings of whole grains e.g. 1⁄2 cup hot cereal; 1 slice of whole grain bread
- 1 serving of ground flaxseeds e.g. 1 tbsp ground
- 1 serving of nuts and seeds e.g. 1⁄4 cup nuts; 2 tbsp nut butter
- Herbs and spices (for nutrients and to flavour food, rather than fat, sugar, and salt and other additives)
- Beverages e.g. water, green tea, hibiscus tea
- Regular physical Activity
In the last month or so there have been a number of publications highlighting the benefits of eating a healthy plant-based diet. For example, a healthy plant-based diet may reduce the risk of death in people with chronic kidney disease and reduce the risk of hepatocellular carcinoma in a variety of ethnic groups. A new umbrella review of systematic reviews shows that vegetarian and vegan dietary patterns, are associated with a reduced risk of and mortality from cardiovascular disease (CVD) and coronary heart disease. Vegan diets were associated with benefits for CVD risk factors such as lower blood pressure, LDL-cholesterol, triglycerides, CRP, and body mass index (BMI) when compared to non-vegetarian dietary patterns.
Overall, the evidence for animal-free/plant-based diets continues to be strong.
Association of metabolic obesity phenotypes with risk of overall and site-specific cancers: a systematic review and meta-analysis of cohort studies
With the focus on obesity, it is interesting to read this new study that explores how metabolic health, combined with obesity status, influences cancer risk. Recognising that obesity is a known risk factor for various cancers, the paper explores whether metabolic health status alters these risks. It categorises participants into four metabolic obesity phenotypes:
- Metabolically Healthy Normal Weight (MHNW)
- Metabolically Unhealthy Normal Weight (MUNW)
- Metabolically Healthy Overweight/Obese (MHOW/OB)
- Metabolically Unhealthy Overweight/Obese (MUOW/OB)
The authors conducted a meta-analysis of 31 publications from 15 cohort studies. Studies were selected based on predefined inclusion criteria for overall and site-specific cancer risks.
The analysis finds that compared to metabolically healthy individuals with normal weight, the MUOW/OB group showed a significantly increased risk for overall cancer. The MUNW and MHOW groups also had elevated risks, though the strongest associations were with the MUOW/OB phenotype. MUOW/OB individuals had higher risks for multiple cancers, notably postmenopausal breast cancer, colorectal cancer, endometrial cancer, thyroid, liver, and pancreatic cancers.
The authors hypothesise that mechanisms leading to the increased risk of cancer include chronic inflammation, insulin resistance, and hormonal changes that link obesity, metabolic dysfunction, and cancer development. Elevated insulin levels, commonly found in MU phenotypes, may promote cell proliferation and inhibit apoptosis, contributing to cancer progression.
The study concludes that both metabolic dysfunction and obesity independently and synergistically elevate cancer risks, with the highest risks observed in the MUOW/OB phenotype across various cancer types. It highlights the importance of considering metabolic health in cancer prevention strategies, particularly for individuals with obesity.
New studies further highlight the role of diet for cancer prevention and for improving cancer outcomes. Greater adherence to a healthy diet was shown to improve survival in Black women with ovarian cancer. Similarly, healthier diets were associated with a lower risk of disease progression in men with prostate cancer.
Aerobic Physical Activity and Depression Among Patients With Cancer A Systematic Review and Meta-Analysis
It is refreshing to witness more studies reporting holistic approaches to cancer care, since lifestyle medicine and integrative approaches are important for improving quality of life for those with cancer. This study evaluated the impact of aerobic physical activity (APA) on reducing depression among people with cancer
Depression is common among people with cancer, with prevalence rates between 13% and 27%, impacting quality of life, adherence to treatment, and even survival. While APA has been shown to alleviate depression in the general population, its specific effects on people with cancer are less clear. This study aimed to synthesise existing research to assess APA’s effectiveness in reducing depressive symptoms in adults with cancer across various types, stages, and treatment phases. Only randomised controlled trials (RCTs) comparing APA interventions (like cycling, walking, or jogging) to usual care were included. The review included adults of all ages, cancer types, and stages. Depression severity was the primary outcome, with assessments categorized into short-term (within one month post-intervention), medium-term (1-6 months), and long-term (6-12 months) impacts on depression.
The analysis showed that APA significantly reduced short-term depressive symptoms with this positive effect observed across various cancer types, treatment stages, and modes of delivery (e.g., supervised vs. unsupervised, individual vs. group sessions). Medium-term effects (1-6 months post-intervention) were not statistically significant. Long-term effects (6-12 months post-intervention) showed a significant reduction in depressive symptoms, though the data were limited to three studies. Weekly APA of ≥150 minutes was associated with greater reductions in depression than less frequent activity.
Overall, the study concluded that APA offers a modest yet significant reduction in depressive symptoms for people with cancer, especially in the short term, and suggested that APA should be recommended for adults with cancer. Future research should explore APA’s effectiveness for cancer patients with clinical depression, expand to understudied populations (e.g., metastatic cancers, pediatric cases), and consider APA in combination with other therapeutic interventions.
Physical activity is now considered optimal first line treatment for mild to moderate depression in the general population. Guidelines for managing anxiety and depression in people with cancer also include integrative therapies such as mindfulness based interventions, yoga, music therapy, relaxation, and reflexology were recommended du and tai chi and/or qigong.
Association between plant and animal protein and biological aging: findings from the UK Biobank
A persisting concern amongst dietitians is the adequacy of plant sources of protein for supporting recovery and preventing sarcopenia. This new study adds to existing data to suggest plant sources of protein may be superior to animal protein for healthy ageing.
The analysis uses data from 79,294 UK Biobank participants and employs four indices to assess biological aging: Klemera-Doubal Biological Age (KDM-BA), PhenoAge (PA), Allostatic Load (AL), and Leukocyte Telomere Length (LTL). The results show that higher plant protein intake, but not animal protein, correlates with indicators of slower biological ageing. Replacing 5% of energy from animal protein with plant protein was associated with a 19-28% reduction in the odds of accelerated ageing (based on KDM-BA, PA, AL) and a 12% increase in LTL. The benefits were most obvious for substitution of whole grains for red meat or poultry and substitution of nuts for red or processed meat. Substitution with legumes had less consistent impacts. Further analysis suggested that these benefits may be mediated by differences in serum gamma glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) pointing to better liver/metabolic health. Yogurt was also found to show benefits for healthy ageing, suggesting that the health of the gut microbiome may be important.
The findings supports the hypothesis that higher plant protein intake contributes to healthier biological ageing. It advocates for dietary guidelines that encourage plant protein consumption over animal protein to promote health and longevity, highlighting whole grains and nuts as particularly beneficial sources.
Read our article on plant-based diets for older adults for further information.
A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial
We know that dietary risk factors account for 70% of the risk of developing type 2 diabetes and that intensive diet and lifestyle interventions are effective for inducing remission in people with established diabetes. This study investigates the effects of a whole-food, plant-based (WFPB) diet combined with moderate exercise on glycaemic control and medication use in people with type 2 diabetes. Conducted over 24 weeks in the Marshall Islands, it is one of the largest and longest trials of its kind.
169 adults with type 2 diabetes, aged 18–75, were randomised into two groups: one receiving the WFPB and exercise intervention (PB+Ex) and the other receiving standard medical care (SMC). The PB+Ex group followed a WFPB diet and moderate exercise regimen, including supervised meal provision and classes during the first 12 weeks, transitioning to self-guided adherence for the remaining 12 weeks. The SMC group continued their usual diet and standard care. Primary outcome measures included, HbA1c levels, fasting glucose, insulin levels, HOMA-IR (measure of insulin resistance), and medication usage. Secondary outcomes focused on weight, lipid levels, blood pressure, and inflammation markers (CRP).
Key Findings
- Glycaemic Control: The PB+Ex group showed significant improvements in HbA1c, reducing it by an additional 14 mmol/mol (1.3%) at 12 weeks and 8 mmol/mol (0.7%) at 24 weeks compared to the SMC group. Improvements in fasting glucose, insulin, and HOMA-IR were also observed early in the intervention.
- Diabetes Remission and Medication Reduction:
- Approximately 8% of PB+Ex participants achieved diabetes remission, while none did in the SMC group.
- A majority (63%) of the PB+Ex participants reduced their diabetes medications, as opposed to 24% in the SMC group.
- Cardiovascular medication use also decreased, with 67% of the PB+Ex group reducing or stopping these medications versus only 15% in the SMC group.
- Weight and Cardiovascular Health:
- The PB+Ex group experienced modest weight loss (average 2.7 kg) and reductions in waist circumference.
- They also demonstrated lower triglycerides, blood pressure, and heart rate during the initial 12 weeks, though some of these effects diminished as the intervention intensity decreased in the later phase.
- Inflammation: CRP levels, an inflammation marker, significantly dropped in the PB+Ex group, indicating reduced systemic inflammation.
The authors conclude that a WFPB diet with moderate exercise is effective for managing type 2 diabetes by improving blood sugar control, reducing reliance on medications, and fostering diabetes remission in some participants. These findings support WFPB diets as a viable lifestyle intervention for diabetes management and underscore the benefits of diet quality and exercise in chronic disease management.
Effect of a multidisciplinary lifestyle intervention on body composition in people with osteoarthritis: Secondary analysis of the “Plants for Joints” randomized controlled trial
The Plants For Joints study team have already reported both short term and long term benefit of a whole food plant-based intensive lifestyle medicine programme for people with rheumatoid arthritis and osteoarthritis. This current analysis reports a secondary analysis evaluating the impact of the lifestyle intervention on body composition in patients with metabolic syndrome-associated osteoarthritis (MSOA). The 16-week lifestyle intervention focused on a whole food, plant-based diet, along with exercise, stress management, and sleep optimisation. The approach is similar to Dr Dean Ornish’s intensive lifestyle medicine programmes.
The key findings are summarised below:
- Body Composition Improvements:
- Participants in the intervention group experienced significant reductions in body weight (an average of 5.2 kg) and fat mass (3.9 kg) over 16 weeks.
- Using MRI spectroscopy, substantial reductions in liver fat percentage were demonstrated, indicating improvement in non-alcoholic fatty liver disease.
- Muscle Mass and Bone Density:
- Despite weight loss, participants did not experience a significant reduction in muscle mass or bone mineral density, alleviating concerns about WFPB diets potentially leading to muscle or bone loss in this population.
- Metabolic and Inflammatory Markers:
- Improvements in metabolic markers, including lower insulin levels and better liver enzyme profiles, suggest reduced insulin resistance and inflammation, enhancing overall metabolic health.
The study concludes that a WFPB lifestyle intervention can improve body composition in MSOA patients by reducing body fat, particularly liver fat, while maintaining muscle mass and bone density. This intervention supports using plant-based diets combined with physical activity to manage osteoarthritis and associated metabolic syndrome effectively.
These findings underscore the potential for lifestyle modifications to complement osteoarthritis treatment, particularly for patients with metabolic complications.
The 2024 state of the climate report: Perilous times on planet Earth
This months sees the COP16 biodiversity meeting take place and provides a reminder that animal agriculture is the leading driver of biodiversity loss on land and in our oceans. At the same time, this annual report from climate scientists warns us again that ‘we are on the brink of an irreversible climate disaster’ driven by rising greenhouse gas emissions, land use changes, and unprecedented global temperatures
.The report highlights:
- Escalating Climate Indicators: In 2023 and 2024, record-breaking sea and air temperatures, reduced sea ice, and rising global temperatures signify a worsening climate crisis. 25 of 35 “planetary vital signs,” such as CO₂ and methane levels, are at extreme levels, underscoring the failure of global emission reduction efforts.
- Major Climate Disasters: From heatwaves in Asia to hurricanes and floods worldwide, climate-driven events have intensified, causing human suffering, displacement, and loss of life. These events are linked to climate change and exacerbated by high greenhouse gas emissions, reaching billions of dollars in damage.
- Feedback Loops and Tipping Points: Climate feedback loops (like melting permafrost releasing methane) and potential tipping points (e.g., the Amazon and Greenland ice sheet) could lead to irreversible changes, accelerating global warming beyond human control.
- Oceans and Ice: Ocean acidity and heat content are at record highs, with marine ecosystems and coral reefs facing mass mortality. Sea level rise, driven by melting glaciers and thermal expansion, poses threats to coastal communities.
- Global Inequities: The effects of climate change disproportionately affect lower-income countries, who contribute less to global emissions but face harsher climate impacts. This raises ethical concerns, calling for equitable policies.
- Societal Collapse Risks: Increasing climate-induced stresses, biodiversity loss, and ecological overshoot (consumption beyond Earth’s capacity to regenerate) hint at potential societal collapse if current trajectories continue.
The report stresses urgent action to phase out fossil fuels, reduce methane emissions, and adopt sustainable consumption practices, warning that without immediate transformative change, the future of humanity is at grave risk.
It is also timely to read the Greenpeace report: Turning Down The Heat, which highlights the impact of methane emissions from meat and dairy industries on global warming. Farming animals, particularly for meat and dairy, is the largest human-driven source of methane, a potent greenhouse gas with a high short-term warming impact. Without intervention, methane from meat and dairy could increase global temperatures by 0.32°C by 2050. Some of the top meat and dairy companies have methane emissions comparable to major fossil fuel corporations, yet face less regulatory scrutiny. Notably, JBS, the world’s largest meat producer, emits more methane than ExxonMobil and Shell combined. If we continue with our current diet patterns, especially in high and middle income countries then these methane emission will continue to drive global warming. Yet, if we adopt plant-based diets aligned with the EAT-Lancet Planetary Health Diet, methane emissions could be reduced. Reducing meat and dairy consumption worldwide could reduce anticipated warming by 0.13°C by 2050. The report accuses meat and dairy companies of “greenwashing” through inadequate climate pledges, promoting ineffective or unverified carbon offsets instead of reducing numbers of farm animals and supporting farmers to produce plant-based foods that are far less damaging to the environment.
Finally, this year’s Lancet Countdown report on health and climate change has just been published. It is not happy reading. It states that we are facing record breaking threats due to global inaction with people all over the world experiencing the consequences of climate change. Regarding food production and diet, the situation continues to worsen. The food system is responsible for 30% of greenhouse gas emissions (GHGs), with 56% of 2021 emissions driven by the consumption of red meat and dairy. High income countries are still the biggest contributors to agricultural emissions, 60% of which are derived from red meat and dairy consumption. Unhealthy diets, too high in red and processed meat and insufficient in healthy plant foods, are also a major cause of chronic ill health. Diet-related deaths have increased from 141 deaths to 144 deaths per 100 000 people (+3%), including increases from 14 deaths to 16 deaths per 100 000 attributable to red meat intake (+9%). Yearly diet-related deaths increased by 830,000 (+8%), from 10·4 to 11·2 million. These figures include 315,000 additional deaths from low intake of whole grains, vegetables, and legumes, 150,000 from high red meat intake, and 70,000 from high dairy intake in 2021, compared with 2016. Agriculture remains a key driver of deforestation.
UK-specific data are summarised here. In 2021, consumption of red meat and dairy resulted in 68% of total agricultural emissions and production of red meat and dairy accounted for 72% of all agriculture production-related emissions. Over 38,500 deaths were associated with excessive consumption of red meat and dairy, and nearly 36,000 deaths were associated with insufficient consumption of nutritious plant-based foods (including fruits, vegetables, legumes, wholegrains, nuts and seeds). Together, these accounted for 32% of all diet-related deaths that year. There is a clear message that a shift to a plant-based diet and production system is required.
The report also reminds us that emissions from the healthcare sector continues to rise with health systems in high and very high development index countries contributing to 91% of global healthcare emissions. Lifestyle medicine approaches are key to addressing the four pillars of sustainable healthcare: prevention, patient empowerment, low carbon alternatives and lean pathways.
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