Review of the plant-based nutrition and lifestyle medicine news October 2025
This month brings together new, practice-changing evidence across nutrition, chronic disease prevention, cancer, brain health, and social prescribing. PLUS, more on planetary health. It’s a long one!
The Big Picture: What’s Driving Ill-Health — And What We Can Change (GBD 2023)
This updated analysis from the Global Burden of Disease (GBD) synthesises an enormous evidence base of 375 diseases and injuries and 88 modifiable risk factors across 204 countries using updated methods and >35,000 new data sources. Nearly half of all health loss in 2023 (about 46% of total disability adjusted life years – DALYS) was attributable to modifiable risks, reaffirming prevention as our biggest lever for improving healthy life expectancy. The leading causes of death were cardiovascular diseases, respiratory conditions, Alzheimer’s disease, diabetes and cancer. The top risk factors globally were high systolic blood pressure, particulate matter air pollution, smoking, high fasting plasma glucose, and low birthweight/short gestation. High blood pressure alone accounted for an estimated 8.4% of total DALYs. While communicable, maternal, neonatal and nutritional conditions continue to decline, the burden from non-communicable diseases has risen, driven by ageing populations and increasing metabolic risks.
Crucially for clinical practice, the analysis shows divergent trends: age-standardised burdens attributable to many behavioural and environmental risks are falling, but metabolic risks are not. From 2010 to 2023, ill health attributable to high body mass index (BMI) rose by ~10%, and those due to high fasting plasma glucose increased slightly, in contrast to substantial declines for risks like smoking and unsafe water/sanitation.
Dietary risks remain a major, modifiable driver of premature death and disability worldwide. The risk cluster includes low intakes of fruits, vegetables, legumes, whole grains, and nuts and seeds; high sodium; high intakes of red and processed meat and sugar-sweetened beverages; and industrial trans fats. Many diet–disease pathways are mediated through metabolic factors such as blood pressure, blood lipids and glucose. Methodologically, GBD 2023 tightened mediation modelling and, notably, revised the theoretical minimum risk exposure level for trans fatty acids, reflecting the consensus that even very low exposures carry harm. It’s worth noting that meat and dairy are a source of trans fatty acids.
Geography matters. Particulate matter pollution dominates in South Asia and parts of sub-Saharan Africa; smoking remains a leading risk in Western Europe and high-income Asia Pacific; and high BMI or high fasting glucose top the list in several regions of the Americas and Australasia. For clinicians and policymakers, this argues for integrated strategies: clean air and tobacco control plus aggressive management of blood pressure and glucose and a focus on improving diet quality at a population scale.
You can read the summary of the report here and search for country profiles here.
The EAT–Lancet Commission 2025: Health, Sustainability, and Justice
The updated EAT–Lancet Commission on Healthy, Sustainable, and Just Food Systems, published in 2025, marks a significant evolution in our understanding of how food connects health, the environment, and social justice. Since the first report in 2019, the world has faced multiple converging crises including, geopolitical instability, the COVID-19 pandemic, escalating climate impacts, and deepening inequalities. Yet despite these challenges, the message is more urgent and unequivocal than ever: our global food system remains the single largest driver of environmental degradation and a fundamental determinant of human health and wellbeing.
At the heart of this new analysis lies the Planetary Health Diet (PHD), a pattern of eating that is predominantly plant-based, rich in whole grains, fruits, vegetables, legumes, nuts, and seeds, and complemented by modest amounts of animal-sourced foods. The PHD obtains 87.7% of energy from plant-based foods and meat, dairy and eggs are not considered essential. Thus, a 100% plant-based or vegan diet is compatible with the PHD.
The evidence supporting this way of eating has only strengthened over the past six years. Adopting a largely plant-based diet could prevent up to 15 million (27%) premature deaths annually, while substantially reducing the risk of cardiovascular disease, type 2 diabetes, cancer, dementia, and unhealthy ageing. The diet remains flexible and culturally adaptable, providing a framework within which regional food traditions can thrive. It supports adequate nutrition at all stages of life, including pregnancy and childhood (age 2 and above), with careful attention to key nutrients such as vitamin B12, iron, calcium, and iodine.
Perhaps the most profound shift in this Commission is the explicit integration of justice alongside health and sustainability. The 2025 report recognises that our food systems are not only environmentally unsustainable but also socially inequitable. Nearly half of the world’s population lives below the social foundations required to meet basic human rights such as access to food, clean environments, and decent work. Meanwhile, the diets of the wealthiest 30 percent of people are responsible for more than 70 percent of the environmental impact of global food production. The Commission calls for a transformation that is both nutritious and fair, ensuring that the benefits and burdens of food systems are shared equitably and that those most affected by injustice, smallholder farmers, women, and marginalised communities, have a voice in shaping the solutions.
Scientifically, the updated Commission represents a step change. For the first time, researchers have quantified food’s contribution to all nine planetary boundaries, those thresholds that define the safe operating space for humanity. The findings are sobering: food systems are the dominant cause of transgressing five of these boundaries, including land use, biodiversity loss, greenhouse gas emissions, freshwater depletion, and nitrogen and phosphorus pollution. Even with ambitious interventions, healthier diets, more efficient agriculture, and a 50% reduction in food waste, the world only just manages to return to safe limits for climate and freshwater use. The report also highlights the need for sustainable and ecological intensification, farming practices that restore soil health, enhance biodiversity, sequester carbon, and reduce dependence on synthetic fertilisers and pesticides.
I am delighted to see that Conservation Agriculture, pioneered by my father Dr Amir Kassam, is endorsed (panel 5) as the sustainable, ecological and just solution to food production intensification, enabling food systems to operate within planetary boundaries. Conservation Agriculture does not require any inputs from farmed animals as the healthy soil and its components are self-sustaining without the need for animal grazing and manure. Biomass is incorporated directly into soils by soil biodiversity, particularly earthworms and further processed by soil bacteria and fungi. Conservation Agriculture also requires much reduced inputs of chemicals and fossil fuel than tillage-based agriculture and it is entirely possible to practice within organic farming systems. You can read more about our vision for a sustainable plant-based farming system here.
The transformation envisioned by the Commission will reshape how and what we eat. It implies a 33 percent reduction in ruminant meat production, alongside a 63 percent increase in the cultivation of fruits, vegetables, and nuts. This shift would create a food system that is less resource-intensive, less polluting, and better aligned with human health. Crucially, the authors stress that food must also be delicious, desirable, and culturally meaningful if such dietary changes are to be sustained.
Where I think health and planetary priorities digress are with the continued recommendations for fish consumption. This would require increased fish production by up to 46% globally, when current levels of production have been shown to be unsustainable and hugely unethical. I look forward to learning how the authors propose this will be achieved.
Overall, this report strengthens the scientific and ethical case for plant-forward, minimally processed diets as the cornerstone of human and planetary health. It reminds us that our plates are powerful tools, not only for preventing disease and mitigating climate change but also for advancing equity and compassion in a world that urgently needs both.
Plant-Based Meat and Dairy Alternatives: Modelled Impacts on Health and Nutrient Adequacy
This new study published in the American Journal of Clinical Nutrition offers an important complement to the EAT–Lancet Commission by examining how the replacement of meat and dairy with plant-based substitutes affects health and nutrient adequacy in practice. Using national dietary data from over 2,000 French adults, the researchers simulated diets in which all meat, milk, and dairy desserts were replaced with plant-based alternatives. They then modelled the impacts on nutrient deficiency and chronic disease–related mortality.
The results are reassuring. On average, replacing animal products with plant-based substitutes did not increase the overall risk of nutrient deficiency. While the likelihood of vitamin B12 and riboflavin deficiency rose slightly (unsurprising given their predominance in animal foods) this was offset by improved intakes of fibre, unsaturated fats, and folate. The benefits were most pronounced when meat was replaced, leading to marked reductions in premature deaths from cardiovascular disease, type 2 diabetes, and cancer. These gains were mainly attributed to the sharp fall in red and processed meat consumption and improvements in the quality of dietary fats. However, the high sodium content of some meat substitutes modestly reduced these advantages, highlighting the importance of product formulation.
Across all substitution scenarios, the models projected that between 3,700 and 6,700 premature deaths from chronic diseases could be averted each year in France, depending on the nutritional quality of the substitutes. The most nutritionally robust plant-based products, those fortified with key vitamins and minerals and lower in sodium, offered the greatest benefit.
The study also reinforces that not all plant-based substitutes are equal. Their health impacts vary substantially depending on how they are formulated. Poor-quality substitutes, often more energy-dense and highly processed, increased the proportion of ultra-processed foods in the diet, whereas higher-quality products kept this rise minimal. Fortification, particularly with vitamin B12 and calcium, made a measurable difference to nutrient adequacy.
This research therefore provides critical nuance to the EAT–Lancet Commission’s broader message. While the Commission rightly centres plant-based diets in its vision for planetary and human health, it pays limited attention to the rapidly growing market of meat and dairy alternatives that are now helping consumers make the transition away from animal products. This study demonstrates that, when well designed and appropriately fortified, such products can facilitate healthier diets and significantly reduce chronic disease burden without compromising nutrient adequacy.
The findings also underscore the responsibility of industry and policymakers to ensure that plant-based alternatives support, rather than undermine, public health goals. Reformulation to lower sodium, mandatory fortification standards, and clear front-of-pack labelling could help consumers choose products that align with both health and sustainability.
In summary, this study provides robust evidence that replacing animal products with high-quality plant-based alternatives is a safe and effective strategy for improving population health and reducing premature mortality. It highlights the potential of innovation in the plant-based food sector to accelerate dietary change, if guided by nutritional science and supported by effective policy.
The MyPlanetDiet Randomised Controlled Trial: Sustainable Diets and Micronutrient Adequacy
Following the encouraging evidence on the potential of plant-based meat and dairy alternatives to improve health outcomes, the MyPlanetDiet randomized controlled trial provides a much-needed real-world test of whether sustainable dietary patterns can also meet micronutrient requirements.
This 12-week trial, conducted in Ireland and Northern Ireland, enrolled over 350 healthy adults and compared two diets: one based on conventional healthy eating guidelines and another explicitly designed around environmental sustainability principles. The sustainable diet emphasised fruits, vegetables, legumes, nuts, and wholegrains, while reducing red and processed meat and limiting dairy and fish to modest amounts.
As expected, the sustainable diet significantly lowered dietary greenhouse gas emissions, by almost one-third, demonstrating that personal dietary change can meaningfully reduce environmental impact. However, the study’s findings also highlight important nutritional considerations that must accompany such transitions.
Participants following the sustainable diet experienced measurable reductions in the intake of several key micronutrients, including vitamin B12, riboflavin, calcium, iodine, and zinc. The prevalence of inadequate intakes rose most notably for vitamin B12, calcium, and zinc, even though participants were still consuming some animal foods.
Interestingly, despite these lower intakes, blood biomarkers of nutrient status remained largely unchanged over the 12-week period. This likely reflects both the short study duration and the body’s ability to draw on existing nutrient stores. Yet the results underscore the need for careful planning, fortification, and monitoring as populations move toward more plant-forward eating patterns.
The control group, who followed national healthy eating guidelines, also reduced their dietary emissions, by around 14 percent, but without any loss of nutrient adequacy. This finding is encouraging: even modest shifts toward healthier food choices can have measurable benefits for planetary health.
The trial exposes a familiar but resolvable tension: diets that are good for the planet can fall short in certain micronutrients unless we pay deliberate attention to sources of vitamin B12, iodine, calcium, and zinc. The inclusion of fortified plant-based milks, nutritional yeast, or supplements where appropriate can close these gaps without reverting to resource-intensive animal agriculture.
Taken together with the earlier study on plant-based substitutes, the MyPlanetDiet results suggest that the success of sustainable diets will depend not only on reducing meat and dairy but also on ensuring nutritionally adequate, accessible, and appealing plant-based alternatives. High-quality, fortified products and public-health strategies that promote nutrient literacy are essential if sustainable eating is to benefit both people and the planet.
The Global Burden of Cancer: A Growing but Preventable Crisis
The Global Burden of Disease 2023 Cancer Study offers the most comprehensive assessment to date of the worldwide cancer landscape. In 2023 there were an estimated 18.5 million new cancer cases and 10.4 million deaths, making cancer the second leading cause of death globally after cardiovascular disease. The burden continues to rise, with forecasts predicting 30 million new cases and nearly 19 million deaths annually by 2050, a 75% increase driven largely by ageing populations and population growth.
Yet within these numbers lies an urgent message of opportunity. More than 40 percent of all cancer deaths in 2023 were attributable to modifiable risk factors, meaning that millions of cases are preventable. The most significant drivers remain tobacco use, unhealthy diets, alcohol consumption, obesity, physical inactivity, and air pollution. Dietary risks alone contribute to a substantial fraction of global cancer deaths, particularly those from colorectal, breast, prostate, lung, oesophageal, and stomach cancers.
The study highlights the inequity of cancer’s toll. Nearly two-thirds of new cases and deaths now occur in low- and middle-income countries, where prevention, early detection, and treatment services remain under-resourced. Without decisive action, these regions will bear the brunt of the projected increase.
Encouragingly, age-standardised mortality rates have declined modestly over the past three decades, reflecting progress in tobacco control, screening, and treatment. But the decline is far too slow to meet the UN Sustainable Development Goal of reducing premature non-communicable disease mortality by one-third by 2030.
The evidence is clear: cancer is not inevitable. Tackling its modifiable causes through population-level policies, reducing tobacco and alcohol use, promoting whole-food plant-based diets, increasing physical activity, and addressing environmental pollutants, could save millions of lives each year. The study calls for a shift from treatment-dominated strategies to prevention-centred, equitable cancer control, supported by universal health coverage and stronger public-health infrastructure.
Food as Medicine in Gastrointestinal Cancer Therapy
A companion Nature Reviews Gastroenterology & Hepatology commentary deepens this message by exploring how nutrition can be used therapeutically in the prevention and management of gastrointestinal cancers.
Rates of colorectal and liver cancer are rising sharply, especially among younger adults, with clear links to diet and lifestyle. High intakes of red and processed meat, alcohol, and energy-dense, pro-inflammatory foods increase risk, while diets rich in wholegrains, fibre, legumes, fruit, and vegetables are consistently protective.
Beyond prevention, diet also influences treatment response, recurrence, and survival. In people with colorectal cancer, a higher adherence to a healthy plant-based diet ( as defined by the plant-based diet index) was associated with significantly longer survival and lower recurrence, even in metastatic disease. Conversely, diets that promote insulin resistance, high in refined carbohydrates and saturated fats, are linked to higher cancer-specific mortality.
Emerging research is revealing biological mechanisms behind these effects. Red meat intake can induce mutational signatures in colorectal tumours, contributing to DNA damage and worse outcomes. In contrast, fibre-rich plant foods lower insulin and IGF-1 levels, reduce inflammation, and foster a more diverse gut microbiome. The metabolites produced by these healthier microbiota, notably short-chain fatty acids, appear to enhance immune function and suppress tumour progression.
Early intervention trials are beginning to confirm that personalised nutrition can improve outcomes. Randomised studies in colorectal cancer survivors show that targeted dietary counselling enhances nutritional status, physical functioning, quality of life, and even survival. The field now calls for larger, integrated studies that combine clinical outcomes with biomarker, microbiome, and metabolomic data to guide precision nutrition in oncology.
Health Inequalities and Social Prescribing: Framing and Findings
A new government analysis, Health Trends and Variation in England (September 2025), starkly documents widening inequalities in life expectancy and, more importantly, healthy life expectancy, with stratification by geography, deprivation, ethnicity and gender. These gaps are not inevitable; they reflect the social and environmental conditions in which people are born, live, work and age. Reversing them requires a shift from reactive, biomedical care to proactive, preventive, and socially informed practice.
One of the most promising ways to address the social and lifestyle determinants of health within clinical settings is through social prescribing, connecting patients to community-based activities and support that nurture wellbeing beyond what medical care alone can achieve. This landmark Lancet Public Health study provides the first national analysis of England’s social prescribing scheme since its formal integration into NHS primary care in 2019.
Social prescribing encompasses a diverse range of non-clinical services designed to meet social, emotional, and practical needs. These include exercise and walking groups, volunteering opportunities, arts and cultural programmes, gardening projects, befriending services, mental health and counselling support, skills training, employment and housing advice, and financial guidance. In England, the predominant model is the GP–link worker system, in which a patient referred by their GP is supported by a trained link worker who co-designs a personalised care plan and connects them to relevant community resources.
Using data from more than 1.2 million patients across 1,736 GP practices, the study tracked how this system has developed over time. The findings reveal remarkable growth: between 2019 and 2023, there were over 9.4 million GP consultations involving social prescribing, with 5.5 million resulting in formal referrals, far exceeding the NHS Long Term Plan target of 900,000 referrals by 2023–24. In 2023 alone, 1.3 million people were referred to social prescribing link workers, confirming that this approach is now embedded in the fabric of primary care.
Equity of access has also improved. The proportion of patients referred from the most deprived communities nearly doubled, from 23% in 2017 to 42% in 2023, demonstrating progress in reaching those most affected by social and health inequalities. Participation among ethnic minority patients rose to around 22%, surpassing their representation in the wider population. These data counter early concerns that social prescribing might benefit mainly the more advantaged; instead, it appears to be strengthening inclusion.
Encouragingly, service refusal rates fell sharply, from 22% in 2019 to just 11% in 2023. Women and people from minority ethnic backgrounds were more likely to accept referrals, while younger adults increasingly engaged in social prescribing activities. Together, these findings reflect a growing trust in the model and a recognition among patients and clinicians that health is shaped as much by connection, purpose, and community as by medicine.
Beyond patient wellbeing, social prescribing also offers systemic benefits. Around one in five GP consultations involves social or emotional needs that do not require medical treatment. By linking people to community support, social prescribing helps reduce the strain on primary care, while promoting physical activity, mental health, and social cohesion.
In summary, this nationwide analysis presents social prescribing as a major public health success. It demonstrates that when health systems move beyond a purely biomedical model, by investing in the social foundations of health, they can deliver care that is preventive and equitable.
Prediabetes Remission Without Weight Loss: Rethinking the Target
This analysis in Nature Medicine turns a familiar narrative on its head: people with pre-diabetes can return to normal glucose regulation without losing weight, and they are then far less likely to develop type 2 diabetes. Drawing on the German PLIS (Prediabetes Lifestyle Intervention Study) trial with up to 10 years’ follow-up and replicated in the U.S. Diabetes Prevention Program, the study shows that remission in the absence of weight loss cut future diabetes risk by roughly 70%, a protection comparable to weight-loss–driven remission.
What changes, if not the number on the scales? The answer is fat distribution and metabolic health. Among participants who did not lose weight, those who achieved remission avoided the usual increase in visceral adipose tissue (the metabolically hazardous fat around abdominal organs) and instead stored any additional fat in subcutaneous depots. Their subcutaneous-to-visceral fat ratio rose, and this shift was associated with better insulin sensitivity, improved β-cell function, stronger GLP-1–mediated insulin responses, and greater suppression of glucagon after glucose, an ensemble of changes that normalised glycaemia despite stable or even higher body weight. Circulating adiponectin, a hormone linked to insulin sensitivity, was higher after the intervention in those who with remission, consistent with the healthier fat distribution.
Diet quality appears central to this redistribution story. In PLIS, the lifestyle targets were classic quality metrics, fat less than 30% of energy, saturated fat less than 10%, and fibre greater than 15 g per 1,000 kcal, rather than a prescribed weight-loss quota. The authors point to convergent evidence that dietary quality dictates where fat is stored. Diets higher in polyunsaturated fats and lower in saturated fats are less likely to promote visceral fat gain, even during periods of weight stability or weight gain. Higher fibre intake improves insulin sensitivity, dampens post-meal glycaemic excursions, and supports a gut microbiome favourable to metabolic health.
In practical terms, this means prioritising whole plant foods, legumes, whole grains, vegetables, fruit, nuts and seeds, and replacing sources of saturated fat with foods naturally higher in unsaturated fats, while keeping highly refined carbohydrates to a minimum.
These results remind me of one of the original diabetes remission studies, in which participants were asked to consume a high fibre, high carbohydrate diet without losing weight. This led to a number of patients reducing or eliminating the need for medications, emphasising that diet quality matters most.
Alcohol Use and Brain Health: No Safe Limit
This multi-cohort analysis is one of the largest and most rigorous examinations of alcohol and brain health to date, combining prospective data from more than half a million adults in the UK Biobank and US Million Veteran Program with genetic (Mendelian randomisation) evidence drawn from approximately 2.4 million participants across 45 cohorts. The authors integrate traditional observational associations with both linear and non-linear genetic analyses to ask a simple but important question: is there any level of alcohol intake that is safe for the brain?
In conventional cohort analyses, the familiar U-shaped curve appears, higher dementia risk in non-drinkers and heavy drinkers, with the lowest risk among light drinkers. However, when drinking patterns over time are assessed, the researchers find that people who go on to develop dementia tend to reduce their alcohol intake in the years before diagnosis. This reverse causation helps explain the illusion of benefit in light or moderate drinkers.
The genetic analyses cut through this bias. Using Mendelian randomisation, which approximates lifelong exposure and eliminates issues relating to confounding, the study shows a dose-related increase in dementia risk as alcohol consumption rises, with no evidence of a protective effect at any level.
The policy implications are clear. Reducing or eliminating alcohol use could lower population dementia incidence. The authors state ‘Halving the population prevalence of alcohol use disorder may reduce dementia cases by up to 16%’. For clinicians and the public, the message is straightforward. If people choose to drink, less is safer, and for brain health there is no threshold below which alcohol can be considered risk-free.
Read more about the impact of alcohol on health outcomes in my article here.
Plant-Based Diet Quality and Dementia Risk in Cardiometabolic Disease
This new UK Biobank analysis strengthens the case that diet quality, specifically a healthy plant-based diet pattern, is a powerful lever for dementia prevention, even among people already living with cardiometabolic disease. In more than 71,000 adults aged 55 years and older, baseline heart disease, stroke or type 2 diabetes nearly doubled subsequent dementia risk. Yet that excess risk was markedly modified by what people ate. Those with cardiometabolic disease who most closely adhered to a healthful plant-based diet (higher intake of whole grains, vegetables, legumes, fruit, nuts and minimal refined or ultra-processed foods) had a 61% lower risk of dementia. Conversely, an unhealthful plant-based diet, more refined grains, sugary drinks, sweets and ultra-processed plant foods, was associated with over a threefold higher risk among those with cardiometabolic disease. These associations persisted after adjusting for age, sex, education, deprivation, BMI, smoking, physical activity, alcohol, hypertension and APOE4 status. Mediation analyses suggested that better glycaemic control (lower HbA1c) may be one pathway by which a healthful plant-based diet supports brain health.
Lifestyle beyond diet still matters, but the impact of diet was dominant. Among people with cardiometabolic disease who were not following a healthful plant-based pattern, being physically active, avoiding smoking and not drinking attenuated risk. However, in those already eating a high-quality plant-based diet, adding these behaviours produced only a small, non-significant further reduction, underscoring diet quality as a central pillar of risk modification in this high-risk group.
Conclusions
Taken together, these studies move us beyond abstract ideals and toward actionable evidence. Diet and lifestyle approaches not only support disease prevention but can improve treatment outcomes, address health inequalities and support planetary health. A whole food plant-based diet is an essential part of a healthy, sustainable and just lifestyle. For policy-makers, putting this into action requires making the healthiest choice the easiest and most affordable one, particularly for those currently furthest from good health.
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