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

This month I cover diet and exercise for cardiovascular health and cancer, whether fish is required in the diet and plant-based diets for psoriasis and weight management.

Diet quality continues to undetermined health, social and economic outcomes in the UK

Poor diet quality in the UK continues to drive chronic ill health, premature mortality and has a negative impact on wider social and economic outcomes. An updated analysis from the Food Farming and Countryside Commission, just two years after the first, reveals that diet-related outcomes are getting worse.

The report states that the evidence that diet-related ill health causes economic harm has strengthened. 2.8 million people of working age are out of work due to long-term ill health. Poorer household and deprived places are affected more by chronic ill health. This is in part driven by inequitable access to healthy food given that poorer households now have to spend 85% of their income to afford a healthy diet in line with Government guidelines.

The estimated health-related costs attributable to unhealthy diets have risen to £298 billion a year. These are costs relating to healthcare, social care, welfare costs and costs related to loss of productivity and loss of quality of life. In contrast, the cost of making healthy diets (Eatwell Guide) affordable to all has reduced to £51 billion.

The need to address diet-related ill health has never been more important. This requires Government, healthcare and civil society to work together to ensure healthy, diets are accessible and affordable for all.

It is interesting to read a newly published modelling study that explores the impact of on health of reducing processed and red meat consumption in the UK in line with the Climate Change Committee recommendations. Data were analysed to model the impact of a 35% and 50% reduction and the results showed that when replaced with vegetables and legumes this would reduce the number of chronic disease cases by 3.4 and 5.6 million, and increase life expectancy by 7.2 and 9.4 months, respectively over a 30-year period. This benefit was mainly due to reductions in cardiovascular disease. There would also be a huge economic saving to this degree of disease prevention.

One way of implementing healthier diets, especially for those with chronic conditions, is through provision of medically tailored groceries or meals or produce prescription. We already have good practice examples such as the Alexandra Rose Charity fruit and vegetable vouchers given out via GP practices to people from deprived communities. Results have shown significant improvement in diet quality along with measurable improvements in health and lower reliance on health services.

A new publication reports the impact of providing plant-based medically tailored groceries to 68 people of lower socioeconomic means in Massachusetts, US. A retrospective analysis using electronic health records found that people receiving these plant-based groceries over a 3-year period had reductions in their body weight, BMI and blood pressure, but not HbA1c.

Nutrition for prevention and management of cardiovascular disease

It’s good to see this new scientific statement from the American College of Cardiology (ACC) on healthy diet patterns for cardiovascular health. The central message is unchanged. Healthy diets are high in fruit, vegetables, whole grains, legumes, nuts and seeds, whilst being low in red and processed meat and ultra-processed foods and avoiding alcohol. The report recommends prioritising plant sources of protein over animal sources.

Vegetarian and vegan diets are included as heart healthy dietary patterns (when they are built around whole foods). However, the report then contradicts itself by stating ‘long-chain omega-3 fatty acids are best obtained through regular fish consumption’.

It is not clear to me how that conclusion has been reached. People following vegetarian and vegan diets consistently have better cardiovascular health outcomes. There is an open question as to whether people who do not eat fish would benefit from a direct source of long-chain omega-3 fats i.e. from algae-based supplements. These are available and a well-established alternative to omega-3 fats from fish. At the moment the UK population eat on average one or less portion of fish a week. If we were to increase consumption this would be wholly unsustainable for ocean health and food security.

In my opinion we need to think beyond the oversimplified connection of fish with omega-3 fats and consider health more holistically, just as the One Health approach recognises. Headlines this week on how waste from chicken farming is being fed to farmed salmon is horrifying and cannot be justified. Plant-based diets are an excellent option for health and the planet and thus should be recognised for these co-benefits.

The ACC guidance does not specifically address diet in children. Given that atherosclerotic cardiovascular disease begins in childhood, it is important to recognise the role of modifiable risk factors early in life. This is why I like the 2022 nutrition guidance from the American Society of Preventive Cardiology, which specifically addresses paediatric populations. The advice remains the same as for adults, with fruit, vegetables, whole grains, beans, seafood, nuts and seeds central.

Interestingly, a population-based, prospective analysis from the Netherlands which included 3990 children reported that greater adherence to a healthy plant-based diet was associated with improved cardiometabolic health. This included lower systolic and diastolic blood pressure and lower total cholesterol. These are key drivers of atherosclerosis, which starts in childhood, and determine future cardiovascular health. The results are consistent with those from other cohort studies that include vegan children, which show that a vegan diet is associated with lower cholesterol levels.

Exercise prescription for cardiovascular health

The ACC have also published a scientific statement on exercise prescriptions for cardiovascular health in adults. There is nothing particularly new in the document, but it is great to see the evidence and practical guidance all in one place with useful infographics. Aerobic, strength and balance exercises are important for all aspects of cardiovascular health and relevant to all cardiovascular conditions. There are very few contraindications and a few clinical scenarios where exercise testing is required before recommending regular exercise.

The guidance notes that despite the strong evidence for prescribing exercise for prevention and management of cardiovascular conditions, implementation is still an issue. For those of us in lifestyle medicine, the key components of an exercise prescription are well known – frequency, intensity, time, and type (FITT) – but need to be individualised based on a person’s health status, functional capacity, treatment goals, symptoms, medications, comorbidities, and personal preferences. Practical issues also need to be considered including, access to facilities, equipment, cost, and likelihood of long-term adherence.

The UK Government have recently updated their physical activity guidelines including advice across the life span.

A large analysis published in the BMJ brought together data from 124 randomised trials (18 429 participants) to assess the impact of structured exercise on bone health in middle aged and older adults. The results showed that brisk walking or jogging appeared to yield improvements in bone mineral density (BMD) comparable to combined aerobic-resistance exercises. Clinically meaningful BMD gains were generally observed at a threshold of 2-3 hours of brisk walking per week with a plateau in effect occurring at around 5 hours per week. This suggests that high intensity regimens may not be necessary. Mixed aerobic and mind-body exercises were associated with a reduced risk of incident fractures. The authors conclude that exercise prescription should be incorporated into treatment plans for preserving bone health with ageing.

Unlike for nutrition advice, there is little controversy around exercise as medicine. The main challenges are around implementation and equitable access.

Is eating fish really as healthy as we are led to believe?

Continuing on the theme of eating fish, it is interesting to note that this one-of-a-kind analysis of data from the Framingham Heart Study Offspring Cohort finds that fish consumption does not predict for better brain health or a lower risk of dementia over a 21-year follow up period.

We will never have a long enough randomised study that can definitely answer the question as to whether eating fish is required for optimal brain health. Therefore researchers used what is called target trial emulation framework to simulate a randomised study. This methodology provides the ability to infer a causal relationship between exposure and outcome from observational data. In the case of this study, the question was – is regular fish consumption associated with a lower risk of Alzheimer’s disease and if so is the relationship causal?

The results showed that sustained fish consumption was not associated with a lower risk of Alzheimer disease and was researchers were not able to demonstrate an independent effect of fish consumption for prevention of dementia.

So the questions remain, does fish add any additional benefits to an otherwise health plant-based diet? The answer may well be no when it comes to brain health. The good news, according to larger observational datasets, is that it is never too late to change your diet in order to benefit brain health in later life.

Lifestyle intervention for men with prostate cancer

We have known for a few decades now that lifestyle interventions are important for improving outcomes in men with prostate cancer. Dr Dean Ornish was one of the first to demonstrate the benefits for men with early prostate cancer. He was also able to demonstrate mechanism of action such as positive changes in gene expression and increase in telomere length.

It is great to see the publication of the STAMINA intervention in men with prostate cancer on androgen deprivation therapy (ADT) in the UK. Men on ADT experience fatigue and negative impacts on quality of life. The trial was a multi-centre randomised study across 15 NHS trusts and included 389 men in the intervention arm and 311 men in the optimised usual care arm. The STAMINA lifestyle intervention comprised supervised aerobic and resistance exercise for 12 months, dietary advice, behavioural support, and complimentary gym membership. Optimised usual care comprised clinician training, educational materials, behavioural prompts, and safety-to-exercise checks.

The intervention was carried out in Nuffield Health fitness centres. I cannot locate information on the exact dietary advice but assume it would be inline with the recommendations of the Eatwell Guide.

At 12 months, the study met its primary end points and showed that compared to the control group, men in the intervention group experienced significant improvements in cancer-related quality of life and reductions in fatigue, using validated methods of assessment. The researchers were also able to demonstrate that the STAMINA lifestyle intervention is cost-effective compared with optimised usual care, being deliverable for £13, 920 per quality-adjusted life years and costing less than £1000 per annum even under the more expensive scenario examined. Given the use of the national network of Nuffield Health centres, this intervention could be implemented at scale immediately. There is also good reason to believe that the intervention would be beneficial for people with other types of cancers.

This study was particularly remarkable as it was able to demonstrate practical application in a real-world cancer settings, completing recruitment of 700 men in a 15- month period. The accompanying editorial reminds us that it took over 15 years to enrol 889 participants in the CHALLENGE trial, and the INTERVAL-GAP 4 trial was terminated due to low recruitment. The authors of the editorial also state that it is no longer ethical to conduct studies where people with cancer are assigned to receive no exercise, given the strength of evidence in support.

Importance of the gut microbiome in people with cancer

One of the most exciting areas of lifestyle medicine and cancer is the well-recognised fact that the health of the gut microbiome can impact response to treatment and survival from cancer. We still have a long way to go to understanding how to best leverage this knowledge into patient care. However, we can support people with cancer to improve their diet quality, which we know will not only improve the health of the gut microbiome but also have a number of other benefits for overall health.

The good news is that dietary modification can alter the gut microbiome in a matter of days. Improving gut microbial health requires a focus on fibre-rich plant-based foods, which is why most studies in the field are focusing on plant-based diets.

Dr Urvi Shah from MSKCC has already published a number of studies demonstrating how a fibre-rich diet has the potential to slow progression in plasm cell neoplasms and improve treatment responses in people with myeloma.

It is great to see another large haematology centre from the US (The Fred Hutchinson Cancer Centre) also apply this known and publish their feasibility study of a whole food plant-based meal intervention in people undergoing stem cell transplantation for myeloma. They were able to show that a whole food plant-based diet for 5 weeks was not only feasible and well tolerated, but it also led to significant changes in the gut microbiome and increased production of short chain fatty acids, compounds known to improve immune and systemic health.

High-fibre interventions are also being studied in people with melanoma, particularly in the setting of immunotherapy.

The Lancet Oncology have published an up-to-date review on cancer and the microbiome that is worth reading. Researchers however seem more interested in pre and probiotic supplements and faecal transplants rather than the tools we already have available to us – a plant-based diet.

Culinary cancer care programmes are desperately needed for supporting patients to eat more fibre-rich plant-based foods. Amy Symington in Toronto, Canada is doing some pioneering work in collaboration with the cancer charity The Gilda’s Club Toronto. She has published results of her work supporting people with cancer to improve culinary skills and diet quality. She was able to demonstrate that her plant-based culinary programme positively impacts diet quality and self-reported improvements in well-being and cancer-related symptoms.

Unfortunately, it seems the Gilda’s Club Toronto closed down in August 2026.

Diet quality and risk of psoriasis.

A new analysis from the UK Biobank, which followed 121,299 participants for a mean of 11.4 years, found that greater adherence to a plant-based diet was associated with a 19% lower risk of developing psoriasis. This was in part due to lower body fatness or adiposity and the finding was independent of genetic risk. It’s worth noting that researchers also assessed the impact of 9 other types of dietary patterns, but no protective impact was found.

Regarding individual foods, refined grains, sugary foods, meat and eggs were all associated with a higher risk of developing psoriasis.

This study follows the publication of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) cross-sectional study that showed that people with a diagnosis of psoriasis eating the least plant-based foods had increased disease severity.

Vegan diets reduce liver fat without need for calorie counting

We know that one of the huge benefits of plant-based diets is the low energy density and hence lower body weight. This has been shown over and over again.

A new publication from the team at PCRM in people with type 2 diabetes added to the evidence. This single arm study included 25 participants who followed a low-fat vegan diet for 16 weeks. They were allowed to eat as much as they wanted to without restricting calories.

The results showed a mean body weight reduction of 6kg (6.6%), mainly due to loss of fat mass. In addition there were significant reductions in muscle and liver fat (33%), insulin resistance and advanced glycation end products. There was also evidence of improved pancreatic beta cell function.

Of course this type of study has significant limitations, being small and without a control group. However, it provides evidence of an alternative way of achieving weight loss and fat loss for people living with type 2 diabetes.

I attended an excellent webinar from MyNutriWeb this month on the role of plant-based diets for people on weight loss medications (GLP-1 medications). The webinar also presented the excellent GLP-1 nutrition guide developed by Proveg International.

See you back in November!

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