Nutrient Adequacy and Health in the Planetary Health Diet: The Role of Dairy

What is the EAT-Lancet? 

The EAT-Lancet is a joint initiative between The Lancet medical journal and EAT, a Swedish non-profit. The Commission, composed of 37 experts from fields such as nutrition, agriculture, sustainability, and public health, aimed to establish a scientific consensus by setting targets for healthy diets and sustainable food production. These targets were organized into 2 categories: (1) Healthy Diet and, (2) Sustainable Food Production.

The original EAT-Lancet diet, also known as the “Planetary Health Diet”, was published in the 2019 EAT-Lancet report and was based on a 2018 modelling study of four dietary patterns (flexitarian, pescatarian, vegetarian, and vegan).² The 2025 report introduced limited updates and presented revisions to the Planetary Health Diet, maintaining a dietary pattern broadly similar to the original ‘flexitarian’ model that prioritizes plant-based foods and restricts animal-based foods. 

Healthy diets: Analysis and considerations 

Evidence-based dietary recommendations are critical for effectively supporting health at both individual and population levels. While the EAT-Lancet reports aim to inform and influence public health guidelines, it is important to note that no systematic review was conducted. The conclusions appear to draw on a limited portion of the available literature and, consequently, may not always fully reflect the broader scientific evidence base. The following sections compare statements from the 2025 report with current scientific evidence, particularly regarding dairy.  

General Nutrition 

Energy requirements. Caloric requirements vary widely and are influenced by socio-economic, physiological, psychological, and environmental factors. The authors modeled diets at 2,400 kcal/day, assuming a healthy body mass index (BMI) of 22 kg/m² and “active” activity levels (defined as “active on average” by the World Health Organization).³ In fact, the same reference indicates that this caloric intake corresponds to very active individuals, suggesting that the authors’ activity assumptions may not align with their cited source. According to this reference, a healthy BMI at typical activity levels would require closer to 2,070 kcal/day.³ With about 31% of adults and 80% of adolescents worldwide currently not meeting physical activity recommendations, high activity assumptions may not reflect the general population.⁴ 

This highlights that the Planetary Health Diet’s calorie level may not correspond to the energy needs of many individuals, potentially leading to excess energy intake and an increased risk of obesity in some. Moreover, given that the availability of the various nutrients in the Planetary Health Diet was calculated based on a high calorie intake, individuals following the diet at a lower energy level may be at higher risk of nutrient deficiencies, raising potential public health concerns. 

Protein. The report states that their proposed diet provides about 14% of daily energy from protein, which is above the 0.7–0.8 g/kg/day requirement cited in the report. However, this amount is insufficient for key populations, such as children and adolescents up to 18 years (0.85-1.05 g/kg/day depending on the age); pregnant or breastfeeding women (1.1 g/kg/day and 1.3 g/kg/day, respectively); and likely for older adults according to recent evidence.^5-8 Additionally, the 0.8 g/kg bodyweight value assumes high-quality protein sources are consumed. Since lower-quality sources, mainly plant-based proteins, compose the majority of the Planetary Health Diet, higher requirements would be necessary to ensure adequate amino acid availability.^9-11 

Micronutrients. In the 2025 report, the authors state that “our primary considerations are specific health outcomes related to insufficient or excessive food intakes, rather than numerical targets for essential nutrients (e.g., average requirements or estimated average requirements).” Accordingly, the Planetary Health Diet acknowledges that it falls short of meeting several important micronutrient requirements. In comparison with Canadian reference values, the Planetary Health Diet does not meet needs for calcium, iodine, vitamin B₁₂, and likely zinc and iron, once bioavailability is considered. Among pregnant and breastfeeding women, additional gaps are seen for riboflavin and pantothenate.  

In response to their own diet’s shortfalls, the authors additionally modeled an additional “optimized” version of the 2025 Planetary Health Diet intended to improve certain nutrient levels. This scenario increased green leafy vegetables to 50% of total vegetables and added 15 grams of mixed algae and an unspecified amount of fermented soy for nutrients such as iodine and vitamin B₁₂.

However, these modifications raise questions about the diet’s feasibility and do not resolve all identified nutrient shortfalls, including calcium. Moreover, while the optimized scenario counts on certain foods to supply specific nutrients, their actual nutrient content can be inconsistent. For example, fermented soy products do not consistently provide vitamin B₁₂, and iodine levels in algae vary widely, making them unreliable sources of these nutrients.^12,13 

These nutrient shortfalls in the updated Planetary Health Diet are largely consistent with the diet proposed in the first iteration of the report, reflecting the minimal changes made to the recommended food categories and amounts. In line with this, Beal et al. (2023) assessed the original EAT-Lancet Planetary Health Diet and found it was inadequate in calcium, iron, zinc, and vitamin B₁₂, with iron being particularly low for women.¹⁴ Unlike the EAT-Lancet analysis, this study accounted for nutrient bioavailability and concluded that animal-source foods should provide approximately 27% of total energy (rather than the report’s recommended 14%) to achieve nutrient adequacy, alongside a reduction in foods rich in phytates, an antinutrient present in plants that can limit absorption of minerals such as iron and zinc. 

Calcium. Calcium adequacy remains a concern with the 2025 Planetary Health Diet when compared to both Canadian and international recommendations. For example, the World Health Organization (WHO) recommends 1,000 mg/day for adults aged 19 years and older, and 1,300 mg/day for adolescents, post-menopausal women, and men over 65, based on short- and long-term outcomes, including skeletal health.¹⁵ Similarly, Canadian recommendations also account for long-term health outcomes such as bone health, contrary to what is stated in the 2025 EAT-Lancet report.¹⁶ The 500 mg/day threshold cited in the EAT-Lancet report for supporting bone health is below intake levels generally associated with optimal skeletal outcomes. It is important to note that calcium plays other critical roles in the body, including neuromuscular function, blood clotting, growth and development, and skeletal structure.^17-20 

Dairy and health 

Dairy is widely recognized for its key nutritional contributions and is included in most national dietary guidelines. Aligned with FAO/WHO principles that emphasize a diverse, balanced, and adequate diet, dairy foods provide essential nutrients such as high-quality protein, calcium, iodine, potassium, and vitamin B₁₂, contributing to overall healthy dietary patterns.²¹ Because of their nutrient density and bioavailability, dairy foods effectively support nutrient adequacy across age groups, and reductions in intake could have unintended consequences on nutrition and health.²²  

The EAT-Lancet reports both recommend a global reference intake of 250 g of dairy per day, with a range of 0–500 g, yet this relatively low target may inadequately account for dairy’s contributions to nutrient adequacy, particularly calcium. The 2025 update further limits animal-source foods to two servings per day, noting that two servings (500 g) of dairy are appropriate for lactovegetarians, while mixed diets should be limited to one dairy and one non-dairy serving. Because dairy and other animal-source foods have distinct nutrient profiles, dietary models that make dairy intake contingent on the intake of other animal-source foods are unlikely to result in equivalent nutritional outcomes. 

In addition to its nutrient content, growing evidence highlights the role of the dairy matrix in influencing the health effects of dairy foods beyond their individual nutrients.^23,24 A substantial body of research supports its positive contributions to health and nutrient adequacy, which is not always conveyed in the report’s portrayal of dairy foods.^{25, 26} Notably, most statements about dairy in the report draw on a 2014 narrative review by one of its own authors, which provides only a partial view of the evidence.²⁷ 

Fracture risk and bone health. Dairy foods, such as milk, yogurt, and cheese, are convenient and highly bioavailable sources of calcium and other nutrients important for supporting bone health across the lifespan. In children and adolescents, a healthy, nutrient-rich diet, particularly sufficient in calcium and vitamin D, supports bone accretion as well as healthy growth and development. Dairy intake has been consistently linked to favourable bone outcomes in this age group, based on robust evidence, including systematic reviews, meta-analyses, and longitudinal studies.^28,29 In adults, dairy consumption is associated with improved bone mineral density, a key predictor of fracture risk.^30,31 Fracture risk is a complex, long-term outcome influenced by many modifiable and non-modifiable factors, which can make it challenging to study. Nevertheless, substantial evidence links dairy intake to a reduced risk of fractures, including: 

• A two-year cluster-randomized controlled trial conducted in 60 long-term care facilities in Australia involving 7,195 residents found that providing an additional 1.5 servings of dairy products daily (for a total of 3.5 servings/day), including milk, yogurt, and cheese, was associated with a 33% reduction in the risk of all fractures, a 46% reduction in the risk of hip fractures, and an 11% reduction in the risk of falls.¹⁸ 

• A 25-year longitudinal study involving 14,220 older Finnish women found that higher consumption of liquid dairy products was associated with a reduced risk of any fracture and osteoporotic fractures, and that cheese consumption was linked to a decreased risk of hip fracture.³² 

• A 2019 meta-analysis found that in non-Hispanic white populations from North America and Europe, higher total dairy intake was associated with an 18% reduced risk of vertebral fractures, and higher yogurt and cheese intake was linked to an 8% and 11% reduced risk of fractures at any site, respectively.³³ 

The EAT-Lancet report notes that some populations have traditionally had low dairy and calcium intakes while exhibiting low incidences of fractures, citing Indonesia as an example. However, mounting evidence suggests that low bone density and fractures are an increasing public health concern in many of these countries, particularly those with ageing populations.³⁴ For instance, the Asian Federation of Osteoporosis Societies estimates that by 2050, the number of hip fractures in Asian countries will more than double, exceeding 2.5 million per year.³⁵ 

Recent regional assessments further indicate that fracture burden may be underestimated. In their 2025 Asia Pacific audit, the International Osteoporosis Foundation (IOF) noted challenges in several countries, including issues with diagnostic infrastructure, awareness, and reporting.³⁶ For Indonesia specifically, the IOF report noted that osteoporosis and osteoporosis-related fractures “remain significantly underdiagnosed and undertreated”.³⁶ This is supported by a study of 249 post-menopausal women, which found that 73.5% had osteoporosis.³⁷  

In Canada, dairy continues to be the primary source of dietary calcium, providing a substantial portion of this essential nutrient.³⁸ Consumption of dairy products has declined over time, particularly fluid milk, and overall calcium inadequacy has increased, with an estimated 68% of Canadians not meeting recommended intake levels through their diet in 2015.^39,40 

Cardiometabolic health. The overall body of evidence indicates that dairy foods, including those with higher fat content, have neutral to protective effects on cardiometabolic health.^41-44 This evidence is not consistently reflected in the report, though several of the studies cited by the authors actually indicate neutral or beneficial associations with dairy intake. 

Systematic reviews and meta-analyses show that dairy products, including full-fat dairy, are not associated with adverse cardiometabolic or body composition outcomes.^43,44 This may be explained by the distinctive fatty acid composition of dairy fat and the functional effects of the broader dairy matrix, which encompass complex interactions between nutrients and bioactive components. In addition, fermented dairy products have been linked to lower risks of type 2 diabetes, all-cause and cardiovascular mortality, further supporting the beneficial role of dairy within a balanced diet.^45,46 

Finally, while the report mentions potential benefits of substituting dairy with plant-source foods, it is essential to consider the overall nutrient profile before recommending such substitutions to avoid unintended impacts on nutrient adequacy. In fact, a 2024 study commissioned by Food Standards Scotland found that reductions in meat and dairy intake could increase the risk of nutrient inadequacies.²⁶  

Cancer. Cancer risk is another outcome examined in the EAT-Lancet 2.0 report. According to the World Cancer Research Fund and other robust studies, strong evidence shows that dairy consumption lowers the risk of colorectal cancer, aligning with the conclusions of the EAT-Lancet 2.0 report.^47-49 Additionally, limited evidence also links dairy to reduced premenopausal breast cancer risk and diets high in calcium to reduced risk of pre- and postmenopausal breast cancer.⁵⁰ While the EAT-Lancet 2.0 report cites a possible association between dairy and prostate cancer, the 2018 Third Expert Report by the World Cancer Research Fund International and the American Institute for Cancer Research found no strong evidence that dairy or calcium-rich diets increase risk.⁴⁹ It reaffirmed earlier findings that evidence for higher dairy intake remains limited and downgraded the evidence for calcium from “strong” to “limited suggestive”.⁴⁹ 

While the EAT-Lancet report represents an ambitious effort to consider global dietary patterns in the context of human health and environmental challenges, the recommended diet falls short in several key nutrients, which could have considerable repercussions on health. It also does not always fully reflect the contributions of dairy foods, which provide a range of essential nutrients and may influence health outcomes beyond their individual components.