~ Courtesy of the World Preservation Foundation
Plant-base Diets: A Solution to Our Public Health Crisis
Joel Fuhrman MD
Director of Research for Nutritional Research Project for the National
Health Association, Board Certified Family Physician, New Jersey, USA
Type II diabetes, which accounts for over 90% of diabetes cases, is preventable and even reversible with excellent nutrition Excess body fat is the most significant cause of type II diabetes. In order to reverse the rising trends of obesity and diabetes and their associated costs, we must emphasize prevention and treatment via dietary and lifestyle modifications.
How Does Obesity Cause Diabetes?
Every cell in the human body needs glucose. Insulin promotes uptake and storage of glucose in muscle and fat cells. Type II diabetes is a disease of insulin resistance – the body is not adequately responding to the insulin being produced.
Obesity is related to the development of diabetes for several reasons. Fat cells are not merely storage houses for extra energy – they produce and secrete substances with significant biological effects, including interfering with the uptake of insulin into other cells. Fat cells release substances such as free fatty acids, hormones, and cytokines that promote insulin resistance.1 Furthermore dietary trans fats and saturated fats interfere with insulin binding to its receptors.2 When an individual is significantly overweight or obese, with more than 50 pounds of additional fat weight, the body demands huge loads of insulin from the pancreas. After years of overworking the pancreas, it loses the ability to keep up with the huge insulin demands. Eventually, with less insulin available to move glucose from the bloodstream into the cells, the glucose level in the blood starts to rise and the person is diagnosed with diabetes.
Drugs Do Little To Help, and Often Can Make Things Worse
Medication is now the accepted treatment for diabetes—even though it’s often the medication itself that is causing more weight gain, worsening symptoms, and making the individual more diabetic. Insulin and many of the oral anti-diabetes drugs promote weight gain, exacerbating the condition.3 Type II diabetic patients exposed to insulin or sulfonylureas (commonly prescribed oral anti-diabetes drugs) which push the failing pancreas to produce more insulin, advance the natural deterioration of the beta cells in the pancreas and have significantly increased incidence of cancer at multiple sites,4,5 higher risk of heart failure and all-cause mortality.6
The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study was conducted to determine whether lowering glucose to near-normal levels (HbA1C <6.0%) with drugs would decrease cardiovascular risk; the study was halted when the results showed that aggressive glycemic control actually increased the risk of death from all causes and from cardiovascular disease.7
Clearly, relying on medication without utilizing dietary and exercise interventions is not ideal. Diabetics take medication but remain overweight and continue to consume the Western diet; they continue to damage their organs, develop complications, and die prematurely.
How Can We Prevent (and reverse) Diabetes?
The cure for type II diabetes is already known – removing the cause can reverse the disease, and the chief cause is excess weight from the Western diet and inactivity. The best and safest “medicine” for a diabetic is a high-nutrient density diet (HND diet; an eating style focused on low-calorie, nutrient-rich plant foods) and exercise.
Weight loss is effective in itself1, but the goal of lifestyle intervention must be to improve pancreatic function and lower insulin resistance over and above what could be accomplished with weight loss alone. An HND diet can accomplish this; by emphasizing micronutrient adequacy, cholesterol, triglycerides, and blood pressure are lowered as weight is lost and blood glucose drops. We have extensive experience treating overweight diabetics with superior nutrition and the results are impressive. The majority are able to restore their glucose levels to the normal range without any further need for medications. They have essentially become non-diabetic again.
Overview of an HND Diet for Diabetes Reversal:
• No refined carbohydrates – both sugars and starches
• Minimal grains (intact grains only) only one serving daily
• Very high fibre (over 50 grams per day)
• High viscous fiber (flax, oats, beans)
• High percentage of resistant starch
• Moderate fat from seeds and nuts
• Very low saturated fat
• Zero trans fatty acids
• Sufficient omega-3 fatty acids
• High phytochemicals and antioxidants
• Low glycemic load
• Very low sodium (less than 1,200 mg/day)
• Low caloric density per food volume
• Minimal or no animal products, used only occasionally as one ounce condiment
The HND diet consists primarily of foods that have been associated with diabetes prevention in the medical literature: its focus is on eating more vegetables, especially low-calorie, high nutrient vegetables such as green vegetables, eggplant, onion, mushrooms, tomatoes, cauliflower, spaghetti squash, zucchini squash and legumes. Animal products are significantly curtailed or eliminated as are processed foods, sweeteners, white rice, white flour, oils and caloric sweeteners. Of note:
• Pooled data from four studies determined that eating 1.35 servings (1 serving = 106 g) of green leafy vegetables vs. 0.2 servings per day provided a 14% decrease in diabetes risk8
• Beans are high-nutrient, high-fiber, and low-calorie. They are digested slowly which induces satiety and stabilizes blood glucose. Therefore, beans are the most appropriate source of carbohydrate for diabetics. A study on 64,000 women followed for 4 years found that high intake of legumes were associated with a 38% decreased risk of diabetes9
• An inverse relationship between nut consumption and diabetes was reported in the Nurses’ Health Study – 5 servings of nuts per week was associated with a 27% decrease in risk10
• Adding three servings of fresh fruit (with a focus on low sugar fruits) per day to one’s diet may decrease diabetes risk by up to 18%11
Scientific support for the therapeutic use of plant-based diets for diabetes
Whole, plant foods have anti-diabetic characteristics.12 As such, randomized trials using a plant-based diet to treat diabetes have yielded impressive results. In a 22-week study published in 2006, a low-fat plant-based diet allowed for an average decrease of 1.23 points in A1C, weight loss of 13 lbs., and 21.2% decrease in LDL cholesterol. Most importantly, 43% of the participants were able to reduce their diabetes medications. An earlier study reported a 28% decrease in fasting blood glucose, as well as reduction or discontinuation of diabetes medications.13 An HND diet, however, potentially has further advantages over a low-fat vegan diet, because an HND diet is based primarily on green vegetables and beans rather than grains and starches, which provides greater micronutrient and resistant starch content. Data was collected from thirteen subjects at baseline and after a median of seven months on a HND diet. Mean values are shown in the table below:14
The current standard of treating diabetes with medications does little to improve long-term patient outcomes, has significant drawbacks and in many cases the medications serve as subconscious permission to continue eating improperly. Evidence on nutritional interventions for diabetics from multiple investigations as well as our own data demonstrates that a plant-based micronutrient rich diet has tremendous therapeutic potential while decreasing cardiovascular risk factors. Additionally, in an earlier study an HND diet was shown to reduce LDL cholesterol by 33%.15 This approach promotes longevity and in many cases can even resolve the diabetes. If this approach was used on a large scale, for both prevention and reversal of chronic disease, rates of obesity, diabetes, cardiovascular disease, and cancer would all drop, resulting in a healthier population and a dramatic reduction in healthcare costs.
1. Khaodhiar, L., S. Cummings, and C.M. Apovian, Treating diabetes and prediabetes by focusing on obesity management. Current diabetes reports, 2009. 9(5): p. 348-54.
2. Riserus, U., W.C. Willett, and F.B. Hu, Dietary fats and prevention of type 2 diabetes. Prog. Lipid Res., 2009. 48(1): p. 44-51.
3. Hermansen, K. and L.S. Mortensen, Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus. Drug safety : an international journal of medical toxicology and drug experience, 2007. 30(12): p. 1127-42.
4. Bowker, S.L., S.R. Majumdar, P. Veugelers, et al., Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin: Response to Farooki and Schneider. Diabetes Care, 2006. 29(8): p. 1990-1.
5. Harish, K., M. Dharmalingam, and M. Himanshu, Study Protocol: insulin and its role in cancer.BMC endocrine disorders, 2007. 7: p. 10.
6. Tzoulaki, I., M. Molokhia, V. Curcin, et al., Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database. BMJ, 2009. 339: p. b4731.
7. Gerstein, H.C., M.E. Miller, R.P. Byington, et al., Effects of intensive glucose lowering in type 2 diabetes. The New England journal of medicine, 2008. 358(24): p. 2545-59.
8. Carter, P., L.J. Gray, J. Troughton, et al., Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and metaanalysis. BMJ, 2010. 341: p. c4229.
9. Villegas, R., Y.T. Gao, G. Yang, et al., Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women’s Health Study. Am. J. Clin. Nutr., 2008. 87(1): p. 162-7.
10. Jiang, R., J.E. Manson, M.J. Stampfer, et al., Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA, 2002. 288(20): p. 2554-60.
11. Bazzano, L.A., T.Y. Li, K.J. Joshipura, et al., Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women. Diabetes Care, 2008. 31(7): p. 1311-1317.
12. Jenkins, D.J., C.W. Kendall, A. Marchie, et al., Type 2 diabetes and the vegetarian diet. Am. J. Clin. Nutr., 2003. 78(3 Suppl): p. 610S-616S.
13. Nicholson, A.S., M. Sklar, N.D. Barnard, et al., Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Prev. Med., 1999. 29(2): p. 87-91.
14. Dunaief, D., Y. Gui-shuang, J. Fuhrman, et al., Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density diet. J. Nutr., 2010. 14(6): p. 500.
Note: To download the full publication of "Plant-based Diets: A Solution to Our Public Health Crisis", please visit the World Preservation Foundation.