Caroline B. Trapp 1  and Neal D. Barnard 1
| Physicians Committee for Responsible Medicine, 5100 Wisconsin Avenue NW, Suite 400, Washington, DC 20016, USA |
Abstract Significant benefits for diabetes prevention and management have been observed with vegetarian and especially vegan diets. This article reviews observational studies and intervention trials on such diets, and discusses their efficacy, nutritional adequacy, acceptability, and sustainability. Research to date has demonstrated that a low-fat, plant-based nutritional approach improves control of weight, glycemia, and cardiovascular risk. These studies have also shown that carefully planned vegan diets can be more nutritious than diets based on more conventional diet guidelines, with an acceptability that is comparable with that of other therapeutic regimens. Current intervention guidelines from professional organizations offer support for this approach. Vegetarian and vegan diets present potential advantages in managing type 2 diabetes that merit the attention of individuals with diabetes and their caregivers.
References
| 1. | World Health Organization: Country and regional data—World: Prevalence of diabetes worldwide. Available at http://www.who.int/diabetes/facts/world_figures/en/index.html. Accessed December 2009. |
| |
| 2. | Bantle JP, Wylie-Rosett J, Albright AL, et al.: Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008, 31(Suppl 1):S61–S78.
  |
| |
| 3. | Berkow SE, Barnard N: Vegetarian diets and weight status. Nutr Rev 2006, 64:175–188.
 |
| |
| 4. | Barnard ND, Katcher HI, Jenkins DJ, et al.: Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev 2009, 67:255–263.
|
| |
| 5. | • Barnard ND, Cohen J, Jenkins DJ, et al.: A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009, 89:1588S–1596S. This study of individuals with type 2 diabetes demonstrated that long-term weight reduction may be facilitated with a low-fat vegan diet or a diet based on conventional guidelines. The vegan diet appeared to be more effective for control of glycemia and plasma lipid concentrations when medication changes were controlled. The vegan diet achieved beneficial outcomes without requiring restrictions of total caloric intake, carbohydrates, or portion sizes. |
| |
| 6. | Berkow SE, Barnard ND: Blood pressure regulation and vegetarian diets. Nutr Rev 2005, 63:1–8.
|
| |
| 7. | Ornish D: Intensive lifestyle changes and health reform. Lancet Oncol 2009, 10:638–639.
|
| |
| 8. | Dowse GK, Gareeboo H, Zimmet PZ, et al.: High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Mauritius Noncommunicable Disease Study Group. Diabetes 1990, 39:390–396.
|
| |
| 9. | Zimmet P, Dowse G, Finch C, et al.: The epidemiology and natural history of NIDDM—lessons from the South Pacific. Diabetes Metab Rev 1990, 6:91–124.
|
| |
| 10. | Flegal KM, Ezzati TM, Harris MI, et al.: Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982–1984. Diabetes Care 1991, 14:628–638.
|
| |
| 11. | Kuzuya T: Prevalence of diabetes mellitus in Japan compiled from literature. Diabetes Res Clin Pract 1994, 24(Suppl):S15–S21.
|
| |
| 12. | Lee ET, Welty TK, Cowan LD, et al.: Incidence of diabetes in American Indians of three geographic areas: the Strong Heart Study. Diabetes Care 2002, 25:49–54.
|
| |
| 13. | Ko GT, Wu MM, Wai HP, et al.: Rapid increase in the prevalence of undiagnosed diabetes and impaired fasting glucose in asymptomatic Hong Kong Chinese. Diabetes Care 1999, 22:1751–1752.
|
| |
| 14. | Dahiru T, Jibo A, Hassan AA, Mande AT: Prevalence of diabetes in a semi-urban community in Northern Nigeria. Niger J Med 2008, 17:414–416.
|
| |
| 15. | Snowdon DA, Phillips RL: Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health 1985, 75:507–512.
|
| |
| 16. | Vang A, Singh PN, Lee JW, et al.: Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab 2008, 52:96–104.
|
| |
| 17. | Fung TT, Schulze M, Manson JE, et al.: Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med 2004, 164:2235–2240.
|
| |
| 18. | •• Tonstad S, Butler T, Yan R, Fraser GE: Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009, 32:791–796. This cohort study of 60,903 individuals found that those following a vegan diet had approximately half the risk of type 2 diabetes, compared with those following nonvegetarian diets, in analyses controlled for body weight, activity, and socioeconomic and lifestyle factors. Inclusion of meat or dairy products, even on a less-than-weekly basis, was associated with increased risk. |
| |
| 19. | Aune D, Ursin G, Veierod MB: Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia 2009, 52:2277–2287.
 |
| |
| 20. | Anderson J, Ward K: High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr 1979, 32:2312–2321.
|
| |
| 21. | Barnard RJ, Jung T, Inkeles SB: Diet and exercise in the treatment of NIDDM. The Need for early emphasis. Diabetes Care 1994, 17:1469–1472.
|
| |
| 22. | Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006, 29:1777–1783.
|
| |
| 23. | CDC: National Diabetes Fact Sheet, 2007. Available athttp://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed December 2009. |
| |
| 24. | Appleby PN, Davey GK, Key TJ: Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutr 2002, 5:645–654.
|
| |
| 25. | Ferdowsian HR, Barnard ND: Effects of plant-based diets on plasma lipids. Am J Cardiol 2009, 104:947–956.
|
| |
| 26. | Ornish D: Mostly plants. Am J Cardiol 2009, 104:957–958.
|
| |
| 27. | Esselstyn CB Jr: Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol 1999, 84:339–341, A8.
|
| |
| 28. | Ornish D, Brown SE, Scherwitz LW, et al.: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990, 336:129–133.
|
| |
| 29. | Pischke CR, Weidner G, Elliott-Eller M, et al.: Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus without diabetes mellitus. Am J Cardiol 2006, 97:1267–1273.
|
| |
| 30. | Soroka N, Silverberg DS, Greemland M, et al.: Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients. Nephron 1998, 79:173–180.
|
| |
| 31. | Knight EL, Stampfer MJ, Hankinson SE, et al.: The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med 2003, 138:460–467.
|
| |
| 32. | de Mello V, Zelmanovitz T, Perassolo M, et al.: Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Am J Clin Nutr 2006, 83:1032–1038.
|
| |
| 33. | Crane MG: Regression of diabetic neuropathy with total vegetarian (vegan) diet. J Nutr Med 1994, 4:431–439.
|
| |
| 34. | McDougall J: Sex and still aging. McDougall Newsletter 2007, 6:1. Available athttp://www.drmcdougall.com/misc/2007nl/aug/fav5.htm. Accessed December 2009. |
| |
| 35. | Barnard ND, ed.: Dr. Neal Barnard's Program for Reversing Diabetes. New York: Rodale, Inc.; 2007. |
| |
| 36. | • Turner-McGrievy GM, Barnard ND, Cohen J, et al.: Changes in nutrient intake and dietary quality among participants with type 2 diabetes following a low-fat vegan diet or a conventional diabetes diet for 22 weeks. J Am Diet Assoc 2008, 108:1636–1645. This randomized, controlled clinical study found that participants following a low-fat, plant-based diet almost doubled their intake of fruit and vegetables, and improved the overall nutritional quality of their diet to a greater extent than those following a conventional diabetes diet. Both dietary groups were low in vitamins D and E, calcium and potassium, and consumed excess sodium. |
| |
| 37. | McCullough ML, Willett WC: Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. Public Health Nutr 2006, 9:152–157.
|
| |
| 38. | •• Craig WJ, Mangels AR: Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009, 109:1266–1282. This position paper offers a comprehensive, evidence-based summary of the health effects of vegetarian and vegan diets across the life span and their role in the preventing and treating specific chronic diseases. Important nutrition considerations are addressed. |
| |
| 39. | American Diabetes Association: Standards of medical care in diabetes—2010. Diabetes Care 2010, 33(Suppl 1):S11–S61.
|
| |
| 40. | Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ: Acceptability of a low-fat vegan diet compares favorably to a step II diet in a randomized, controlled trial. J Cardiopulm Rehabil 2004, 24:229–235.
|
| |
| 41. | Turner-McGrievy GM, Barnard ND, Scialli AR, Lanou AJ: Effects of a low-fat vegan diet and a Step II diet on macro- and micronutrient intakes in overweight postmenopausal women. Nutrition 2004, 20:738–746.
|
| |
| 42. | Barnard ND, Scialli AR, Bertron P, et al.: Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol 2000, 85:969–972.
|
| |
| 43. | Barnard ND, Gloede L, Cohen J, et al.: A low-fat vegan diet elicits greater macronutrient changes, but is comparable in adherence and acceptability, compared with a more conventional diabetes diet among individuals with type 2 diabetes. J Am Diet Assoc 2009, 109:263–272.
|
| |
| 44. | Young DR, Vollmer WM, King AC, et al.: Can individuals meet multiple physical activity and dietary behavior goals? Am J Health Behav 2009, 33:277–286.
|
| |
| 45. | Turner-McGrievy GM, Barnard ND, Scialli AR: A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity (Silver Spring) 2007, 15:2276–2281.
|
| |
| 46. | Smith CF, Burke LE, Wing RR: Vegetarian and weight-loss diets among young adults. Obes Res 2000, 8:123–129.
|
| |
| 47. | Kuo CS, Lai NS, Ho LT, Lin CL: Insulin sensitivity in Chinese ovo-lactovegetarians compared with omnivores. Eur J Clin Nutr 2004, 58:312–316.
|
| |
| 48. | Petersen KF, Dufour S, Befroy D, et al.: Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. N Engl J Med 2004, 350:664–671.
|
| |
| 49. | Jehn M, Clark JM, Guallar E: Serum ferritin and risk of the metabolic syndrome in U.S. adults. Diabetes Care 2004, 27:2422–2428.
|
| |
| 50. | Cook JD: Adaptation in iron metabolism. Am J Clin Nutr 1990, 51:301–308.
|
| |
| 51. | Marlett JA, McBurney MI, Slavin JL: Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc 2002, 102:993–1000.
|
| |
| 52. | Food and Agriculture Organization of the United Nations: Livestock's Long Shadow: Environmental Issues and Options. Available at http://www.fao.org.ezp-prod1.hul.harvard.edu/docrep/010/a0701e/a0701e00.HTM. Accessed December 2009. |
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