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Improving Diabetes Outcomes With a Plant-Based Diet
By Constance Brown-Riggs, MSEd, RDN, CDCES, CDN
Mainstream diabetes health organizations continue to recognize the value of plant-based diets in managing diabetes and reducing diabetes-related complications. This year, the American Association of Clinical Endocrinologists and American College of Endocrinology was added to this list, with the recommendation for a plant-based diet included in their 2020 Consensus Statement on type 2 diabetes management.
Evidence demonstrates the benefits of a plant-based diet in treating CVD—the leading cause of death for individuals with type 2 diabetes.
Hypertension and dyslipidemia, commonly found in people with type 2 diabetes, are risk factors for CVD. Scientific studies show the efficacy of controlling blood glucose, blood pressure, and cholesterol levels to prevent or slow the progression of CVD in people with type 2 diabetes.1 However, according to the 2020 National Diabetes Statistic Report issued by the Centers for Disease Control and Prevention, only 36.4% of people with diagnosed type 2 diabetes are achieving metabolic goals.2
Successful diabetes management is dependent on the treatment of the ABCs of diabetes, namely A1c, blood pressure, and cholesterol. Numerous studies show that a plant-based diet reduces A1c, blood pressure, cholesterol, waist circumference, and body weight.3 Vegan and vegetarian meal patterns—the two most common approaches found in the literature—are identified in the American Diabetes Association (ADA) 2019 Nutrition Consensus Report as acceptable for diabetes management.
During the 2020 Academy of Nutrition and Dietetics Food & Nutrition Conference & Expo™, Meghan Jardine, MS, MBA, RDN, LD, CDCES, and Toby Smithson, MS, RDN, LD, CDCES, FAND, a diabetes lifestyle expert, presented “Diabetes Reversal from Plant-Based Eating: Reality or Fallacy?” During the presentation, Jardine, associate director of diabetes nutrition education at the Physicians Committee for Responsible Medicine in Washington, D.C., discussed the efficacy and mechanism by which plant-based diets improve diabetes outcomes.
Plant-based diets target insulin resistance, which is the hallmark of type 2 diabetes. Insulin resistance is associated with elevated cholesterol, high blood pressure, central obesity, and glucose intolerance. Accumulation of harmful fat in beta cells contributes to insulin resistance and beta cell dysfunction.4 Moreover, plant-based diets are high in fiber, antioxidants, magnesium, and phytonutrients, all shown to promote insulin sensitivity.5
“Plant-based diets are high in phytochemicals, specifically polyphenols that protect beta cells from oxidative stress, improve beta cell function, and enhance peripheral glucose uptake,” Jardine says. Achieving a healthy body weight also improves insulin resistance. “It’s also proposed that weight loss reduces pancreatic fat stores and improves beta cell function,” Jardine says.
Due to the positive impact of plant-based diets on type 2 diabetes, some have thought they may have the potential to reverse the disease. The term “diabetes reversal” is controversial, as it implies a cure for diabetes. The ADA uses the term “remission”—defined as the maintenance of euglycemia (complete remission) or the prediabetes level of glycemia (partial remission) with no diabetes medication use for at least one year. Jardine acknowledges there are no documented studies on plant-based diets demonstrating they lead to complete diabetes remission. “However, I have seen many cases of patients achieving normal glucose, weight management, and off most or all medications with a healthful plant-based diet. I have not seen this level of improvement with more moderate dietary changes,” Jardine says.
Smithson, the principal partner of Diabetes Every Day, a website that offers practical diabetes lifestyle messaging, and author of Diabetes Meal Planning and Nutrition for Dummies, cautions health care providers against making promises of diabetes reversal to patients. “We can tell them their diabetes will be improved with a plant-based diet,” Smithson says.
Getting Clients to Eat More Plants
Smithson provides the following tips nutrition professionals can use to encourage clients to successfully adopt a more plant-based meal pattern.
• Define plant-based eating. Since there are so many variations of plant-based diets, it’s important to tell clients that a plant-based diet emphasizes legumes, whole grains, vegetables, fruits, nuts, and seeds, and encourages minimal animal products.
• Individualize meal plans according to your client’s comfort level. Plant-based meal planning shouldn’t be an all-or-nothing endeavor. Encourage clients to start by filling one-half of their plate with vegetables; next, recommend they swap animal protein foods for plant-based protein sources, or suggest choosing one or two days per week to experiment with plant-based eating.
• Check blood sugar twice. Suggest clients check their blood glucose before a meal and two hours after the start of eating a meal to assess how the change in their eating pattern is affecting their blood glucose levels. A plant-based eating plan tends to be higher in carbohydrate intake, so adjustments in lifestyle behaviors, such as medication use and/or exercise, may be needed.
• Explore ethnic cuisine. Recommend clients think globally when planning meals. They can turn Thai and Chinese dishes into vegan fare by adding tofu. They also can add beans to Ethiopian and Mexican dishes and lentils to Indian dishes as a protein source.
Bottom Line
A plant-based eating pattern emphasizes legumes, whole grains, vegetables, fruits, nuts, and seeds, and discourages most or all animal products. Evidence supports the value of a plant-based diet in achieving metabolic goals in people with diabetes and reducing CVD risk factors.
— Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is a national speaker and author of the award-winning Diabetes Guide to Enjoying Foods of the World, a convenient guide to help people with diabetes enjoy all the flavors of the world while still following a healthful meal plan.
References
1. American Diabetes Association. 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes — 2020. Diabetes Care. 2020;43(Suppl 1):S111-S134.
2. US Department of Health and Human Services; Centers for Disease Control and Prevention. National Diabetes Statistic Report 2020: estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2020.
3. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731-754.
4. DeFronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes, and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia. 2010;5(7):1270-1287.
5. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14(5):342-354.