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Tag: plant-based diets

  • Are Branched-Chain Amino Acids Good for Us?  | NutritionFacts.org

    Are Branched-Chain Amino Acids Good for Us?  | NutritionFacts.org

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    I discuss why we may not want to exceed the recommended intake of protein.

    Diabetes isn’t just about the amount of body fat, but also the distribution of body fat. At 0:26 in my video Are BCAA (Branched-Chain Amino Acids) Healthy?, you can view cross-sections of thighs from two different patients using MRI. In the images, the fat shows up as white and the thigh muscle is black. At first glance, you might think the bottom cross-section has more fat since it’s ringed with more white. That is the subcutaneous fat, the fat under the skin. But, if you look at the top cross-section, you’ll see how the middle of the thigh muscle is more marbled with fat, like those really fatty Japanese beef steaks. That is the fat infiltrating into the muscle. In the graph below and at 0:48 in my video, the two cross sections are colored so you can see the different types of fat: the fat infiltrating the muscle in red, the fat between the muscles in green, and subcutaneous fat outside of the muscles and under the skin in yellow. If you add up all three types of fat, both of those thighs actually have the same amount of fat—just distributed differently.

    This seems to be the critical factor in terms of determining insulin resistance, the cause of type 2 diabetes. Researchers found that the subcutaneous adipose tissue, the fat right under the skin, was not associated with insulin resistance. Going back to the two cross sections, as seen below and at 1:20 in my video, it is healthier to have the bottom thigh with the thicker ring of subcutaneous fat but less fat infiltrating muscle than the top thigh with more fat present in the muscle.

    Is it possible a more plant-based diet also affects a more healthful distribution of fat?

    We now know the effect of a vegetarian diet versus a conventional diabetic diet on thigh fat distribution in patients with type 2 diabetes. Researchers took 74 people with diabetes and randomly assigned them to follow either a vegetarian diet or a conventional diabetic diet. Both diets were calorie-restricted by the same number of calories. The vegetarian diet was also egg-free, and dairy was limited to a maximum of one serving of low-fat yogurt a day. What did the researchers find? The reduction in the more benign subcutaneous fat was comparable; it was about the same in both groups. However, the more dangerous fat—the fat lodged inside the muscle itself—“was reduced only in response to a vegetarian diet.” So, even getting the same number of calories, there can be a healthier weight loss on a more plant-based diet.

    Those eating strictly plant-based also had lower levels of fat stuck inside the individual muscle fibers themselves, which may help explain why vegans in particular are often found to have the lowest odds of diabetes. It is not just because vegans are generally slimmer either. Even if you match subjects pound for pound, there is significantly less fat inside the muscle cells of vegans compared to omnivores. This is a good thing, since storing fat in muscle cells “may be one of the primary causes of insulin resistance,” which is what’s behind both prediabetes and type 2 diabetes. On the other hand, if you put someone on a high-fat diet, the fat in their muscle cells shoots up by 54 percent in just a single week.

    What about a high-protein diet? That may undermine one of the principal benefits of weight loss: eliminating the weight-loss-induced improvement in insulin resistance. Researchers put obese individuals on a calorie-restricted diet of less than 1,400 calories a day until they lost 10 percent of their body weight. Half of the participants were getting more of a regular protein intake (73 grams a day), and the other half were on a higher-protein diet (about 105 daily grams). Normally, if you lose 10 percent of your body weight, your insulin resistance improves. That’s why it is so critical for obese individuals with type 2 diabetes to lose weight. However, the beneficial effect of a 10 percent weight loss was eliminated by the high protein intake. Those extra 32 grams of protein a day abolished the weight-loss benefit. “The failure to improve…insulin sensitivity in the WL-HP [weight-loss high-protein] group is clinically important because it reflects a failure to improve a major pathophysiological [cause-and-effect] mechanism involved in the development of T2D,” type 2 diabetes. In summary, the researchers concluded that they demonstrated “the protein content of a weight loss diet can have profound effects on metabolic function.” 

    Is this true of any protein? As you can see below and at 4:19 in my video, if you split it between animal protein versus plant protein, following people over time, intake of animal protein is associated with an increased risk of diabetes in most studies.

    Intake of plant protein, however, appears to have either a neutral or even protective association with diabetes, as shown below and at 4:25 in my video. 

    Those were just observational studies, though. People who eat a lot of animal protein might have many unhealthy behaviors. However, you see the same thing in randomized, controlled, interventional trials, where you can improve blood sugar control just by replacing sources of animal protein with plant protein.

    We think it may be the branched-chain amino acids concentrated in animal protein. Higher levels in the bloodstream are associated with obesity and the development of insulin resistance. As you can see below and at 5:00 in my video, we may be able to drop our levels by sticking to plant proteins, but you don’t know if that has metabolic effects until you put it to the test. 

    Ruining the suspense, researchers titled their study: “Decreased Consumption of Branched-Chain Amino Acids Improves Metabolic Health.” They demonstrated that “a moderate reduction in total dietary protein or selected amino acids can rapidly improve metabolic health,” and this included improving blood sugar control, while also decreasing body mass index (BMI) and body fat. As you can see at 5:27 in my video, the protein-restricted group was eating hundreds more calories per day, significantly more calories than the control group, so they should have gained weight. But, no. They lost weight! After about a month and a half, they were eating more calories but lost more weight—about five more pounds than participants in the control group who were eating fewer calories, as you can see at 5:38 in my video. What’s more, this “protein restriction” had people eat the recommended amount of protein per day, about 56 daily grams. They should have been called the normal protein group or the recommended protein group instead, and the group eating more typically American protein levels and suffering because of it should have been called the excess protein group. Just sticking to the recommended protein intake doubled the levels of a pro-longevity hormone called FGF21, too, but we’ll save that for another discussion.

    To better understand the negative impact of omnivores getting too much protein relative to vegetarians, see my video Flashback Friday: Do Vegetarians Get Enough Protein?.

    I have several additional videos and blogs that may help explain some of the benefits of plant-based proteins. Check in the related posts below.

    Of course, the best way to treat type 2 diabetes is to get rid of it by treating the underlying cause, as described in my video How Not to Die from Diabetes. 

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    Michael Greger M.D. FACLM

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  • The Pros of Garlic Powder for Heart Disease  | NutritionFacts.org

    The Pros of Garlic Powder for Heart Disease  | NutritionFacts.org

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    See what a penny a day’s worth of garlic powder can do.

    In ancient Greece, “the Art of Medicine was divided into three parts”: cures through diet, cures through drugs, and cures through surgery. Garlic, Hippocrates wrote, was one such medicinal food, but that was to treat a nonexistent entity called “displacement of the womb,” so ancient wisdom can only go so far.

    Those who eat more than a clove of garlic a day do seem to have better artery function than those who eat less than that, but you don’t know if it’s cause-and-effect until you put it to the test. 

    As I discuss in my video Benefits of Garlic Powder for Heart Disease, heart disease patients were randomized to receive either garlic powder or placebo tablets two times a day for three months. Those lucky enough to be in the garlic group got a significant boost in their artery function—a 50 percent increase in function from taking only 800 mg of garlic powder a day. That’s just a quarter teaspoon of garlic powder. A 50 percent increase in artery function for less than a penny daily!

    If regular, plain old garlic powder can do that, what about those fancy Kyolic® aged garlic extract supplements? They can be 30 times more expensive and don’t work at all. After four weeks, there was zero significant improvement. It’s hard to improve on Mother Nature.

    Garlic powder can improve the function of our arteries, but what about the structure of our arteries? Dozens of studies on garlic all compiled together show that garlic can reduce cholesterol levels in the blood by more than 16 points. So, might garlic powder actually be able to slow the progression of atherosclerosis? Researchers studied a garlic powder tablet versus a placebo for three months. As you can see below and at 1:42 in my video, the placebo group got worse, which is what tends to happen. Eat the same artery-clogging diet, and your arteries continue to clog. However, the progression of the disease appeared to slow and even stall in the garlic group. 

    Of course, it would be nice to see the thickening of the artery wall reverse, but, for that, one might have to add more plants than just garlic to one’s diet. Still, though, that same quarter teaspoon of a simple spice available everywhere may be considered as an adjunct treatment for atherosclerosis, the number one killer of both men and women in the United States and around much of the world.

    What about garlic for high blood pressure? A systematic review and meta-analysis of randomized controlled trials “demonstrated that garlic has a statistically significant and clinically meaningful effect” on both systolic and diastolic blood pressures, reducing the top number by nearly seven and the bottom number by about five. That may not sound like a lot, but reducing diastolic blood pressure (the bottom number) by five points can reduce the risk of stroke by about a third and heart disease by 25 percent, as you can see in the graph below and at 2:38 in my video. 

    “Plant-based medicine provides beneficial effects, alongside with only minimal or no complications”—that is, little or no side effects—“and compared to other medicine are relatively cost-effective.” I’d say so, at as little as a penny per day.

    What else can garlic do? See related posts below.

    Here’s a tasty, garlicky recipe from The How Not to Die Cookbook: Garlic Caesar Salad Dressing. 

    Of course, the best way to treat heart disease is to simply get rid of it by treating the underlying cause. See How Not to Die from Heart Disease.

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    Michael Greger M.D. FACLM

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  • A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

    A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

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    What are the effects of eating only five days a week or following a fasting-mimicking diet five days a month? 
     
    Instead of eating every other day, what if you ate five days a week and fasted for the other two? As I discuss in my video The 5:2 Diet and the Fasting-Mimicking Diet Put to the Test, the available data are similar to that of alternate-day fasting: About a dozen pounds of weight loss was reported in overweight men and also reported in overweight women over six months, with no difference found between participants on the 5:2 intermittent fasting regimen and those on a continuous 500-calories-a-day restriction. The largest trial to date found an 18-pound weight loss within six months in the 5:2 group, which isn’t significantly different from the 20 pounds lost in the continuous calorie restriction group. Weight maintenance over the subsequent six months was also found to be no different.
     
    Though feelings of hunger may be more pronounced on the 5:2 pattern than on an equivalent level of daily calorie cutting, it does not seem to lead to overeating on non-fasting days. One might expect going two days without food may negatively impact mood, but no such adverse impact was noted for those fully fasting on zero calories or sticking to just two packets of oatmeal on each of the “fasting” days. (The oatmeal provides about 500 calories a day.) Like alternate-day fasting, the 5:2 fasting pattern appeared to have inconsistent effects on cognition and on preserving lean mass, and it also failed to live up to the “popular notion” that intermittent fasting would be “easier” to adhere to than daily calorie restriction. 
     
    Compared to those in the continuous-restriction control group, fewer subjects in the 5:2 pattern group expressed interest in continuing their diet after the study was over. This was attributed to quality-of-life issues, with 5:2 fasting participants citing headaches, lack of energy, and difficulty fitting the fasting days into their weekly routine. However, as you can see below and at 1:53 in my video, there has yet to be a single 5:2 diet study showing elevated LDL cholesterol compared with continuous calorie restriction at six months. Nor has it been shown for a year. This offers a potential advantage over alternate-day regimens. 

    Instead of 5:2, what about 25:5, spending five consecutive days a month on a “fasting-mimicking diet” (FMD)? Longevity researcher Valter Longo designed a five-day meal plan to try to simulate the metabolic effects of fasting by being low in protein, sugars, and calories with zero animal protein and zero animal fat. By making the diet plant-based, he hoped to lower the level of the cancer-promoting growth hormone IGF-1. He indeed accomplished this goal, along with a drop in markers of inflammation, after three cycles of his five-days-a-month program, as you can see below and at 2:33 in my video. 

    One hundred men and women were randomized to consume his fasting-mimicking diet for five consecutive days per month or maintain their regular diet the whole time. As you can see in the graph below and at 2:47 in my video, after three months, the FMD group was down about six pounds compared to the control group, with significant drops in body fat and waist circumference, accompanied by a drop in blood pressure. 

    Those who were the worst off accrued the most dramatic benefits, as seen in the graph below and at 3:04 in my video. What’s even wilder is that three further months after completion, some of the benefits appeared to persist, suggesting the effects “may last for several months.” It’s unclear, though, if those randomized to the FMD group used it as an opportunity to make positive lifestyle changes that helped maintain some of the weight loss. 


    Dr. Longo created a company to market his meal plan commercially, but, to his credit, says “he does not receive a salary or a consulting fee from the company…and will donate 100% of his shares to charity.” The whole diet appears to be mostly dehydrated soup mixes, herbal teas like hibiscus and chamomile, kale chips, nut-based energy bars, an algae-based DHA supplement, and a multivitamin dusted with vegetable powder. Why spend 50 dollars a day on a few processed snacks when you could instead eat a few hundred calories a day of real vegetables? 
     
    How interesting was that? All-you-can-eat above-ground vegetables for five days would have the same low amount of protein, sugars, and calories with zero animal protein or animal fat. But we’ll probably never know if it works as well, better, or worse because it’s hard to imagine such a study ever getting done without the financial incentive. 

    To learn more about IGF-1, see my video Flashback Friday: Animal Protein Compared to Cigarette Smoking.
     
    In this series on fasting, I’ve covered several topics, including the basics of calories and weight loss, water-only fasting, and the types of alternate-day fasting, see them all in the related videos below. 
     
    I close out the series with videos on time-restricted eating: Time-Restricted Eating Put to the Test and The Benefits of Early Time-Restricted Eating. 
     
    If you want all of the videos in one place, I’ve done three webinars on fasting—Intermittent Fasting, Fasting for Disease Reversal, and Fasting and Cancer—and they’re all available for download now. 

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    Michael Greger M.D. FACLM

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  • Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

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    Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss. 
     
    An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing. 
     
    For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.” 
     
    You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.” 
     
    What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.” 
     
    Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.  

    The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.

    As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
     
    Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. 

    There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books. 

    It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans. 

    And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers. 

     
    For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below. 

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    Michael Greger M.D. FACLM

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  • The Safety of Keto Diets  | NutritionFacts.org

    The Safety of Keto Diets  | NutritionFacts.org

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    What are the effects of ketogenic diets on nutrient sufficiency, gut flora, and heart disease risk? 

    Given the decades of experience using ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients, vitamins, and minerals has been documented in those on strict ketogenic diets, as you can see in the graph below and at 0:14 in my video Are Keto Diets Safe?. 

    Dieting is a particularly important time to make sure you’re meeting all of your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that you’d have to eat more than 37,000 calories a day to get a sufficient daily intake of all essential vitamins and minerals, as you can see in the graph below and at 0:39 in my video. 


    That is one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it, “What could be more nutrient-dense than a vegetarian diet?” Choosing a healthy diet may be easier than eating more than 37,000 daily calories, which is like putting 50 sticks of butter in your morning coffee. 
     
    We aren’t just talking about not reaching your daily allowances either. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency, which can cause sudden cardiac death. The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber, and resistant starches found concentrated in whole grains and beans that you’d miss out on? 
     
    Not surprisingly, constipation is very common on keto diets. As I’ve reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to “reduce the species richness and diversity of intestinal microbiota,” our gut flora. Microbiome changes can be detected within 24 hours of switching to a high-fat, low-fiber diet. A lack of fiber starves our good gut bacteria. We used to think that dietary fat itself was nearly all absorbed in the small intestine, but based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon. This may result in “detrimental changes” in our gut microbiome, as well as weight gain, increased leaky gut, and pro-inflammatory changes. For example, there may be a drop in beneficial Bifidobacteria and a decrease in overall short-chain fatty acid production, both of which would be expected to increase the risk of gastrointestinal disorders. 
     
    Striking at the heart of the matter, what might all of that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. However, from a heart-disease perspective, it matters if it’s animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based, low-carb diet was associated with higher death rates from cardiovascular disease and a 50 percent higher risk of dying from a heart attack or stroke, but no such association was found for lower-carb diets based on plant sources.  
     
    And it wasn’t just Harvard. Other researchers have also found that “low-carbohydrate dietary patterns favoring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favored plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain bread, were associated with lower mortality…” 
     
    Cholesterol production in the body is directly correlated to body weight, as you can see in the graph below and at 3:50 in my video. 

    Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But if we put people on very-low-carb ketogenic diets, the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects either; within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better, which appears to be the case with low-carb diets in general.  

    For more on keto diets, check out my video series here. 

    And, to learn more about your microbiome, see the related videos below.

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    Michael Greger M.D. FACLM

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  • Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

    Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

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    Plant-based diets are the single most important—yet underutilized—opportunity to reverse the pending obesity and diabetes-induced epidemic of disease and death. 

    Dr. Kim Williams, immediate past president of the American College of Cardiology, started out an editorial on plant-based diets with the classic Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” In 2013, plant-based diets for diabetes were in the “ridiculed” stage in the official endocrinology practice guidelines and placed in the “Fad Diets” section. The guidelines acknowledged that strictly plant-based diets “have been shown to reduce the risk for T2DM [type 2 diabetes] and improve management of T2DM” better than the American Diabetes Association recommendations, then inexplicably went on to say that it “does not support the use of one type of diet over another” with respect to diabetes or in general. “The best approach for a healthy lifestyle is simply the ‘amelioration of unhealthy choices’”—whatever that means. 

    But, by 2015, the clinical practice guidelines from the same professional associations explicitly endorsed a plant-based diet as its general recommendation for diabetic patients. The times they are a-changin’! 

    As I discuss in my video Plant-Based Diets Recognized by Diabetes Associations, the American Diabetes Association itself is also now on board, listing plant-based eating as one of the dietary patterns acceptable for the management of the condition. The Canadian Diabetes Association, however, has really taken the lead. “Type 2 diabetes mellitus is considered one of the fastest growing diseases in Canada, representing a serious public health concern,” so it isn’t messing around and recommends plant-based diets for disease management “because of their potential to improve body weight and A1C [blood sugar control], LDL-cholesterol, total cholesterol and non-HDL-cholesterol levels, in addition to reducing the need for diabetes medications.” The Canadian Diabetes Association uses the Kaiser Permanente definition for that eating pattern: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs, as well as all refined and processed foods,” that is, junk. 

    It recommends that diabetes education centers in Canada “improve patients’ perceptions of PBDs [plant-based diets] by developing PBD-focused educational and support as well as providing individualized counseling sessions addressing barriers to change.” The biggest obstacle identified to eating plant-based was ignorance. Nearly nine out of ten patients interviewed “had not heard of using a plant-based diet to treat or manage T2DM.” Why is that? “Patient awareness of (and interest in) the benefits of a plant-based diet for the management of diabetes…may be “influenced by the perception of diabetes educators and clinicians.” Indeed, most of the staff were aware of the benefits of plant-based eating for treating diabetes, yet only about one in three were recommending it to their patients.  

    Why? One of the common reasons given was they didn’t think their patients would eat plant-based, so they didn’t even bring it up, but “[t]his notion is contrary to the patient survey results that almost two-thirds of patients were willing” to at least give it a try. The researchers cite the PCRM Geico studies I’ve covered in other videos, in which strictly plant-based diets were “well accepted with over 95% adherence rate,” presumably because the study participants just felt so much better, reporting “increased energy level, better digestion, better sleep, and increased satisfaction when compared with the control group.” 

    A number of staff members also expressed they were unclear about the supportive scientific evidence as their second reason for not recommending this diet, but it’s been shown to be more effective than an American Diabetes Association–recommended diet at reducing the use of diabetes medications, long-term blood sugar control, and cholesterol. It’s therefore possible that the diabetes educators were simply behind the times, as there is “a lag-time” in the dissemination of new scientific findings from the literature to the clinician and finally to the patient. Speeding up this process is one of the reasons I started NutritionFacts.org. 

    As Dr. Williams put it, “the ‘truth’ (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction, and mortality [heart attacks and cardiac death], as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions.” We’ve got the science. The bigger challenge is overcoming the “inertia, culture, habit, and widespread marketing of unhealthy foods.” He concludes, “Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” disease and death. 

    I highlighted the PCRM Geico studies in my videos Slimming the Gecko and Plant-Based Workplace Intervention. 

    Aren’t plant-based diets high in carbs? Get the “skinny” by checking out my video Flashback Friday: Benefits of a Macrobiotic Diet for Diabetes. 

    To learn more about diet’s effect on type 2 diabetes, see the related videos below. 

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    Michael Greger M.D. FACLM

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