, RD, author and internationally acclaimed speaker, gives us an update on the scientific evidence suggesting that whole food plant-based diets provide powerful treatment options for patients with type 2 diabetes. She shares some practical suggestions for designing optimal plant-based diets for diabetes.
"I'm here at the VegMed conference in Berlin, Germany, in the 2018 Vegmed, it's just an outstanding conference. It would be nice to see it flourish in other areas, have VegMed in every country. The topic that I was asked to speak on today was diabetes, type 2 diabetes specifically. It's an area that is really very near and dear to my heart because on my father's side of my family there is a tremendous amount of diabetes. My father died of diabetes. And also because I work with the population of the Marshall Islands in Pacific. There They are among the highest rates of diabetes in the world. How I love the people of the Marshall Islands! They are the most joyful, this super high spirited lovely human beings and they are wiping themselves out with diabetes. It's absolutely a tragedy. There are probably over half of the population has either diabetes or pre-diabetes.
I have a very special interest in diabetes. So if you look around the world, just since the 1980s we've doubled the incidence of diabetes. We are now closed to 9 % of the population has diabetes. In North America, the United States specifically, somewhere between 49 and 52% of the adult population has either diabetes or pre-diabetes. And pre-diabetes is just a slightly lower blood sugar before you have full-blown diabetes but many people with pre-diabetes do develop type 2 diabetes. So half the population. This is just astounding. It's a situation that's very concerning in terms of growth in diabetes throughout the world. The countries that are at the greatest risk that are projected to increase a 100% or more are actually the poorest countries in the world who are increasing their intake of processed foods and animal products. It's a very concerning situation.
One thing we see, I mentioned - 12 -14% of Americans have diabetes and 9% of global population has diabetes, within the vegetarian population we see much smaller numbers. For example, in “Adventist Health Study 2” 3,2% of lacto-ovo-vegetarians have diabetes and 2,9% of vegans have diabetes. If you follow the vegetarians and vegans that are diabetes free for couple of years to see who develops diabetes relative to very similar health conscious omnivorous, controlling for exercise and smoking and drinking and all that sorts of things, vegans have 62& lower risk and vegetarians have a 38% lower risk, lacto-ovo-vegetarians. So they are tremendously protected, even when we control for things like, as I mentioned, exercise and so forth. This is really very very significant.
We also have studies that have looked at using a plant based diet is treatment for diabetes. We see really quite remarkable results. We've got the Physicians Committee for Responsible Medicine that has done a number randomized controlled trials that have shown that a low fat vegan diet is a lot more powerful in treating diabetes than a standard conventional diet. There is a group in Czech Republic that has done similar studies that have shown very good results. In Marshall Islands we did 5 overlapping interventions comparing control doing usual care versus people receiving a very intensive lifestyle intervention. And we saw in 12 weeks a nuance drop of almost 2 points on a average, which is really quite remarkable. So we had very very good results.
I was back in 2014, we had a blood glucose traps of over 6 mmol/L on average in our participants in the interventions. When you put together a plant based diet well, what happens is you essentially disable the drivers of insulin resistance, which is the big cause of type 2 diabetes. When you look at the drivers - inflammation, oxidative stress, lipotoxicity and disbiosis - these are all are factors that a plant based diet just literally puts an end to. So people who are on a plant based diet have less inflammation, they have less oxidative stress, they have better, healthier gut microbiota and they have far less lipotoxicity. When you do a really well constructed plant based diet, at least you put a huge dent in those drivers of diabetes.
Today we talked about all of those things but we also talked about how do you design a diet that will really provide maximum protection. Number 1 is people need to recognize that all diets, whether they are omnivorous diets or whether they are vegetarian diets, they are good, healthy or unhealthy patterns. You can do a vegan diet where you are living off French fries and soda. That is not going to contribute to health. It could be much worse than a healthy omnivorous diet where you are eating a lots of fruits and vegetables and whole grains and beans and a little bit of meat. You could do much better than a vegan eating potato chips and soda. The diet needs to be well designed. But a well designed plant based diet actually maximizes the components in the diet that are most protective and minimizes the components in the diet that are most harmful. What you need to do is: number one is you make whole plant foods the foundation of the diet. So you are warning to be consuming at least 9 or 10 servings of vegetables and fruits a day. And you want those foods to be wide range, a big variety, colorful. I always say, all the colors of the rainbow, where you are having at least 3 dark greens, 2 orange red, 2 purple blue or 2 orange yellow, 2 red pink and one purple blue and 1 white beige. So the whole rainbow.
The other thing you wanna be doing is: you want to eliminate as far as possible refined carbohydrates. The mainstream world right now has the banner up against carbohydrates and they say: "Get rid of carbohydrates, especially if you have diabetes”. What they are forgetting is that the healthiest people in the world, if you look at the Blue zones, the healthiest people in the world, 50-80% of the calories come from carbohydrates. The thing is they're a really couple different categories of carbohydrates. When carbohydrates come in a form of whole plant foods, they are naturally packaged with fiber and phytochemicals and antioxidants and they are very protective to health. When you strip everything off value in a carbohydrate foods, from the carbohydrates before you eat it, it's a problem. We take a reasonable carbohydrate food, like a grain of wheat, for example, we remove the germ and the bran and we left pure starch. And as I mentioned in my lecture, nobody eats a bowl of white flour. You make a white flour out of whole grain. And before you eat it, you add sugar and fats and salt and artificial colors and preservatives and then you eat it. And you are eating garbage. Not only have you removed what's a value in the original food, you've added all of this harmful compounds, it makes things much worse. 90% of carbohydrates people are eating are refined. So it makes a huge difference whether you're getting your carbohydrates from sugar and white flour products versus lentils and sweet potatoes. It's a very different bowl game. So that's number 2: getting rid of refined carbohydrates.
Number 3 is you wanna get your protein from plant foods rather than animal products. We have many studies that have compared sources of protein and risk of diabetes or progression of diabetes. And what we see is we see very strong. There was a study out of Harvard that looked at over 2000 people and what they found was the intake of animal protein was strongly associated with diabetes risk and the intake of plant protein was associated with reduced risk. And they actually quantified this showing that for every 5% protein consumed, if you replace the 5% animal protein with plant protein, you would reduce your risk of diabetes by 23%. It's just shocking.
There've been a number of studies, there was another study from 2014 where they found that in looking at people over 50 years of age, those that consumed 20% or more of their calories from protein, had 4 times the risk of diabetes in people between 50 and 65, and in people over 65, 10 times higher risk of diabetes, when 20% of your calories came from protein. The caveat is that this was only truth the protein came from animal foods. If the protein came from plant foods, the risk was pretty much abolished or at least greatly attenuated. Again, we just have a number of studies showing people are better off with plant protein. When you compare animal and plant protein, the plant protein contains fiber, it contains phytochemicals, it contains antioxidants, it contains a lot of anti-inflammatory, just nutrients that are protective. Where is with meat, you've got a lot more pro-oxidants, you've got Neu5Gc which is pro-inflammatory molecule, you've got saturated fat which tends to be pro-inflammatory, you form TMAO from the carnitine in meat which is inflammatory and very atherogenic, there is heme iron which is pro-oxidant. All kinds of things that can contribute to oxidative stress and inflammation. So we wanna get our protein more from plant foods.
And then fat is another macronutrient. We have to consider sources of fat as well. When you get your fat from processed foods or animal products, you tend to be getting more trans fatty acids and more saturated fat, again which can contribute to insulin resistance and problems. So we recommend lowering your total fat but getting most of your fat from whole plant foods, like nuts and seeds, for example.
The other features of the diet that you need to consider are certainly you want make sure that you getting all the nutrients you need. And for diabetes we think of things like potassium and magnesium that are very very critical nutrients. Vitamin D and so forth. So you want the diet to be very well balanced. Then you need to load up on this protective components like antioxidants and phytochemicals. Phytochemicals are just chemicals in plants. And fiber of course as well. This again: only plants, only plants, only plants. That's the broken record: the things that protect us are in plants. All this people in Ketogenic diets and diets that are eliminating plants and saying: "Eat always fat and meat", they are forgetting that, they are eliminating in the most protective compounds in the diet and they are concentrating the things that are most harmful. It makes no sense at all. So in fiber, I would say, you need probably ideally 40-50-60 grams in the diet every day which means at least 12 to 15 or 20 grams per meal. Which means where do we get them, certainly not from meat. There is 0 fiber in meat. Fish, poultry, there is no fiber in sugar, there is no fiber in oil even. So you wanna be relying on more whole foods.
The other thing that we need to consider is all of this compounds that contribute to oxidative stress, all of the chemical contaminates in foods, like the pesticides and herbicides and all of the heavy metals and the persistent organic pollutions that move up the food chain. Obviously we wanna choose organic where we can but a lot of this compounds again are concentrated in animal products because they move up the food chain. So we wanna eat lower down which means eating more plant foods. And then the other group are the products of oxidation formed from cookings. When we cook at very high temperatures, especially deep frying, we produce compounds and products of oxidation that are very harmful to human health. Thinking about frying, we produce Advanced Glycation End-products and when you cook starchy foods at high temperature, you produce acrylamide. When you cook meat at high temperature, you produce heterocyclic amines. When you black in any food, you produce polycyclic aromatic hydrocarbons. All of this things, not only they're carcinogenic but they tend to be quite inflammatory. When you are trying to fight a disease that is very associated with inflammation, you wanna really get rid of those things. It means eating more raw foods, preparing foods using moist cooking methods, like steaming, more often. And really avoiding high temperatures when you do cook with dry heat.
And then of course the critical thing is to try to avoid being over weight. This is something that I'm actually finding quite interesting because, of course in United States and Canada, in United States right now 70% of the population is either overweight or obese. And this is an absolutely stunning figure. In the United States you are an abnormality, you abnormal if you are normal weight. So people who are normal weight, often people say to them: "You are so skinny!" Because the norm is being overweight. They are not used to seeing people of normal weight. It's crazy! But any way. In Europe it's not so much so. But what I find very interesting is that even 5 pounds of excess weight can contribute to insulin resistance. It doesn't take much. One story that I find quite fascinating is when I was in Taiwan to do a lecture on this topic, I met a lady who was not much different in size from me. She was about 53 and 115 pounds, which is what 60 kilos, 53 kilos, something like that. And she was diabetic. She had type 2 diabetes. And I looked at her and I thought: "How can she have diabetes? She is so slim!" But what I realized is she was probably 10 or 15 pounds above her healthy weight because she was an Asian lady with very small bounces. Even when we look at her and say: "She is slim. Why would she have diabetes?" In Asia the normal weight is lower and people need to be lean. Even that much excess weight, especially in the Asian population, can cause diabetes. Some people think they are lean enough but for their physiological stature they maybe caring a little bit of extra weight that's contributing to insulin resistance. They actually need to be really lean to get rid of that.
It's quite interesting. I mean for most people. They are quite over weight to have type 2 diabetes, but not everyone. So this is quite interesting as well. But to me this is a really good news. I think most people with type 2 diabetes can overcome this disease completely if they are motivated. And that is a big IF. There is a fellow in the UK who's doing some work. He's name is Roy Taylor. He did this Twin Cycle Hypothesis for diabetes, the very interesting research. There are 2 cases where they found diabetes insulin resistance could be erased in a week. One was they did a gastric bypass surgery. With gastric bypass surgery the fat in the liver declines so rapidly that insulin resistance gets riverse even before intramyocellular lipids are gone. And the second was feeding people an extremely low calorie diet, like 600-800 calories a day. And they can get the insulin resistance to be gone in a week. People are going to live on 600-800 calories. But what's really interesting is if you can get rid of that fat in the liver, you see insulin resistance disappear. Even if we do it slightly more gradually overtime with a plant based low fat no sugar added diet, we can see reversal of diabetes in fairly short order. It's quite remarkable. I've seen some pretty amazing recoveries and people who get off all the medication and have normal fasting glucose levels. That's the good news.
The other good news to me (it could be bad news to some and it could be good news to some): there is nobody on this planet that can eat or exercise for you. You are the captain of that ship. You really have control over that. So it's not like you go to a doctor and he writes under prescription for a medication and then your blood sugars are controlled for the next 20 years but you stil develop all the complications and you die of the disease. In this case you can actually change what you choose to put in your body. And because of your choices you can reverse this disease, be in total control, get off the crappy medications. That will reduce your risk of complications in the long run. It's a miracle of sorts in my view. But what is so wonderful is your body wants to be healthy. It wants to heal itself. All it needs is the raw material with which to re-build the body tissues so it can be healthy again. You can do it, it's totally in your control. The other thing is that there are people around you within your country who want to help you do that, who would be willing to help you make that transition. It's really quite a wonderful thing. I think everybody has it within themselves to do that. Sometime it helps to go to a place where they can feed you 3 meals a day and so you don't have to actually do it yourself but to do an intervention. It can be very empowering and once you've tasted the food and you've done it and you see the results, then it's all good news".
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