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Type 2 diabetes and the vegetarian diet^1,2,3,4

¹ From the Clinical Nutrition & Risk Factor Modification Center (DJAJ, CWCK, AM, ALJ, and LSAA) and the Department of Medicine, Division of Endocrinology and Metabolism (DJAJ), St Michael’s Hospital, Toronto; the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto (DJAJ, CWCK, AM, and LSAA); the Department of Medicine, Children’s Hospital, Boston (DSL); the Physicians Committee for Responsible Medicine, Washington, DC (NDB); and the VA Medical Center, Graduate Center for Nutritional Sciences, University of Kentucky, Lexington (JWA).

Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.

Key Words: Type 2 diabetes • plant foods • vegan and vegetarian diets • glycemic index • nuts • vegetable proteins • soy • plant sterols • fiber

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