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A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial^1,2,3,4

¹ From the Department of Medicine, George Washington University School of Medicine, Washington, DC (NDB, JC, and HF); the Physicians Committee for Responsible Medicine, Washington, DC (NDB, AG, and HF); the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada (DJAJ); the Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Canada (DJAJ); the Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, NC (GT-M); and Nutrition Coaching, LLC, Arlington, VA (LG).

² Presented at the symposium, "Fifth International Congress on Vegetarian Nutrition," held in Loma Linda, CA, March 4–6, 2008.

³ Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant R01 DK059362-01A2) and the Diabetes Action Research and Education Foundation.

⁴ Address reprint requests and correspondence to ND Barnard, 5100 Wisconsin Avenue, Suite 400, Washington, DC 20016. E-mail: nbarnard{at}pcrm.org.

Background: Low-fat vegetarian and vegan diets are associated with weight loss, increased insulin sensitivity, and improved cardiovascular health.

Objective: We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia, weight, and plasma lipids.

Design: Free-living individuals with type 2 diabetes were randomly assigned to a low-fat vegan diet (n = 49) or a diet following 2003 American Diabetes Association guidelines (conventional, n = 50) for 74 wk. Glycated hemoglobin (Hb A_1c) and plasma lipids were assessed at weeks 0, 11, 22, 35, 48, 61, and 74. Weight was measured at weeks 0, 22, and 74.

Results: Weight loss was significant within each diet group but not significantly different between groups (–4.4 kg in the vegan group and –3.0 kg in the conventional diet group, P = 0.25) and related significantly to Hb A_1c changes (r = 0.50, P = 0.001). Hb A_1c changes from baseline to 74 wk or last available values were –0.34 and –0.14 for vegan and conventional diets, respectively (P = 0.43). Hb A_1c changes from baseline to last available value or last value before any medication adjustment were –0.40 and 0.01 for vegan and conventional diets, respectively (P = 0.03). In analyses before alterations in lipid-lowering medications, total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups, respectively (P = 0.01); LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups, respectively (P = 0.03).

Conclusions: Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations. Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established. This trial was registered at clinicaltrials.gov as NCT00276939.

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