We read the position statement on nutrition therapy with great interest (1). In our observation, the article appears to have missed some of the major benefits of a whole-foods, plant-based diet, also referred to as a vegan or vegetarian dietary pattern.
The article states that, in a review of six vegetarian and low-fat vegan studies, there was not a consistent improvement in glycemic control or cardiovascular disease risk factors “except when energy intake was restricted and weight was lost.” In fact, all but one of the five vegan intervention studies cited encouraged ad libitum intake of whole grains, legumes, vegetables, and fruit. Participants achieved weight loss and A1C reduction without having to count carbohydrates or consciously limit portions. The sixth study was a population study of over 60,000 participants (Adventist Health Study-2) where those in the vegan and vegetarian groups were found to have a prevalence of type 2 diabetes of 2.9% and 3.2%, respectively. The protection from type 2 diabetes was observed even after correcting for several lifestyle factors, including BMI.
In addition to causing weight loss and glycemic control, vegan and vegetarian dietary patterns also lower blood pressure and improve cholesterol (2). If a medication did all those things, it would be the pharmacological advance of the century.
Cardiovascular disease is still the number one cause of death for people who have diabetes. Ornish et al. (3) demonstrated reversal of coronary atherosclerotic plaques in people with severe coronary artery disease in the Lifestyle Heart Trial not with medications or invasive procedures but with a low-fat, whole-foods vegetarian diet. Medicare reimburses certified sites that provide this type of education to patients with cardiovascular disease.
Furthermore, there is a growing body of research linking red and processed meats to a variety of health problems including type 2 diabetes. Participants from the Health Professionals Study, the Nurses’ Health Study I, and the Nurses’ Health Study II who increased their red meat intake by a half serving a day increased their risk of type 2 diabetes by 48% in a 4-year period (4).
People who have type 2 diabetes should receive education on plant-based nutrition as an option for managing their diabetes. They will not have to count carbohydrates or calories. They will enjoy a lot of delicious foods, lose weight, lower their blood pressure and cholesterol, and may even be able to reduce their medications. There are great resources available for health care providers to educate their patients on this way of eating (5). It is also well established that this type of eating pattern is healthful and adequate (2). The position statement missed the opportunity to provide this information, which has been well documented in the literature.
Article Information
Acknowledgments. The authors acknowledge Neal Barnard and Carrie Clyne of the Physicians Committee for Responsible Medicine for their review of the manuscript.
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
