Plant based diet diabetes

THURSDAY, July 25, 2019 (HealthDay News) — Turns out that the old adage — an apple a day keeps the doctor away — may actually be true. New research suggests that the more plant foods you eat, the lower your risk of type 2 diabetes.

People who ate a mostly plant-based diet reduced their risk of diabetes by 23%, the study found.

The association was even stronger — a 30% drop in risk of type 2 diabetes — for people who ate healthy plant-based foods, including veggies, fruits, legumes, nuts and whole grains. These foods contain fiber, vitamins, minerals, antioxidants and other beneficial ingredients.

So, what isn’t an especially healthy plant food? Processed foods and foods with added sugar. Think foods like white bread, white pasta, breakfast cereal, chips or cookies. The researchers also didn’t include starchy vegetables, such as potatoes, in their healthy-choices list.

“A plant-based diet is very healthful in reducing the risk of type 2 diabetes,” said the review’s senior author, Dr. Qi Sun. He’s an associate professor at the Harvard T.H. Chan School of Public Health in Boston.

And the more healthy plant foods, the better, Sun said. But “you should be picky about what types of foods you count as plant-based,” he added.

Sun also explained that a diet doesn’t have to be strictly vegan or vegetarian to be healthy. He said it’s a good idea to minimize animal protein, but choices like fish, chicken and yogurt can still be part of a healthful diet.

The study didn’t spell out exactly why a mainly plant-based diet appeared to lower type 2 diabetes risk. The researchers controlled the data to account for weight, but Sun said people who eat more plant-based foods may maintain a healthier weight, leading to a lower diabetes risk.

He said it’s also possible that beneficial compounds, like antioxidants and beneficial plant oils, might help promote insulin sensitivity or reduce inflammation. If you’re eating more plant foods, you’re probably eating fewer animal products. And that reduces the amount of potentially harmful substances you consume, such as cholesterol, saturated fat and sodium.

New Diabetes Study Underscores Benefits of Sticking to a Healthy Plant-Based Diet

People who stick to a plant-based diet have a 23 percent lower risk of developing type 2 diabetes, according to a report published this week in JAMA Internal Medicine. What’s more: The quality of the plant-based diet mattered. People who focus on whole plant foods and eat fewer refined sugars and carbohydrates can further reduce their risk by 30 percent.

Presenting one of the most comprehensive reports of its kind, researchers from the Harvard T.H. Chan School of Public Health analyzed the results of nine studies that pertained diet and diabetes risk, with a total of 307,099 participants (23,544 of whom had type 2 diabetes). The study’s authors found that, overall, the higher the adherence to a plant-based dietary pattern, the lower the risk of developing type 2 diabetes. This association was stronger when researchers defined the plant-based dietary pattern as emphasizing fruits, vegetables, whole grains, legumes, and nuts.

“Overall, these data highlighted the importance of adhering to plant-based diets to achieve or maintain good health, and people should choose fresh fruits and vegetables, whole grains, tofu, and other healthy plant foods as the cornerstone of such diets,” says the study’s senior author Qi Sun, MD, ScD, associate professor in the Department of Nutrition at the Harvard T.H. Chan School of Public Health.

The report notes that healthful plant foods contain fiber, vitamins and minerals, antioxidants, and unsaturated fatty acids, which might explain why consuming them could help prevent diabetes. The report also notes that plant-based dieters avoid red and processed meats—foods that have been shown to increase the risk of type 2 diabetes, possibly due to their higher heme iron or dietary cholesterol content.

While studies were observational and relied on responses from dietary questionnaires, the report supports previous findings. Prior studies have demonstrated that diet can play a role in reducing insulin sensitivity, blood pressure, weight gain, and inflammation—all of which can contribute to diabetes risk. And a plant-based diet may be more effective in managing type 2 diabetes than the diets currently recommended by several diabetes organizations.

“This study adds to what we already know from a wealth of scientific literature: Eating more plants, fewer animal foods, fewer highly processed foods is a great recipe for the health of our species as well as other species and the planet as a whole,” wrote Michelle McMacken, MD, assistant professor at NYU School of Medicine and director of Bellevue Hospital Weight Management Clinic, in a post on Instagram. “What’s not to love?”

Learn more about how a vegan diet impacts diabetes.

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Plant-based diets tied to lower risk of type 2 diabetes

By Lisa Rapaport

(Reuters Health) – People who tend to eat mostly plants may be less likely to develop type 2 diabetes, a research review suggests.

Researchers examined data from nine previously published studies with a total of 307,099 participants, including 23,544 people who developed type 2 diabetes. The length of the studies ranged from 2 to 28 years. All of the studies used food frequency questionnaires to assess participants’ diets.

Overall, people who most closely adhered to a vegan, vegetarian or other type of plant-based diet were 23% less likely to develop type 2 diabetes than people who consumed the least amount of plant-based meals, researchers report in JAMA Internal Medicine.

“Plant-based diets can promote metabolic health and reduce diabetes risk through many pathways, including preventing excess weight gain, improving insulin sensitivity, reducing inflammation, and other mechanisms,” said Dr. Qi Sun, senior author of the study and a researcher at the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital in Boston.

People who eat a healthy variety of plant-based meals can lower their diabetes risk even when they’re not strict vegetarians – avoiding meat, poultry and fish – or vegans – also avoiding animal products like milk and eggs.

But they may not benefit as much if their plant-based diet is full of foods like French fries, white bread, and white rice, Sun said by email.

“It does matter what veggies people eat and how the veggies are processed,” Sun said. “Therefore, consuming healthy plant foods that are not or minimally processed, such as fresh fruits and vegetables, legumes, nuts, and whole grains, should be emphasized.”

People in the study who followed this advice – with the healthiest mix of fruits, vegetables and whole grains in their plant-based diets, were 30% less likely to develop type 2 diabetes than participants who tended to ignore this idea.

Type 2 diabetes, the most common form, is linked to obesity and aging and happens when the body can’t properly use or make enough of the hormone insulin to convert blood sugar into energy. Left unchecked, diabetes can lead to serious complications like nerve damage, blindness, amputations, kidney damage and heart problems.

Doctors typically advise patients with type 2 diabetes to follow a low-calorie, low-fat and low-carbohydrate diet that includes lots of fresh fruits, vegetables and whole grains as well as lean poultry and fish. Fatty, sugary foods are discouraged along with consuming too much red or processed meat.

None of the smaller studies in the current analysis were controlled experiments designed to prove whether a plant-based diet helps prevent diabetes or serious complications from the disease.

Still, the results offer fresh evidence of the potential for good eating habits to help prevent and manage diabetes, said Samantha Heller, a nutritionist at New York University Langone Medical Center in New York City.

“Adding more whole plants such as broccoli, edamame, quinoa, extra virgin olive oil, almonds, and berries, to our diet is a great way to help manage type 2 diabetes and weight,” Heller, who wasn’t involved in the study, said by email.

“Higher fiber foods are healthy for the gut microbiome, improve gastrointestinal function, improve insulin sensitivity, and help manage blood sugar,” Heller added. “However, it is important to remember that even (portion sizes) of healthy foods matter.”

SOURCE: http://bit.ly/30NStrN JAMA Internal Medicine, online July 22, 2019.

Veganism and diabetes

Barley pilaf with tofu

Thinking of going vegan?

According to Vegan Life Magazine, the number of vegans in the UK has risen by a whopping 350 per cent over the past decade, with veganism becoming one of the fastest-growing lifestyle choices.

But is following a vegan diet healthy, and can it provide all the nutrients your body needs – especially if you’re living with diabetes? Could it actually bring about health benefits?

We share the nuts and bolts of eating vegan, and explore how those living with diabetes can practise this safely and with confidence.

What is veganism?

According to the Vegan Society, ‘veganism is a way of living which seeks to exclude, as far as is possible and practicable, all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose. Vegans follow a plant-based diet avoiding all animal foods such as meat (including fish, shellfish and insects), dairy, eggs and honey – as well as products like leather and any tested on animals’.

Vegan Life Magazine report that the vegan movement is growing fastest in the younger population: almost half (42 per cent) of the 542,000 vegans in the UK are aged between 15–34, compared with just 15 per cent who are over 65.

People choose to follow a vegan lifestyle for different reasons such as concern about animal welfare and the planet. However, another contributing factor which may encourage people to follow a vegan diet is that it can provide some health benefits.

It has also become considerably easier to ‘go vegan’ these days. Not so long ago, you’d have to make a special trip to a health food store for ingredients such as tofu or tempeh,

but now you can find most of the produce needed for a healthy vegan diet in your regular supermarket. Additionally, more restaurants are now offering vegan options on their menus to cater for the growing numbers.

Spicy bean quesadillas

Health benefits of a vegan diet

Plant-based foods – which are a large part of a vegan diet – particularly fruit, vegetables, nuts, pulses and seeds, have been shown to help in the treatment of many chronic diseases and are often associated with lower levels of Type 2 diabetes, less hypertension, lower cholesterol levels and reduced cancer rates.

Some studies also show that vegans are less likely to be overweight and tend to have a lower percentage of body fat, which in turn will reduce the risk of many other diseases.

Are vegan foods always healthy?

Not necessarily – even though most of the foods are naturally good for you, it doesn’t necessarily mean that all vegan diets are healthy. Ingredients such as salt, sugar and fat can still be added, making them less healthy.

With the increased risk of cardiovascular disease (CVD) in people with diabetes, keeping your weight under control and reducing blood pressure and blood cholesterol are all essential and plant-based foods can help with this.

General healthy eating advice – to choose wholegrain, low-GI carbs over refined options, to eat less salt, saturated fat and sugar and to watch your weight – still apply to people eating a vegan diet.

A little more care and attention is needed when planning a vegan diet, particularly for children. When you first embark on a vegan diet, you must ensure that it will provide all the key nutrients that are necessary for good health. Speaking to a dietitian can be helpful to make sure your diet is balanced.

Are vegan diets suitable for people with diabetes?

Vegan diets tend to be lower in saturated fat, higher in fibre, fruit and vegetables and other protective substances like phytochemicals and antioxidants – as a result, they fit well with the current dietary guidelines for people with diabetes.

There is no reason why you shouldn’t choose to follow a vegan diet if you wish, but it’s important to discuss the matter with your diabetes team if you have any queries or concerns.

Vegan stack burger

Making it work for you

Before embarking on a vegan diet, it’s helpful to do your research. The Vegan Society is an excellent source of information with lots of useful tips and advice.

Whether you are ready to go completely vegan, or would like to start by increasing plant-based meals in your diet, or removing meat or dairy products gradually, there are a few important aspects to consider.

Below, we have listed some particular considerations regarding how to maintain a healthy, balanced diet.

Maintaining good nutrition

Consuming enough protein is a concern for many new vegans. However, it may not be as big a problem as we anticipate. Most of us eat far more protein than our body requires, and there are plenty of vegan foods which are good sources of protein:

  • nuts, seeds and most of their butters (e.g. cashew, tahini, peanut, almond and Brazil)
  • beans and pulses (eg butterbeans, chickpeas and lentils)
  • vegetable milks (eg soya, almond and hempseed)
  • quinoa
  • soya products (eg tofu, soya cheese and soya milk)
  • vegan Quorn.

There is generally more carbohydrate in plant-based protein sources, so it’s possible that your carbohydrate intake may increase when you switch to a vegan diet. However, you can still watch your portions and always look for low glycaemic index (GI) options and pick foods that are high in fibre. The GI is a measure of how quickly carbohydrate is absorbed – the quicker it is, the higher the GI.

Vitamins

The body needs vitamin B12 to maintain healthy blood and a healthy nervous system. We get vitamin B12 from food but it is only found naturally in animal products. However, many vegan foods are fortified with B12 to compensate for this. The Vegan Society recommend that you should eat a food fortified with B12 at each meal, or take a supplement that contains at least 10 micrograms of B12 each day in order to stay healthy. Fortified foods and/or supplements are the only reliable sources of B12 in a plant-based diet.

Vegan foods fortified with B12 include:

  • some plant milks and yogurts
  • some breakfast cereals
  • some spreads
  • yeast extract.

Calcium

It’s also important to ensure that a vegan diet contains enough calcium, which is important for strong bones. Calcium is needed throughout life, but particularly while bones are still growing until around the age of 25. you should choose dairy alternatives, such as plant-based milks and yogurts which are fortified with calcium.

Vegan foods fortified with calcium include:

  • almonds
  • oranges
  • kale
  • red kidney beans
  • chickpeas
  • tahini
  • some fortified foods (e.g. wholegrain breads).

You may have heard that spinach is a good source of calcium. Unfortunately, although it does contain calcium, it also contains chemicals which bind to the calcium and therefore make it difficult for the body to absorb. Don’t let that stop you eating spinach though, as it still contains lots of other good stuff.

Other nutrients

Omega-3

Omega-3 fatty acids are useful in the treatment and prevention of heart disease. As people with diabetes have an increased risk of heart disease they may benefit from including Omega-3 in their diet. It can, however, be more difficult when following a vegan diet.

Vegan sources of Omega-3 include:

  • flaxseed and rapeseed oil
  • walnuts
  • soya-based foods (eg soya milk, tofu and walnuts).

These sources are not as good as oily fish, so it’s important to include them on a regular basis in order to get adequate amounts of Omega-3 fatty acids. You may want to consider taking a supplement, but make sure you choose one which is suitable for vegans.

Iron

As meat is rich in iron, some people following a vegan diet may be concerned that they won’t be able to get enough from their food.

There are good vegan sources of iron, including:

  • bread
  • breakfast cereals
  • dark green vegetables
  • nuts
  • dried fruit
  • beans and pulses.

Consuming more fruit and vegetables can also help as they are high in vitamin C which increases the amount of iron your body absorbs.

Your diabetes and your food choices

If you’re considering a vegan diet – for health, lifestyle or other purposes – it’s possible to ensure it’s both healthy and balanced. As well as offering a number of potential health benefits, particularly for people with diabetes, the good news is that it’s never been easier to begin.

Vegan recipes

Wherever you might be in your journey, from complete veganism to simply reducing animal products and increasing plant-based meals, here are a selection of some delicious recipes to try:

  • Andean-style quinoa

  • Carrot and cumin salad

  • Apple strudel

  • Saag aloo

  • Tofu goujons

  • Coconut rice pudding

  • Channa dahl

  • Gado gado

  • Vegetable tagine

  • Layered potatoes

  • Wild mushroom risotto

  • Muesli energy bars

  • Mulligatawny soup

  • Apricot porridge

  • Tomato and olive salad

  • Smoky tofu kebabs

You can also type ‘vegan’ into our recipe search bar and check out any delicious recipes which feature this logo.

Study Suggests Why a Plant-Based Diet May Help Prevent Type 2 Diabetes

Improving Blood Sugar Control to Promote a Healthy Weight

In the study, originally published in February 2018 in Nutrients, Dr. Kahleova and her colleagues followed 75 overweight and obese adults without diabetes whom they had randomly assigned to a vegan diet or a control diet for a 16-week period.

The vegan group ate meals composed of vegetables, grains, legumes, and fruits, and they limited their daily fat intake to about 1 ounce or less. (A vegan diet calls for completely omitting animal products, including not only meat, but also cheese, eggs, and milk.) Meanwhile, the control group maintained their current diets, which included meat and dairy. Neither group restricted their calories.

Subjects had to complete a three-day dietary record at the start and finish of the study to demonstrate that they were sticking to their assigned eating plan.

Although participants were diabetes free, they all had high body mass indexes (BMIs) of 28 to 40, which put them at high risk for developing type 2 diabetes. At the beginning of the study, about one-third had prediabetes, meaning their blood sugar levels were higher than normal but not high enough to signify type 2 diabetes.

“Insulin resistance is high in overweight people without diabetes, exerting high demands on beta cells to produce insulin,” says Kahleova. “By the time type 2 diabetes is diagnosed, about 50 percent of the beta cells are already dead. Therefore, the greatest opportunity to preserve beta-cell function is before diabetes onset.”

The average age of the participants was 53, and about 9 out of 10 subjects were women. All had no history of smoking or alcohol or drug abuse, and none were following a vegan diet before the study began.

A sign of beta-cell failure is a loss of sensitivity to glucose. On the basis of an analysis of blood samples at the beginning and end of the study, scientists determined that beta-cell glucose sensitivity increased by 65.5 percent in the vegan group, resulting in a marked increase in insulin secretion compared with the control group.

Researchers speculate that a diet high in plants and low in animal products may produce these positive results by reducing oxidative stress and inflammation.

“I was struck by the power of a plant-based diet to improve beta-cell function,” says Kahleova.

The study authors observed an average drop in BMI of 2 among the vegan group but no change in the control group. They also noted that, in most cases, those with prediabetes who followed the vegan eating plan were able to put the health condition in remission.

RELATED: A Plant-Based Diet Is Linked to a 23 Percent Reduced Risk for Type 2 Diabetes

Unveiling the Power of a Plant-Based Diet in Type 2 Diabetes Prevention

“This study is great because it shows that nutritionally you may be able to prevent type 2 diabetes,” says Audrey Koltun, RD, a certified diabetes educator with Cohen Children’s Medical Center in New Hyde Park, New York.

Kristin Kirkpatrick, RD, the manager of wellness nutritional services at the Cleveland Clinic, says this investigation supports previous research showing an association between plant-based eating plans and a reduction in diabetes risk. For example, a review of three studies published in June 2016 in PLoS Medicine suggests that cutting back on meat and dairy, and increasing fruit, veggie, nut, and seed intake, is linked to a “substantially” lower risk for type 2 diabetes.

“Even starting small can help,” says Kirkpatrick, who was not involved in the research. “Choose one or two days a week that will just be plant-based. Make more effort to get natural color in your diet, and try to omit all processed red meat,” such as bacon, sausage, deli meat, and hot dogs, per the World Health Organization, which notes that these foods are also associated with a higher risk for cancer.

Yet Koltun, who wasn’t involved in the study, warns that not all vegan foods are good for you. “French fries, chips, and white bread are all vegan foods,” she says. “You have to follow a healthy vegan diet with real fiber from whole grains, nuts, and legumes. These foods help slow down how fast a meal is digested, therefore requiring less abundance of insulin to be used.”

While Koltun helps her patients who are obese or overweight eat healthier, she recognizes that changing eating habits can be challenging. “Sometimes, it’s like you’re asking them to bungee jump off the Empire State Building. They just don’t want to do it.”

RELATED: The Best and Worst Foods to Eat in a Type 2 Diabetes Diet

Recognizing the Limitations of the Current Study on Plant-Based Diets

Both Koltun and Kirkpatrick flagged limitations in the investigation. Researchers relied on self-reported dietary data, which is not always accurate, and the subjects were predominantly women. Participants were already health-conscious and willing to make substantial changes to their diet, which may not be representative of the general population.

Currently, Kahleova and her collaborators are continuing this research — 244 people have now completed the study, and the authors plan to publish updated results in the near future.

“Plant-based diets have been shown to be sustainable in the long term,” says Kahleova. “They not only reduce the risk of diabetes but also cancer and heart disease, and they may prolong life by 10 to 12 years.”

RELATED: An Ultimate Guide to the Mediterranean Diet

Reverse Diabetes with Plant-Based Diets: Two Doctors Invite You To Try

(Photo by Earl Dotter)

Top four reasons why Latino patients are good candidates to go plant-based
In 2012, Dr. Leon and Dr. Carral, who originally hail from Mexico, launched Vegetariano en 21 Días (at www.vegetarianoen21dias.org) in conjunction with Physicians Committee for Responsible Medicine, to provide free Spanish-language 21-day diet challenge along with online support like information on the health benefits of a plant-based diet, webcasts, and recipes. The program was initially designed for US Spanish-speaking audiences, but the challenge went viral, with participants from throughout the Spanish-speaking world. Leaning on its success, PCRM has launched similar challenges for people in India, China, and elsewhere.
But how do you convince patients to try out the diet? Dr. Leon and Dr. Carral postulate that Latinos in the US are ideal candidates to transition to plant-based: their cultural and culinary backgrounds make the switch relatively easier, and the population, with significant diet-based health risks, can greatly benefit from the diet. Here are some reasons Latinos should go whole-foods, plant-based:
Diabetes is sky-high among Latinos. Over 12 percent of Hispanic Americans have diabetes, compared to 9.4 percent of the population overall. Among Mexican Americans, the number is 13.8 percent. Additionally, for immigrants, studies show that the longer a person lived in the United States, the more likely they are to develop diabetes.
Second-generation Latino immigrants are sicker and die earlier than their parents. “A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents,” summarizes a New York Times article. Much can be attributed to the adoption of a standard US lifestyle, including the diet. Returning to the diet of one’s immigrant parents may assist in reducing those increased rates of disease.
Traditional foods were vegan before colonialism. And, until recently, few had the resources to eat meat daily. In pre-Columbian times, that Al Pastor didn’t have any pork and beef, chicken, lamb, and goat were also off the table. This message to “decolonize your diet” is resonating with Latinos, particularly younger ones, who are rediscovering what “traditional” foods really are, and giving beans, vegetables, and whole grains the foci of the dinner plate. Additionally, many of our patients are just one or two generations away from primarily plant-based foods. Dr. Carral encourages giving a pep talk: “You’re in charge. It’s not that hard; your grandparents were doing it, and you can do it, too.”
Latinos still generally know their way around the kitchen. Dr. Carral points out that one of the best ways to improve one’s diet is to start cooking. “Millenials are the first generation that didn’t see their parents cook. We have that advantage: we still know what it is to be in the kitchen and eat homemade food,” he said, noting that many Latino families, because of possibly both culture and economic restrictions, still cook. Those who cook at home consume fewer calories and have a lower risk of diabetes, regardless of diet. Familiarity with cooking gives Latinos a significant leg-up in the road to plant-based. Any food made in the home will likely be healthier than what’s available at fast-food restaurants. With recipes, support, and substitutions, Latinos can make quickly prepared and healthy choices in the kitchen that will benefit the entire family.

Earlier this year, dozens of promotores de salud from around the US and Puerto Rico logged in to participate in the final sessions of MCN’s hypertension and diabetes ECHO project, presented in Spanish. The group had come together every two weeks for five months, to talk with experts, hear case studies, and learn from each other on diverse issues like diabetes and mental health, patient management during emergencies, social determinants of health, and telemedicine. The final session focused not just on management, but on prevention and even the reversal of diabetes, hypertension, and other chronic diseases. For most of the attendees, the notion of reversal of diabetes was a shock, but they presented a very viable alternative about which participants were eager to learn: a plant-based diet with lifestyle changes.

Joaquin Carral, MD, co-presenter, wasn’t surprised that the message was new to participants: “In med school, they tell us that diabetes is not reversible. That’s what the drug companies tell us as well. But if we do lifestyle changes, it changes drastically for people… Even people with insulin — if they make the changes, they can cut medications,” said Dr. Carral.

During the ECHO session, Dr. Carral and Aurora Leon, MD, shared the successes they have had both personally and professionally with a plant-based diet: unprocessed whole foods like whole grains, beans and lentils, vegetables, and fruit — with no meat (including fish and chicken), dairy, or eggs.

“I have had patients who don’t believe me,” Dr. Leon admitted. One incredulous patient started on the plant-based diet for 30 days as Dr. Leon recommended, and decided to make the change to plant-based eating permanent. “After a month, she noticed she didn’t have pain in her joints, and just because of that, she said she’d never go back.” But patients don’t just notice less joint pain, more energy, less bloating, less acid reflux; the changes are measurable. “You can measure your A1C, your lipids — you can see your numbers changing. That’s why people continue. They feel good and they can see the results,” she noted.

Recent literature backs their assertions up, demonstrating that such a diet addresses not just diabetes and hypertension but many of the top killers in the US. A diet of whole grains, vegetables, fruits, and legumes and absent of meat, eggs, and dairy has been shown to reduce the risk of heart failure and even reverse heart disease. Studies further show it can reduce prostate cancer cell growth, and, paired with exercise, it results in “major reductions” of breast cancer risk factors like the production of insulin-like growth factor-I (IGF-I).

The session was wildly popular, with more questions and conversation after the presentation than any other session in the ECHO series. Alma Galván, MCH, Senior Program Manager and the coordinator and facilitator of the ECHO series, notes that “Dr. Carral and Dr. Leo were very enthusiastic and engaging presenters, providing a professional, clear, and simple way to explain the backbone issues and misconceptions behind unhealthy habits.”

Further interest after the session prompted an post-ECHO project encore presentation during the summer, for the duo to dive deeper into the research. During a follow-up interview, the two physicians went over numerous recommendations on how clinicians can approach the lifestyle change, including the following five tips:

1. “Do the research.”

Clinicians first need to understand the science, they say. The top killers in the United States can be reduced or eliminated by cutting out meat, dairy, and eggs and replacing it with vegetables, whole grains, and legumes. Despite plenty of internet challenges to the contrary, the scientific literature is abundant and easily accessible. Dr. Leon and Dr. Carral recommend several resources for the clinician to better understand what has been studied and what the results indicate.

Forks over Knives articles: The wellness articles section of the popular vegan documentary Forks over Knives includes this hour-long panel discussion on plant-based diets for health from the Unite to Cure Fourth International Vatican Conference in Rome earlier this year. In the video, leading physician advocates discussed a new Harvard study that shows that plant-based diets can reduce mortality by a third. Other new articles catalog the various hospitals going plant-based, new studies on diabetes and nutrition, and more. The website also features healthy recipes and more resources.

Nutritionfacts.org: This comprehensive nutrition site, run by Michael Gregor, MD, runs daily videos examining new nutrition research, on everything from flax and blueberries to coffee and artificial sweeteners. Watch his 1.5-hour long video presentation, “How Not to Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.” Nutritionfacts.org can be a good resource for patients, as well. Check out the page en Español, with text in Spanish and videos with Spanish subtitles.

Proteinaholic: If you prefer a book over a video, Dr. Leon recommends this read from Dr. Garth Davis, a well-known weight loss surgeon from Austin.

2. “Every step in the right direction is a step toward health.”

That’s why each patient’s path is different. One of Dr. Carral’s patients had rising prostate-specific antigen test numbers. He was on four diabetes medications and yet still had an A1C of 12. Dr. Carral could see that he was motivated for health and well-organized — a good candidate for the complete and “cold-turkey” switch to plant-based. He had never heard of going plant-based for his health concerns, but with Dr. Carral’s encouragement, he adopted the diet. Within a few months, his A1C dropped to 6.5 and he was on just one medication. His PSA dropped and then stabilized. He asked Dr. Carral, “I’ve been coming here for three years and no one ever talked to me about diet.” For other patients, a slower transition would be more effective. Dr. Carral recommends to encourage people to cook food — any food — at home. Home-cooked will be healthier, and can set the patient up for increasing vegetable consumption and decreasing meat consumption as he or she gets more comfortable in the kitchen. For other patients, Dr. Carral notes, making diet changes has to wait until drug or alcohol addictions are addressed. “We’re not looking for everyone to become vegan or plant-based. It’s about moving in that direction, seeing it as option,” Dr. Carral clarified. “Everyone can change, little by little.” And each change toward a plant-based diet can benefit the health of the patient.

3. “Change your life first.”

Perhaps the most controversial point in a relatively controversial topic is Dr. Leon’s top recommendation for clinicians. “If the doctor smokes, won’t tell you to quit smoking,” she quips. She recommends doctors to take the 21-day challenge themselves, to see how they feel, to uncover obstacles or unexpected benefits. Many clinicians, she notes, have already cut out meat, dairy, and eggs. “Providers are changing because their patients are trying it and they have had big results. A typical response is ‘just keep doing what you’re doing because it works’… but then they start to become curious.” Many clinics have plant-based diet programs and hospitals’ in-patient meal programs are going plant-based as well.

4. “We’re just starting with trust and empowering the patients.”

Clinicians serving mobile patients like agricultural workers know the frustration of diagnosing a patient with diabetes, prescribing medications, and then discovering a year later, when the patient returns, that the patient was unable to access prescription refills on his migration route — and his diabetes remains out of control. Empowering patients to embrace a lifestyle option that often saves money compared to the standard diet, is available wherever they go, and — for Latino patients — fits their cultural background, can be an effective and efficient treatment option.

5. “We want health from head-to-toe, not just in the waistline.”

Dr. Carral noted that many of the popular diets — Atkins, Paleo, and Keto, and variations of those — are effective in losing weight in the short term but are hard to keep up and unhealthy in the long term. A shift to a plant-based diet can be a decision for long-term health and well-being. But any patient who is actively dieting is a great candidate for plant-based, Dr. Carral adds, as the patient is showing the motivation and putting in the effort to switch to a healthier lifestyle. Encouraging patients to transition to plant-based will give them the benefits of other diets — a loss in weight, an increase in energy — along with the many long-term health benefits that those diets lack.

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