Plant-Based Diet: Diabetes Cure Or Myth?

A plant-based diet is a powerful tool for preventing and managing type 2 diabetes, and even putting type 2 diabetes into remission.

The underlying cause of type 2 diabetes is fat accumulation inside the cells. Insulin is a hormone secreted from the pancreas in response to rising blood sugar levels after we eat. Insulin then acts as a key to unlock the cells so that the glucose can move from the blood into the cells, where it can be used to produce energy. However, too much fat stored inside our muscle and liver cells, as well as elevated free fatty acids in the blood and the resultant inflammation, prevent these cells from functioning normally. For example, when there is too much fat inside our muscle cells, they are less responsive to insulin and become insulin resistant, which means they take up less glucose, leading to higher levels of glucose in the blood. This can be due to consuming too many calories in total, and too many calories from saturated fat.

A plant-based diet can remove this excess fat from the cells and improve blood glucose control. A meta-analysis published in 2017 estimated that each kilogram of weight lost is associated with a 0.1 percentage point reduction in HbA1c. The randomized clinical trials published by the Physicians Committee, mentioned above, have shown that weight loss is correlated with a reduced HbA1c. Weight loss resulting from a plant-based diet is often attributed to a lower caloric density of the food consumed, resulting in decreased energy intake, as well as lower fat and higher fiber intakes.

A new study found that among a group of patients with type 2 diabetes, over a third were able to reverse their diagnosis by being treated with a low-fat, whole food, plant-predominant diet. This validates the anecdotal successes many plant-based doctors and dietitians have seen among their patients and builds on previous research showing that vegan diets outperform conventional diabetes diet recommendations.

A plant-based diet can reverse type 2 diabetes

A plant-based diet can be a powerful tool for preventing and managing type 2 diabetes, and even putting type 2 diabetes into remission. Type 2 diabetes is a global epidemic, with approximately 422 million cases worldwide and a rapidly rising prevalence in middle- and low-income countries. In the United States, type 2 diabetes is the seventh leading cause of death.

The Underlying Cause of Type 2 Diabetes: Fat Accumulation Inside the Cells

Insulin is a hormone secreted by the pancreas, specifically from beta cells, in response to rising blood sugar levels after eating. Insulin acts as a key to "unlock" the cells so that glucose can move from the blood into the cells, where it is used to produce energy. However, too much fat stored inside muscle and liver cells, as well as elevated free fatty acids in the blood and resultant inflammation, prevent these cells from functioning normally. Consuming too many calories in total, and too many calories from saturated fat, can lead to this fat accumulation. A low-fat, plant-based diet can remove this excess fat from the cells and improve blood glucose control.

Preventing Type 2 Diabetes

It has been estimated that a suboptimal diet is responsible for more than 70% of new cases of type 2 diabetes. Vegan and vegetarian diets have been consistently found to be protective against developing type 2 diabetes. Specific food groups have also been found to increase or decrease the risk of type 2 diabetes.

• Processed meat: Aside from being classified as a carcinogen for colorectal cancer by the World Health Organization, processed meat increases the risk of type 2 diabetes more than any other type of meat. Consuming processed meat is estimated to result in one in five new cases of type 2 diabetes.
• Red meat: Weekly total meat consumption over 17 years has been associated with a 74% increased risk of developing diabetes compared with a vegetarian diet. Just two servings of red meat per week have been associated with an increased risk of type 2 diabetes.
• Whole grains: Whole grains are protective against type 2 diabetes. A comprehensive meta-analysis of prospective studies and randomised controlled trials found that compared with those who rarely or never ate whole grains, those who consumed just 48-80 grams per day had a 26% lower risk of developing type 2 diabetes.
• Fruit: A common misconception is that fruit should be avoided by people with type 2 diabetes because it is high in sugar. However, the sugar in fruit comes packaged with fibre, phytochemicals, antioxidants, and more. Research has found that those who eat more fruit have a lower risk of developing type 2 diabetes. And in those who already have type 2 diabetes, fruit can improve blood sugar control.
• Sugar-sweetened beverages (SSBs): SSBs, which include drinks such as sodas, energy drinks, sweetened tea, and sweetened juices, have consistently been shown to increase the risk of type 2 diabetes. One large meta-analysis found that every serving of SSB consumed per day increased the risk of type 2 diabetes by 27%.

Managing Type 2 Diabetes

A low-fat, plant-based diet can improve blood glucose control, body weight, and cardiovascular risk factors in individuals with type 2 diabetes. Each of these is central to diabetes management.

• Glycemic control: A meta-analysis of six randomised controlled trials (involving 255 participants) demonstrated that vegetarian diets were associated with a 0.4% greater reduction in glycated haemoglobin (HbA1c) when compared with other prescribed eating patterns for diabetes. A 2006 randomised controlled trial found that 43% of the vegan group were able to reduce their diabetes medications compared with 26% of the control group.
• Body weight: Weight loss, if a person is overweight, is a key factor for improving glycemic control. A meta-analysis published in 2017 estimated that each kilogram of weight lost is associated with a 0.1 percentage point reduction in HbA1c. The randomised clinical trials published by the Physicians Committee, mentioned above, have shown that weight loss is correlated with a reduced HbA1c.
• Cardiovascular risk factors: A meta-analysis of nine randomised controlled trials in patients with type 2 diabetes (involving 664 participants), comparing vegetarian interventions with control diets, showed significant improvements in cardiovascular risk factors, including lipids, blood pressure, glycemic control, body weight, and abdominal adiposity.

Mechanisms by Which a Low-Fat, Plant-Based Diet Improves Glucose Control

• Weight loss: Weight loss, if a person is overweight, is a key factor for improving glycemic control. A meta-analysis published in 2017 estimated that each kilogram of weight lost is associated with a 0.1 percentage point reduction in HbA1c. The randomised clinical trials published by the Physicians Committee, mentioned above, have shown that weight loss is correlated with a reduced HbA1c.
• Reduced intracellular fat: Fat accumulating within muscle and liver cells causes insulin resistance. In a 2020 randomised controlled trial by the Physicians Committee, it was found that reducing the fat inside these cells improves insulin sensitivity and beta-cell function.
• Reduced saturated fat intake: Animal products are a major source of saturated fat in the American diet. A diet high in saturated fat has been shown to reduce insulin sensitivity in as little as four weeks in individuals with a normal insulin sensitivity at baseline, despite no changes in their body weight.
• Increased fibre: Consuming more fibre, which is exclusively found in plants, is associated with improved blood sugar control. This is mainly because fibre slows down the rate of absorption of glucose from the gut.

A plant-based diet can reduce the risk of developing type 2 diabetes

Type 2 diabetes is a global epidemic, with approximately 422 million cases worldwide and a rapidly rising prevalence in middle- and low-income countries. It is a major worldwide health challenge affecting individuals, families, communities, and governments. The International Diabetes Federation estimated that 463 million people (9.3% of the worldwide population) had diabetes in 2019. Prevalence is expected to increase to 578 million (10.4%) by 2030. Globally, diabetes caused 15 million deaths and contributed to 12% of healthcare expenditures in 2015.

A plant-based diet is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment. Diets that emphasise whole grains, vegetables, fruits, and legumes and exclude animal products improve blood glucose concentrations, body weight, plasma lipid concentrations, and blood pressure and play an important role in reducing the risk of cardiovascular and microvascular complications.

Observational studies in widely diverse locales have identified large reductions in diabetes risk among populations consuming vegan and vegetarian eating patterns, compared with other dietary patterns.

The Adventist Health Study-2 (AHS-2), which started in 2002, included 22,434 men and 38,469 women living throughout the USA and Canada; 65.5% were non-Hispanic white and 26.9% were black. Compared with non-vegetarians, the odds ratio for diabetes prevalence was 49% less among vegans and 46% less among lacto-ovo vegetarians, after adjustments for BMI and other lifestyle variables.

In a prospective analysis of this same cohort (AHS-2) of 15,200 men and 26,187 women (17% black) who did not have diabetes at baseline, vegan and lacto-ovo vegetarians had a 77% and 54% reduction in risk of developing diabetes, respectively. After controlling for BMI and other lifestyle factors, odds were 62% less for vegans and 38% less for the lacto-ovo vegetarians. The reduced risk was particularly pronounced among black vegans who, in the adjusted analysis, had a 70% reduced risk, and black lacto-ovo vegetarians (52% reduced risk), compared with non-vegetarians.

The Harvard study that included 26,357 men from the Health Professionals Follow-Up Study (1986-2006), 48,709 women from the Nurses' Health Study (1986-2006), and 74,077 women from the Nurses' Health Study II (1991-2007) found that increasing meat by half a serving per day was associated with a 48% increase in diabetes risk over a 4-year period. Decreasing meat portions by half a serving a day was associated with a reported 14% reduction in diabetes risk.

In another report that included over 20,000 men and women health professionals from the same Harvard cohorts, 16,162 participants developed diabetes during 4,102,369 person-years of follow-up. It was reported that when participants followed a healthy plant-based diet that focused on whole grains, fruits, and vegetables, and was low in refined grains, sugar-sweetened beverages, and red and processed meats, there was an associated 34% reduction in diabetes risk.

The European Prospective Investigation into Cancer and Nutrition (EPIC) study's InterAct Project followed 340,234 adults from 8 European countries for 11.7 years and reported significant associations between meat consumption and type 2 diabetes risk. For men, consumption of red and processed meat increased diabetes risk, whereas for women there was a positive association between total meat and poultry consumption.

In the Rotterdam study, a high intake of plant-derived products and a low intake of animal products was associated with lower insulin resistance, prediabetes, and type 2 diabetes. These outcomes remained significant after adjustment for body weight.

The Tzu Chi Health Study found significant reductions in diabetes risk among vegetarian Buddhists. Compared with the omnivore group, the vegetarian group had a 51% lower risk in men and a 75% lower risk in postmenopausal women for type 2 diabetes after controlling for BMI and other lifestyle factors.

Mechanisms by which plant-based eating patterns affect insulin resistance and weight management

Insulin resistance and subsequent impairment in β-cell function are the hallmarks of type 2 diabetes pathophysiology. Plant-based eating patterns are beneficial for patients with diabetes by improving insulin sensitivity and improving body weight. Insulin resistance is caused by lipid accumulation within muscle and liver cells that typically begin many years before the diagnosis of type 2 diabetes. This lipid accumulation is highly responsive to diet changes. High-fat diets downregulate the genes required for mitochondrial oxidative phosphorylation in skeletal muscle. High-fat diets also appear to disrupt the normal intestinal barrier to bacterial endotoxins that, entering the bloodstream, may disrupt glucose oxidation processes. The effects of changes in fat intake on glycemic control can be observed, not only after long-term interventions but after single meals; high-fat meals can cause postprandial elevations in plasma glucose that can remain high for a long period of time.

In a case-control study, Goff et al. compared 24 healthy vegans to 25 healthy omnivores matched for sex, age, BMI, per cent body fat, energy intake, and physical activity levels. Individuals who followed a vegan diet had significantly lower intramyocellular lipid concentration, which was associated with 32% greater homeostatic model assessment of β-cell function. In a randomised trial in overweight non-diabetic individuals without limitations on energy or carbohydrate intake, a low-fat vegan diet reduced hepatocellular lipid concentrations by 34.4% and intramyocellular lipid concentrations by 10.4%. These changes in hepatocellular and intramyocellular lipid concentrations correlated with changes in insulin resistance (both r = 0.51; P = 0.01). These findings suggest that low-fat, plant-based (especially vegan) diets improve glycemic control because of their ability to reduce lipid accumulation in muscle and liver, in addition to their effects on body weight.

Plant-based diets may also improve β-cell function. In a randomised trial, 75 participants who were overweight or obese were assigned to a low-fat plant-based diet or no diet changes for 16 weeks. Meal-stimulated insulin secretion markedly increased in the intervention group compared with controls (interaction between group and time, G×t [P <0.001]). This study demonstrates the potential that a plant-based eating pattern can play a role in reversing β-cell dysfunction and peripheral insulin resistance in patients with type 2 diabetes.

Weight management plays an important role in improving insulin sensitivity and glycemic control and reducing cardiovascular disease (CVD) risk factors. Excess body weight is associated with risk of CVD and all-cause mortality among people with type 2 diabetes. Individuals following vegetarian, especially vegan, diets have lower mean BMIs, compared with non-vegetarians. Population studies have revealed that body weight increases progressively with increased meat consumption.

In addition to preventing weight gain, a plant-based eating pattern is an effective weight management tool. In randomised trials, plant-based interventions for patients with type 2 diabetes have resulted in greater weight loss compared with control diets containing animal products, with a major portion of weight loss attributable to a loss of visceral fat, a major advantage for reducing insulin resistance and inflammation. The BROAD study demonstrated significant weight loss using a low-fat (∼7–15% of calories from fat), plant-based diet in overweight individuals with ≥1 of the following comorbidities: type 2 diabetes, ischemic heart disease, hypertension, or hypercholesterolemia. Sixty-five adults (aged 35–70 years) were randomly assigned to the plant-based diet or usual care. The reduction in BMI at 6 months was greater in the plant-based group compared with the usual-care group (4.4 compared with 0.4, difference: 3.9) (95% CI: ± 1, P <0.0001). At 12 months, the reduction in BMI in the plant-based group was 4.2 (±0.8). The program did not require restrictions on portion sizes, yet participants reported feeling satisfied, potentially enhancing compliance.

In a randomised trial of individuals with type 2 diabetes, a low-fat vegan diet prescribed with no energy-intake limits was associated with greater weight loss at 22 weeks, compared with a conventional diet that required energy-intake restrictions (–6.5 kg compared with –3.1 kg [P <0.001]). At 74 weeks, weight loss remained significant within each diet group but was not significantly different between groups (–4.4 kg in the vegan group and –3.0 kg in the conventional diet group, P = 0.25).

In a 24-week trial, researchers tested the effects of plant-based diets when used in combination with other interventions, comparing an isocaloric vegetarian diet (animal products were limited to 1 serving of low-fat yoghurt per day) with a conventional diabetes diet that followed the guidelines of the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes. Aerobic exercise was added to both study groups for the second 12 weeks of the study. The vegetarian intervention resulted in more weight loss (–6.2 kg; 95% CI: –6.6, –5.3 compared with –3.2 kg; 95% CI: –3.7, –2.5; interaction group × time P = 0.001) and greater improvements in insulin sensitivity (30%; 95% CI: 24.5, 39 compared with 20%; 95% CI: 14, 25). Reductions in visceral and subcutaneous fat were significantly greater (P = 0.007 and P = 0.02, respectively) in the vegetarian group.

Weight loss on plant-based diets appears to be attributable to two main diet effects. First, increased fibre and carbohydrate intake and reduced fat intake lead to a reduction in the energy density of the diet. Second, plant-based diets have been shown to increase postprandial metabolism (the thermic effect of food). In a randomised trial, participants with a diagnosis of overweight or obesity (BMI 28–40) were assigned to either a low-fat, vegan diet or to make no dietary changes for 16 weeks. The vegan group lost 5.9 kg (95% CI: 5.0, 6.7 kg; P <0.001) and its thermic effect of food (measured by indirect calorimetry) increased by 14.1% (95% CI: 6.5, 20.4; P <0.001). These changes were associated with reductions in hepatocellular and intramyocellular fat and increased insulin sensitivity.

Plant-based eating patterns for macrovascular and microvascular complications of diabetes

The effects of plant-based diets on glycemia, body weight, plasma lipids, and blood pressure collectively reduce the risk of CVD, the leading cause of morbidity and mortality in diabetes patients. CVD encompasses coronary heart disease, cerebrovascular disease, and peripheral arterial disease. A meta-analysis of 9 randomised controlled trials in patients with type 2 diabetes (N = 664), comparing vegetarian interventions with control diets, showed significant improvements in CVD risk factors, including lipids, blood pressure, glycemic control, body weight, and abdominal adiposity.

In addition to being associated with reduced CVD risk, a plant-based diet may help reverse atherosclerotic plaques. Ornish et al. demonstrated significant regression in coronary artery stenosis in patients with moderate to severe coronary artery disease. Participants were randomly assigned to usual care or a low-fat vegetarian diet combined with exercise, stress management, and smoking cessation. After 5 years there was a mean reduction in atherosclerotic stenosis in the vegetarian group, whereas there was a progression of atherosclerosis in the control group. The control group was also more likely to have required coronary angioplasty and bypass surgery than the vegetarian group.

Microvascular complications

Chronic kidney disease

Chronic kidney disease is increasingly prevalent, and diabetes accounts for 44% of all new cases; 20–40% of patients with diabetes have chronic kidney disease. A Western dietary pattern, characterised by a high consumption of red meat, fat, salt, and sugar, is a major contributor to metabolic disturbances leading to the progression of kidney disease. In the Nurses' Health Study, women with mild renal insufficiency at baseline had a significantly greater reduction in renal function with greater consumption of animal protein (especially from meat) over an 11-year period. In contrast, a 24-year follow-up of 14,868 adults in the Atherosclerosis Risk and Communities Study found that a higher adherence to a healthy plant-based diet was associated with a lower risk of chronic kidney disease.

Several studies have reported a reduction of urinary albumin excretion in patients with diabetic nephropathy when consuming a plant-based or reduced-red-meat diet. One study showed a 54% decrease in urinary albumin in patients with type 1 diabetes after 8 weeks of a plant-based diet. The study by Barnard et al. described above in which patients with type 2 diabetes followed a low-fat vegan diet, reported a significant reduction in urinary albumin in participants following a low-fat vegan diet, with no change in the control group following a portion-controlled diet.

Diabetic neuropathy

More than 50% of individuals with diabetes suffer from neuropathy. Common clinical manifestations include pain, insensitivity to injury, orthostatic hypotension, cardiac autonomic neuropathy, gastroparesis, and erectile dysfunction. Diabetic neuropathy can lead to sleep disturbances, depression, and anxiety, and eventually amputations. Current treatment of diabetic neuropathy includes glycemic control to slow disease progression and medications for neuropathic pain. There is no pharmacological treatment that reverses nerve damage caused by neuropathy, apart from methods for improving glycemic control.

A 20-week randomised, controlled trial using a low-fat, vegan intervention demonstrated improved nerve function, as measured by electrochemical skin conductance in the foot, and reduced pain, compared with an untreated control group. These results are consistent with two smaller studies that used a vegan diet, one combined with exercise in which painful neuropathy symptoms were eliminated in 17 out of 21 patients and another in which cutaneous reinnervation and reduced pain were reported in 30 individuals with impaired glucose tolerance.

Comparing a plant-based diet with key aspects of other dietary approaches for type 2 diabetes

Very-low-calorie diets and metabolic surgery

Reversal of insulin resistance and β-cell dysfunction with associated reductions in pancreatic and hepatic triacylglycerol stores has been demonstrated in patients with type 2 diabetes with very-low-calorie diets (600 kcal/d) or bariatric surgery. These interventions are not free from clinical challenges or risk. Very-low-calorie diets require medical management by trained practitioners and may only be appropriate in select patients. Further, the long-term sustainability of such diets is limited; they are frequently followed by progressive weight gain. Adverse effects of metabolic surgery include mortality (rates 0.1–0.5%), dumping syndrome, nutritional deficiencies, increased risk of depression, and substance abuse. A plant-based diet may provide improvements for diabetes without intentional caloric reduction and may do so independently of weight loss.

Mediterranean and Dietary Approaches for Stopping Hypertension (DASH) diets

Mediterranean and Dietary Approaches for Stopping Hypertension (DASH) diets both emphasise the intake of plant-based foods with controlled portions of animal products. Mediterranean diets have been tested for the prevention and treatment of diabetes. Like a plant-based diet, Mediterranean diets emphasise the consumption of fruits, vegetables, whole grains, and legumes, and reduce meat, refined grains, and sugar, while allowing modest amounts of animal products. The term "Mediterranean diet" may be interpreted differently by different people. In research studies, the term refers to a diet that includes abundant plant-based foods, favours olive oil as the primary source of fat, and includes low to moderate amounts of meat, dairy products, eggs, and wine. A high score (range 0 to 9) for Mediterranean diet-style intake, measured by study participants' consumption of fruits, vegetables, whole grains, legumes, nuts, and fish, and the ratio of MUFAs to SFAs, was associated with a 30% reduced risk of developing diabetes in over 25,000 women followed for 20 years. The high Mediterranean diet scores were associated with lower biomarkers of insulin resistance (adiposity, lipoprotein metabolism, and inflammation). A meta-analysis of 9 randomised controlled trials with 1178 patients with type 2 diabetes compared a Mediterranean diet with control diets resulting in a greater reduction in HbA1c (mean difference, –0.30; 95% CI: –0.46, –0.14). There were also improvements in body weight and cardiovascular risk factors.

The outcomes for weight loss using a Mediterranean diet have been mixed. Although a 2016 systematic review reported that clinical trials using Mediterranean diets showed significant weight loss, all of the included studies used exercise or calorie restriction, confounding the effects of the dietary change. The well-controlled Lyon Diet Heart Study and the Prevención con Dieta Mediterránea (PREDIMED) study led to no clinically significant weight loss. In a crossover trial including 62 overweight adults, a low-fat vegan diet led to significantly greater weight loss over a 16-week intervention period, compared with a Mediterranean diet.

The DASH diet was developed to lower blood pressure

A plant-based diet can improve blood glucose control

A plant-based diet is a powerful tool for preventing and managing type 2 diabetes, and even putting type 2 diabetes into remission. A plant-based diet improves blood glucose control by improving insulin sensitivity and reducing intracellular fat.

The Underlying Cause of Type 2 Diabetes: Fat Accumulation Inside the Cells

Insulin is a hormone secreted from the pancreas in response to rising blood sugar levels after we eat. Insulin acts as a key to unlocking the cells so that the glucose can move from the blood into the cells, where it can be used to produce energy. Most of the glucose gets taken up by our muscle and liver cells. However, too much fat stored inside our muscle and liver cells, as well as elevated free fatty acids in the blood and the resultant inflammation, prevent these cells from functioning normally. For example, when there is too much fat inside our muscle cells, they become insulin resistant, which means they take up less glucose, leading to higher levels of glucose in the blood. This can be due to consuming too many calories in total, and too many calories from saturated fat.

Preventing Type 2 Diabetes

Vegan and vegetarian diets have been consistently found to be protective against developing type 2 diabetes. Specific food groups have also been found to increase or decrease the risk of type 2 diabetes.

• Processed meat: Consuming processed meat is estimated to result in one in five new cases of type 2 diabetes.
• Red meat: Just two servings of red meat per week have been associated with an increased risk of type 2 diabetes.
• Whole grains: Whole grains are protective against type 2 diabetes.
• Fruit: Research has found that those who eat more fruit have a lower risk of developing type 2 diabetes.
• Sugar-sweetened beverages (SSBs): SSBs have consistently been shown to increase the risk of type 2 diabetes.

Managing Type 2 Diabetes

A plant-based diet leads to improved blood glucose control. In a 2006 study, 43% of the vegan group were able to reduce their diabetes medications compared with 26% of the American Diabetes Association (ADA) group. And those following a vegan diet had significantly greater improvements in body weight, HbA1c, and LDL cholesterol.

A 2018 study found that a low-fat, plant-based diet significantly improved the function of beta cells, the pancreatic cells that secrete insulin, and insulin resistance.

A 2020 study found that reducing the fat inside liver and muscle cells improves insulin sensitivity and beta cell function.

Mechanisms by Which a Low-Fat, Plant-Based Diet Improves Glucose Control

• Weight loss: Weight loss, if a person is overweight, is a key factor for improving glycemic control.
• Reduced intracellular fat: Fat accumulating within muscle and liver cells causes insulin resistance. In a 2020 study, reducing the fat inside these cells improves insulin sensitivity and beta cell function.
• Reduced saturated fat intake: A diet high in saturated fat has been shown to reduce insulin sensitivity.
• Increased fiber: Consuming more fiber, which is exclusively found in plants, is associated with improved blood sugar control.

A plant-based diet can improve insulin sensitivity

Weight Management

Plant-based diets are associated with a lower body mass index (BMI) and lower body weight. This is because plant-based diets are high in fiber and carbohydrates, which make people feel fuller for longer, and lower in fat, which is calorie-dense.

Fiber and Phytonutrients

Fiber, which is only found in plant foods, slows down the absorption of glucose and is fermented by intestinal bacteria to produce short-chain fatty acids, which improve the body's response to insulin. Plant-based diets are also high in phytonutrients, which can inhibit glucose absorption, stimulate insulin secretion, and enhance glucose uptake.

Saturated Fat, Advanced Glycation End Products, Nitrosamines, and Heme Iron

Saturated fat, which is primarily found in animal-based foods, contributes to lipotoxicity, a phenomenon in which toxic fat metabolites accumulate in the liver and skeletal muscle cells, impairing insulin signaling and reducing glucose uptake. Advanced glycation end products, nitrosamines, and heme iron are also associated with insulin resistance and are found in high concentrations in animal products.

A plant-based diet can reduce the risk of cardiovascular and microvascular complications

Cardiovascular disease (CVD) is the leading cause of death globally, with diets high in sodium, trans fats, and processed meats, and low in vegetables, fruits, nuts, and seeds, being a significant risk factor. Plant-based diets have been shown to lower all-cause mortality and the risk of ischemic heart disease, as well as optimise blood pressure, glycemic, and lipid control.

Plant-based diets and CVD risk

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend a diet rich in vegetables, fruits, legumes, nuts, whole grains, and fish to decrease Atherosclerotic Cardiovascular Disease (ASCVD) risk. A plant-based diet has been shown to lower the risk of CVD and ischemic heart disease (IHD) in both men and women, with one study finding that a plant-based diet reduced the risk of CVD by 34%.

Plant-based diets and microvascular complications

A plant-based diet has been shown to reduce the risk of type 2 diabetes, with cohort studies demonstrating that the prevalence and incidence of type 2 diabetes are significantly lower among those following plant-based eating patterns compared with omnivores and semi-vegetarians. Plant-based diets are also associated with lower body mass indices, which protects against type 2 diabetes.

Plant-based diets and diabetes treatment

Plant-based diets have been shown to be effective in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications. A plant-based diet has been shown to improve glycemic control and reduce the need for medications, with one study finding that a plant-based diet reduced hemoglobin A1c by 0.39 points compared to control diets.

Plant-based diets and cardiovascular risk factors

Plant-based diets have been shown to reduce the risk of cardiovascular disease and its risk factors, including hypertension, hyperlipidemia, and inflammation. Plant-based diets are associated with lower levels of LDL cholesterol, with one study finding that a vegan diet reduced LDL cholesterol by 12% compared to the American Heart Association (AHA)-recommended diet.

Plant-based diets and microvascular complications

Plant-based diets have been shown to reduce the risk of diabetic nephropathy, with studies finding that a plant-based diet improved renal blood flow and glomerular filtration rate, and reduced the production of trimethylamine N-oxide, a compound linked to insulin resistance. Plant-based diets have also been shown to reduce diabetic neuropathy, with one study finding that a plant-based diet resolved burning neuropathy in 81% of participants.

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