Clinical Briefs
With Comments from John La Puma, MD, FACP
Vegan Diet and Diabetes Management
March 2000; Volume 3: 36
Source: Nicholson AS, et al. Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Prev Med 1999; 29:87-91.
We investigated whether gly-cemic and lipid control in patients with non-insulin-dependent diabetes (NIDDM) can be significantly im-proved using a very low-fat, vegetarian (vegan) diet. Thirteen subjects with NIDDM (ages 34-74) recruited from the community were randomly assigned to a very low-fat high complex carbohydrate vegan diet (seven subjects) or a conventional low-fat diet (four subjects); 11 completed the study. The diets were not designed to be isocaloric. Fasting serum glucose, body weight, medication use, and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks. Serum lipids, glycosylated hemoglobin, urinary albumin, dietary macronutrients, and exercise levels were assessed at baseline and 12 weeks.
We observed a 28% mean reduction in fasting serum glucose in the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dL), which was significantly greater than a 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dL), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, and 3.8 kg in the control group (P < 0.005). Of six experimental group subjects on oral hypoglycemic agents, medication use was discontinued in one and reduced in three. Insulin use was reduced in both experimental group patients on insulin. No patient in the control group reduced medication use.
Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance; however, high-density lipoprotein concentration fell more sharply (0.20 mmol/L) in the experimental group than in the control group (0.02 mmol/L) (P < 0.05). The use of a very low-fat, vegan diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise.
COMMENT
Most type II diabetic patients are obese. Current nutritional wisdom counts on counting carbohydrates for better glycemic control. These investigators took a different approach.
They show that motivated, overweight, and medication-dependent diabetics can eat a very low-fat diet, reduce their body weight, and lower their fasting glucose levels over a 12-week period. Changes in glycosylated hemoglobin were not significantly different between the two groups at 12 weeks.
These investigators prescribed Dean Ornish’s original heart disease reversal diet, minus the egg whites: 10-15% protein, <10% fat, and the remainder ad lib unrefined complex carbohydrates. B12 supplements alone were recommended after the study period. Catered lunches and dinners were distributed over the 12-week study; most participants used them. Twice-weekly support groups of uncertain duration and participation, as well as cooking and nutrition classes, were offered. Subjects met with a physician or a nurse every two weeks to assess medication needs, and to measure vital signs, weight, and fasting glucose.
Weaknesses in this study include the small numbers over a short period; inequalities at baseline in exercise and urinary albumin; uncertainty about the method of randomization; and the likely difficulty in reproducing these methods in a general or even specific population. It is not clear whether the benefit derived was from the diet or from weight loss.
Recommendation
Recommend that your diabetic patients find a medically based weight management plan that serves them when eating in and when eating out, for the long term. The healthiest way to do this overall is to put fruits, vegetables, grains, and legumes in the middle of the plate, and fish and other animal foods on a side plate.
March 2000; Volume 3: 36
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content