The Role of Plant Based Diets in Diabetes Prevention and Management

For people living with type 2 diabetes, many diet recommendations are thrown about as a means to control blood glucose levels and manage their overall condition.

However, unlike popular fad diets that ebb and flow into popularity every few years, plant based diets for diabetes are a common stay for their numerous health benefits. Many cultures, religions, and, more recently, scientific communities agree that going plant-based can be the right step toward body wellness.

Here’s the evidence for plant-based eating patterns provided by scientific research bodies and how they relate to improved wellness for people living with type 2 diabetes and similar conditions.

Many religious communities, like the Seventh Day Adventist Church, follow a plant-based diet that excludes most animal products as part of their belief system. An initial study was conducted on over 25,000 Adventist Church members starting in 1960, which followed the subjects for 21 years. It found that non-vegetarian females had 1.4 times the risk of developing diabetes compared to those who followed a vegetarian diet. The ratio for males was higher, at 1.8 times.

A second study went into more detail, comparing lacto-ovo vegetarians, pescetarians, semi-(flexible) vegetarians, and non-vegetarians to those following an entirely vegan diet. It found that the risk of type 2 diabetes graduated in this pattern:

• Lacto-ovo vegetarians: 3.2%

• Pescetarians: 4.8%

• Semi-vegetarians: 6.1%

• Non-vegetarians: 7.6%

• Vegans: 2.9%

These results suggested becoming more reliant on plant-based foods as an effective strategy to prevent type 2 diabetes.

Plant-based diets are gaining traction for the remarkable results they offer to people living with prediabetes, sometimes reversing the condition completely . This was proposed to be the result of multiple factors related to diabetes:

Chronic inflammation is a condition where certain types of the body’s tissues release chemicals (cytokines) that incite a reaction mimicking tissue injury. When the body has to deal with a large amount of these chemicals, it starts to display symptoms of chronic systemic disease.

The conditions where chronic inflammation is implicated include obesity, cardiovascular disease, high cholesterol and triglyceride levels, gallstones, some types of cancer, and type 2 diabetes.

Eating a diet high in red and processed meat has been proven to highly increase inflammation markers . When these foods are reduced or completely eliminated, like in vegetarian and vegan diets, the basal inflammation level drops significantly.

Insulin is a hormone released by pancreatic beta cells to move blood glucose into the body’s cells, to be used either as fuel for cell activity or stored for later use as fat tissue.

Insulin sensitivity is the measure of how receptive the cells are to insulin. It’s affected by the body's inflammation levels, stress, and weight.

Insulin resistance is a condition where the body’s cells aren’t as sensitive to naturally produced (endogenous) insulin. It results in blood sugar spikes and an overworked pancreas trying to keep up.

Another metabolic result of eating red and processed meats is increased insulin resistance. There’s also some evidence pointing toward heme iron, a compound found in high concentrations in red meat, causing damage to pancreatic beta cells , which affects insulin release.

The abundance of fiber in vegan and vegetarian diets allows the gut microbiome to flourish with beneficial bacteria, called probiotics. Increasing your intake of vegetables, nuts, seeds, and whole grains has this effect, even if you don’t completely switch to a meat-free diet.

The gut microbiome has recently become the subject of multiple studies that connect its bacterial flora with the likelihood of metabolic diseases. For example, the gut microbiome of people living with type 2 diabetes who are obese or overweight was compared to people with normal glucose metabolism and BMI, and differences implicating the gut microbiome in developing insulin resistance were found.

A specific study that used fecal microbiota transplantation (FMT) donated from people with normal glucose metabolism to people with insulin resistance found that the FMT helped them lower their BMI and increased their insulin sensitivity.

This specific area is a little more gray than other scientific findings on how a plant-based diet can improve insulin sensitivity and metabolism. However, it’s not controversial to claim that it’s harder to overstep your daily caloric needs on a healthy plant-based diet.

Eating a diet high in processed plant-based food, most of which is usually carbohydrates, can however contribute to a higher BMI. That said, sticking to a whole foods, plant-based diet allows your body to have a suitable caloric deficit. This should help if you’re trying to lose weight healthily, without depriving your body of essential nutrients.

The short answer is yes, a plant-based diet can promote remission of type 2 diabetes.

Type 2 diabetes remission is defined as having a glycosylated hemoglobin (HbA1c) level of < 6.1 without medication, except for oral metformin. This result was achieved in a cohort study published by the International Journal of Diabetes and Clinical Research.

The cohort included 83 type 2 diabetes patients aged 20 years or older, with an emphasis on elderly subjects. The mean age of the participants was 70.1, so most of them had been diagnosed for some time.

The study found that a high-fiber, low-fat, and calorie-restricted plant-based diet helped reduce several metabolic parameters like BMI, fasting blood glucose, and HbA1c.

The study also shows that a low-fat, high-fiber plant-based diet can reduce cardiovascular risk factors through control of systolic & diastolic blood pressure, LDL (bad) cholesterol, as well as triglycerides, while slightly boosting HDL (good) cholesterol.

This is significant because people living with type 2 diabetes are at a higher risk of developing cardiovascular diseases, which is a condition called Metabolic Syndrome .

It was previously recommended for type 2 diabetes patients to adopt a Mediterranean diet, a ketogenic diet, or an omnivorous low-fat diet, to mixed outcomes. These results show the potential outcome of promising a plant-based diet to people living with diabetes who would like to manage their condition through dietary and lifestyle changes.

Diabetes is a systemic condition that affects the whole body’s organs. It’s also a degenerative disease, which means it causes further damage as it progresses.

Unfortunately, many of the changes caused by chronic diseases cannot be reversed. However, stopping the disease progression and preventing further damage should be the focus of the patient and their diabetes care team.

Here are some diabetes complications and more on how a plant-based diet affects their prevalence:

Neuropathy is an outcome of uncontrolled diabetes, affecting the small blood vessels at the ends of the limbs, especially the feet. The condition causes stinging, burning, or numbness and a complete loss of sensation in the feet or legs.

The issue is compounded by impaired wound healing, which is another diabetes complication. This can result in open wounds liable to infection that can progress into lower-limb amputation in some cases.

Although the complete loss of sensation due to nerve damage can’t be reversed, a systematic review of multiple studies found that a plant-based diet can alleviate the pain that comes with diabetic polyneuropathy.

Kidney disease, or diabetic nephropathy, is a common outcome of diabetes due to the passage of large glucose molecules into the undiagnosed patient’s urine. It was found that red and processed meat is a culprit in developing kidney disease, which can compound the inflammatory effect of type 2 diabetes.

That’s why the National Kidney Foundation recommends a plant-based diet to improve the symptoms of diabetic nephropathy.

Diabetic retinopathy is the most common eye problem that results from having diabetes for a long time. It’s a condition that starts by having unfocused, blurry vision, progresses into a loss of peripheral vision, and can conclude with complete retinal detachment and loss of vision in one or both eyes.

A case report and review from 2019 followed a 65-year-old female patient for a few months after she was advised to follow a plant-based diet to control other diabetes symptoms. It was found that after 6 months of a change in diet and exercise habits, diabetic macular edema in her right eye had completely regressed after her type 2 diabetes went into remission.

This proves that, although other factors can help, a plant-based diet has the potential to improve or reverse diabetic retinopathy.

Diabetes contributes to a higher incidence of cardiovascular complications and has been found to have similar causative factors to multiple cancers. This can lead to premature death among people with diabetes when compared to the general population.

A recent 2023 study found that adhering to a low-carbohydrate diet reduced the likelihood of total, cardiovascular, and cancer death among 10,000 participants with type 2 diabetes.

Now that you have all the “hard evidence” that plant-based is the way to go to control your blood sugar levels, the next question to answer is which plant-based eating pattern suits your needs the most.

On the one hand, the less animal products you consume, the better the health outcomes. Most studies focus on entirely plant-based, particularly vegan, diets as their benchmark for health benefits.

On the other hand, highly restrictive dietary patterns have a lower chance of being sustainable for long-term health improvement. Many people feel burned out after a while, especially if they’re not seeing results at the speed they’ve been expecting.

Dieticians recommend you start incorporating more plant-based foods into your daily meals instead of focusing on removing particular foods from your diet. This strategy is called a “plant-forward” diet, which aims to sustainably replace most animal products in your diet with those of plant origin while minimizing the unpleasant side effects of restriction.

Lowering your diabetes risk and improving your overall health is worth changing your habits. With a little effort in adopting plant-forward, vegan, or vegetarian eating patterns, you should find a lot of considerable improvement in your overall well-being.

Recent scientific studies, reports, and reviews have shown a huge role played by plant-based diets in diabetes prevention and management. These aim to provide a realistic approach to reducing the risk of developing diabetes complications while improving other biological markers in the process.

You don’t have to immediately go vegan to reap these benefits. Just incorporating more plant-based foods into your diet and working toward eliminating processed animal products should help you reach your health goals.