Intended for healthcare professionals

Editor's Choice

Food fights

BMJ 2018; 360 doi: (Published 15 March 2018) Cite this as: BMJ 2018;360:k1190

Re: Food fights

Dear Fiona,

I read your editorial note and feature on nutrition in this week’s BMJ with interest, and was delighted to see information about how a very low calorie diet, and a low carb diet can help improve Type II diabetes.

However, one important area of dietary modification that has not been mentioned at all (and perhaps the most important piece in the puzzle - as it reduces insulin resistance which is the main mechanism of harm in Type II diabetes) is a whole-food plant-based diet. There are many studies highlighting the mechanisms by which intramyocellular lipid is created (the consumption of transfats and animal fats directly contributes to this process) and how this causes increased insulin resistance. Some of these studies I have included below. Studies have also shown that this diet is as well tolerated long-term as a low carb diet. Arguably more so, as healthy carbohydrates are not restricted, so satiety is achieved without calorie counting or hunger. This is the likely key to reversing Type II diabetes rather than simply putting it in remission, or managing it with medications. I have also personally seen tremendous results amongst my patients who have begun to eat this way.

Your recent editorial piece on the harms of processed meats and the WHO classification of red meat as a class two carcinogen, as well as the devastation caused to the planet’s delicate ecosystem through animal agriculture and the meat and dairy industry, make the health benefits of a mostly plant based diet all the more compelling.

I hope to see whole-food plant-based nutrition and the overarching health benefits of this way of eating on our top killers in the western world - cardiovascular disease, cancer and diabetes - to be recognised in the lecture series you publish in June.

I look forward to your response,

Ley SH, Hamdy O, Mohan V, et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383:1999–2007

Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009;89:1588s–1596s. [PMC free article] [PubMed]

Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54:2506–2514.

Barnard ND, Katcher HI, Jenkins DJ, et al. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67:255–263. [PubMed]

Vang A, Singh PN, Lee JW, et al. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab.

Lee YM, Kim SA, Lee IK, et al. Effect of a brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12-week randomized clinical trial. PLoS One. 2016;11:e0155918. [PMC free article] [PubMed]

Barnard ND, Gloede L, Cohen J, et al. A low-fat vegan diet elicits greater macronutrient changes, but is comparable in adherence and acceptability, compared with a more conventional diabetes diet among individuals with type 2 diabetes. J Am Diet Assoc. 2009;109:263–272. [PMC free article] [PubMed]

Ye EQ, Chacko SA, Chou EL, et al. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr. 2012;142:1304–13.

Cooper AJ, Forouhi NG, Ye Z, et al. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur J Clin Nutr. 2012;66:1082–1092. [PMC free article] [PubMed]

Rizkalla SW, Bellisle F, Slama G. Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. Br J Nutr. 2002;88(Suppl 3):S255–S262. [PubMed]

Hosseinpour-Niazi S, Mirmiran P, Hedayati M, et al. Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial. Eur J Clin Nutr. 2015;69:592–597. [PubMed]

Jenkins DJ, Kendall CW, Augustin LS, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012;172:1653–1660. [Pu

Fretts AM, Follis JL, Nettleton JA, et al. Consumption of meat is associated with higher fasting glucose and insulin concentrations regardless of glucose and insulin genetic risk scores: a meta-analysis of 50,345 Caucasians. Am J Clin Nutr. 2015;102:1266–1278. [PMC free article] [PubMed]

Feskens EJ, Sluik D, van Woudenbergh GJ. Meat consumption, diabetes, and its complications. Curr Diab Rep. 2013;13:298–306. [PubMed]

Kim Y, Keogh J, Clifton P. A review of potential metabolic etiologies of the observed association between red meat consumption and development of type 2 diabetes mellitus. Metabolism. 2015;64:768–779. [PubMed]

van Nielen M, Feskens EJ, Mensink M, et al. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study. Diabetes Care. 2014;37:1854–1862. [PubMed]

Viguiliouk E, Stewart SE, Jayalath VH, et al. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2015;7:9804–9824. [PMC free article] [PubMed]

Mari-Sanchis A, Gea A, Basterra-Gortari FJ, et al. Meat consumption and risk of developing type 2 diabetes in the SUN Project: a highly educated middle-class population. PLoS One. 2016;11:e0157990. [PMC free article] [PubMed]

Singh I. Low-fat diet and therapeutic doses of insulin in diabetes mellitus. Lancet. 1955;268:422–425. [PubMed]

Kempner W, Peschel RL, Schlayer C. Effect of rice diet on diabetes mellitus associated with vascular disease. Postgrad Med. 1958;24:359–371. [PubMed]

Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32:2312–2321. [PubMed]

Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006;29:1777–1783. [PubMed]

Yokoyama Y, Barnard ND, Levin SM, et al. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014;4:373–382. [PMC free article] [PubMed]

Campmans-Kuijpers MJ, Sluijs I, Nothlings U, et al. Isocaloric substitution of carbohydrates with protein: the association with weight change and mortality among patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:39. [PMC free article] [PubMed]

Sargrad KR, Homko C, Mozzoli M, et al. Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus. J Am Diet Assoc. 2005;105:573–580. [PubMed]

Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010;10:152–158. [PubMed]

de Koning L, Fung TT, Liao X, et al. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93:844–850. [PMC free article] [PubMed]

Kitessa SM, Abeywardena MY. Lipid-induced insulin resistance in skeletal muscle: the chase for the culprit goes from total intramuscular fat to lipid intermediates, and finally to species of lipid intermediates. Nutrients. 2016;8:466. [PMC free article] [PubMed]

Kahleova H, Matoulek M, Malinska H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med. 2011;28:549–559. [PMC free article] [PubMed]

Trapp C, Barnard N, Katcher H. A plant-based diet for type 2 diabetes: scientific support and practical strategies. Diabetes Educ. 2010;36:33–48. [PubMed]

Yours sincerely,

Gemma Newman

GP Ashford, North West Surrey

Competing interests: No competing interests

20 March 2018
Gemma S Newman
GP in Ashford, Surrey
The Orchard Surgery, Ashford