Plant-based diets have moved to the mainstream in recent years, and many people who live with diabetes today are considering adopting a vegan or otherwise plant-centric diet.
In this article, we look at the pros and cons of following a plant-based diet as a scientifically researched diabetic person.
If you follow a plant-based diet
Being diagnosed with type 1, type 2, or prediabetes is a life-changing event, but there are ways to reduce the symptoms, complications and stress associated with diabetes.
One of the most important ways to reduce the burden is to switch to a more whole food plant-based lifestyle.
In fact, in 2018, the American Society of Clinical Endocrinology (AACE) and the American Society of Endocrinology (ACE) released guidelines recommending a plant-based diet as an ideal nutritional plan for diabetics. This is because you can improve your overall health and have better control over your condition.
In 2022, the American School of Lifestyle Medicine (ACLM) issued an expert consensus statement supported by the AACE, supported by the Academy of Nutrition and Tietetics (and), co-hosted by the Endocrine Society, which states that “nutrition interventions as dietary as dietary as a major intervention for T2D are the most effective and most effective in highlighting plant-based foods.”
Today, poor or “suboptimal” nutrition is the main cause of an increase in obesity, chronic diseases, and early death epidemics around the world.
A suboptimal diet includes lots of sodium, saturated fats, and sugar additions, and low in healthy fats, dietary fiber and other important nutrients. These nutrients are found in foods such as fruits, vegetables, nuts, seeds, whole grains and legumes.
It was associated with 45.4% of all deaths related to heart disease in the United States in 2012.
However, studies have shown that switching from a more suboptimal diet to a WFPB diet in people with diabetes or prediabetics can significantly reduce insulin requirements and reduce A1C, as well as increase weight loss, reduce total cholesterol and improve physical quality.
So let’s dig into some research.
Dietary Terminology
While a plant-based diet is generally healthy and associated with a reduced risk of several chronic diseases, the extent of benefits in managing diabetes depends on the particular type of plant-based diet employed.
There are many versions of the plant-based diet, but for brevity, we’ll explain the following:
- Vegetarian diet
- Vegan diet
- WFPB Diet
vegetarian: People who follow the vegetarian diet do not eat meat, chicken or fish, but may consume dairy products and eggs.
Vegan: Those who follow the vegan diet do not eat foods that are either fully or partially derived from animals.
WFPB: Those consuming the WFPB diet avoid most or all animal products and focus on high consumption of whole, minimal, and unrefined ingredients from foods such as fruits, vegetables, legumes, seeds, whole grains, nuts, seeds, and other foods. This diet is usually low in fat, high in fiber and medium protein.
What is the difference between the vegan diet and the WFPB diet?
One of the key reasons why distinguishing between vegan and WFPB diets is the quality of the food. High quality determines the level of health benefits.
For example, if a person lives only by vegan rules to avoid eating animal products, they can indulge in a diet that is technically highly processed, high in sodium, high in sugar, high in saturated fat, low in dietary fiber.
In theory, a strict vegan diet consists of:
- Breakfast: Betty Crocker Biskick original pancakes topped with golden griddle syrup (Made with corn and high fructose corn syrup))
- Lunch: Smucker’s Peanut Butter and Jelly Sandwich (It is made of White bread))
- Snack: Ray’s Classic Potato Chips (It’s rich in salt))
- Dinner: Serving of Ore Itta Golden Tater Tots with Thai Kitchen Hot & Sour Noodle Soup Bowl and Ketchup Sides (Among other issues, more high fructose corn syrup and sodium))
- Dessert: One large Duncan Hines California Walnut Brownie Mix topped with Duncan Hines Chocolate Whip Frosting (Comes with corn syrup))
The vegan WFPB diet will look more like:
- Breakfast: Blackberry smoothie bowl topped with coconut flakes, pepitas (pumpkin seeds), and fresh fruit
- Lunch: Sweet potato stuffed with mashed avocado and roast chick beans
- Dinner: Spaghetti squash noodles with extra virgin olive oil and garlic
- Dessert: Hempseed Energy Bite
Although both meals are vegan, there are significant differences in the quality and nutrition of the foods eaten.
When eating the WFPB diet, what changes can you expect to experience in diabetes?
Once started, your blood sugar levels can change almost immediately or decrease gradually over a few weeks or months.
The clinical changes you may see are reduced insulin resistance and insulin requirements, lower A1C, weight loss, and lower total cholesterol and blood pressure.
What changes do you see insulin in plant-based diets?
Especially when looking at insulin, dosages may need to be adjusted with the help of a healthcare provider (HCP), such as a primary care physician (PCP), endocrinologist, or certified diabetes care and education specialist (CDCE). Reductions vary widely depending on your needs and how closely you stick to your diet.
The parameters that you may need to adjust are:
For those using multiple daily injections (MDI):
For insulin pump users:
- Correction coefficient
- Insulin to carbohydrate ratio
- Base rate
It is not recommended to adjust these settings without HCP guidance. However, it is expected that the ratio of correction factors to insulin to carbohydrates will increase. This can be confusing at first glance, but these numbers use inverse ratios. In other words, the higher the number, the less insulin.
For example, let’s say you have a 1:12 insulin to carbohydrate ratio. This means that you need one unit of short-acting insulin to cover 12 grams of carbohydrates.
After that, start eating the WFPB diet and be aware that when you administer insulin to 12 grams of carbohydrates, the dosage is causing hypoglycemia. HCP then increases the insulin to carbohydrate ratio.
In this example, we say it is increased to 1:15. This means that one unit of short-acting insulin covers 15 grams of carbohydrates, returning blood sugar levels to the target after meals and snacks.
This same situation can occur with correction factors, or the amount of insulin needed to bring blood glucose into the target range. For example, if you’re used to the 1:25 (1 unit of 25 mg/dL) correction factor after starting the WFPB diet, that correction may be too much and you may need to increase the ratio.
Consult your doctor or CDCE when changing these settings. Just like major dietary changes, it is important to closely monitor your blood sugar levels and adjust insulin as needed.
For those who are seeing an increase in blood sugar levels on the WFPB diet, this doesn’t necessarily mean that this new diet isn’t working, and you may need to change your approach or your body may need extra time.
For positive health benefits to occur, you must eat a low-fat, minimal treatment, and of course a plant-based WFPB diet. For more effective glycemic control, we focus on consumption of lower diabetes index (GI) foods.
If you have any questions about what to eat with this type of diet, talk to a registered dietitian (RD).
Do you see changes in blood pressure eating the WFPB diet?
Many people with diabetes also take blood pressure medications. If this is you, try to increase your blood pressure treatment with HCP before switching to this diet.
It is also important to discuss the symptoms and treatment of hypotension during that visit. New dietary patterns can help lower blood pressure levels naturally and require adjustments in the dose of blood pressure medication.
Do I need to talk to a healthcare provider before starting a plant-based diet?
Before starting the WFPB diet, consult with your HCP to discuss any drug changes that may be necessary for insulin resistance and weight loss.
Also, make sure you know how to treat hypoglycemia. A sudden switch from a regular dietary plan to eating a WFPB diet can significantly reduce insulin resistance. This means that diabetic patients who use oral diabetes medications or insulin may experience hypoglycemia.
What if you can’t handle beans in a plant-based diet?
Plant-based diet: According to a doctor’s guide, the ideal recommended intake of legumes (lentils, beans, peas) for plant-based diets is about 1/2 cup per day. To the average person, it may seem like a lot, and even brings you a bit of anxiety due to the past experiences of the beans.
Some people may find that they can’t stand the beans because of flatulence. But don’t worry. Adding beans and other legumes to your diet is a step-by-step process, and when you consume these foods regularly, your body will adjust over time.
Start small legumes such as peas and lentils as they are easy to digest. Also, if you are soaking dry beans, make sure to soak them thoroughly and throw away any water used to soak them.
When introducing legumes into your diet, start with a small amount and gradually increase to 1/2 cup per day, depending on your tolerance. Remember, strengthening your fiber intake through legumes requires hydration levels that help you digest.
For those who cannot tolerate the entire legume due to their digestive state, alternatives such as tempeh and tofu (both minimally processed and fermented bean products) will calm your stomach, providing ample plant-based protein.
Legumes are filled because they are very nutritious and have a high amount of dietary fiber and plant protein. They are a staple on the WFPB diet, but again, if you are switching from a normally bean-free diet, add it gradually over a few weeks.
If you have diabetes, are there any special considerations for eating plant-based foods?
Vitamin B12, also known as cobalamin, is a nutrient necessary to produce red blood cells, nerves, and DNA and perform other necessary functions. Vitamin B12 cannot be produced by the body, so it is important to obtain it through food or supplements.
Vitamin B12 is found mainly in meat, eggs, chicken, and other foods that come from animals. Plant-based sources of vitamin B12 are limited to fortified foods such as shiitake mushrooms (low amounts of B12), algae (seaweed/Nori), and nutrient yeast. Because plant-based sauces are so low, strictly vegan diets can cause vitamin B12 deficiency.
Additionally, some diabetic drugs containing metformin at certain doses are associated with lower levels of vitamin B12. Therefore, diabetic patients treated with metformin should be screened regularly for B12 deficiency, especially for large doses (over 1,500 milligrams per day) and for long-term (over 2 years).
Other factors that may increase the risk of vitamin B12 deficiency are those over 50 years of age and have undergone weight loss surgeries, such as gastric bypass.
What are the symptoms of vitamin B12 deficiency?
Vitamin B12 deficiency is serious and early detection is important. Vitamin B12 deficiency can cause fatigue, constipation, weakness, loss of appetite, weight loss, and megalithoblastic anemia.
Having a vitamin B12 deficiency can also increase nerve problems such as numbness and tingling in the hands and feet. Other symptoms of vitamin B12 deficiency include balance, confusion, depression, poor memory, dementia, and problems with mouth or tongue pain.
A thorough HCP assessment may be able to detect vitamin B12 deficiency, but blood tests are required to confirm the diagnosis.
Do you get enough protein to eat the WFPB vegan diet?
We need enough protein to supply the dietary nitrogen and amino acids our cells need to grow and maintain.
The USDA recommends at least 46 grams of protein for adult women and 56 grams per day for adult males. (Protein recommendations may differ for people with chronic kidney disease (CKD).
The WFPB diet can fill this amount of protein by including protein-rich plants such as beans, peas, lentils, peanuts, almonds, quinoa, chia seeds, hemp seeds, and soy foods.
Eating a diet based entirely on plants requires all the essential amino acids and nutrients you need, without the need for special food supplements or combinations. Furthermore, eating a diet in which protein comes from plants alone is associated with weight loss and reduced insulin resistance.
What about kidney health on the WFPB Vegan diet?
A particularly attractive benefit for people with long-standing diabetes is that high intake of plant protein is associated with a lower rate of renal failure. In other words, diets that replace animal proteins with plant proteins have proven to be more protective of kidney health.
Traditionally, dietary recommendations for people with chronic kidney disease have been to limit the intake of many plant-based foods due to high potassium levels. However, this recommendation has been reassessed in light of several benefits associated with a more whole food, plant-based (WFPB) diet.
These benefits include improved gut health, reduced toxin formation, and increased dietary fiber, which increases gut regularity and short-chain fatty acid production. Short chain fatty acids help stop the growth of harmful intestinal bacteria, improve mineral absorption (such as calcium), reduce blood glucose response to food, and promote bloating and weight loss.
A condition called metabolic acidosis in CKD is exacerbated by eating a diet containing meat and refined grains, increasing the burden of dietary acid. Fruits and vegetables, on the other hand, help to achieve the opposite by neutralizing the acid.
High levels of phosphorus are also a known cause of cardiovascular events and death in people with CKD. However, the majority of hyperphosphorusia comes from highly processed, convenient foods, meat, dark-colored sodas and dairy products, which means eating more WFPB diets and lower phosphorus intake. Certain plant-based foods are also higher in phosphorus such as beans and nuts, but the intestinal absorption of phosphorus from plant-based sources is significantly lower than that of animal-based sources.
Another benefit of the WFPB diet is its high content of magnesium and vitamin K, a nutrient that is often lacking in people with CKD. Eating a variety of plant-based diets can help you deal with these defects. Furthermore, anti-inflammatory properties and ability to reduce oxidative stress associated with the WFPB diet may contribute to slowing CKD progression.
For people with CKD, we recommend managing nutritional potassium, especially if you consume a plant-rich diet. Certain cooking techniques can help reduce potassium levels in vegetables.
These techniques include boiling or leaching. There, vegetables are cut into small pieces, soaked in large amounts of water for several hours, then drained and rinsed before cooking. This process helps to leach some of the potassium, making these foods more suitable for low potassium diets.
However, if you have CKD, it is essential to refer to your HCP or RD for personalized guidance on managing potassium intake through diet and cooking methods. Careful management of potassium levels is important when tracking WFPB diets, as dietary needs and health considerations differ significantly among people with CKD.
How do I start a plant-based diet?
Below are eight tips to get started on the WFPB diet for diabetes.
Diet based on vegetables. Place a variety of non-flexible vegetables, including mixed-leaf greens, mung beans, roasted Brussels sprouts, cauliflower, broccoli, asparagus, and cabbage in at least half the plate.
Add meat to accent. When eating meat, reduce the amount and accent it instead of the main focus of your meal.
Please select Whole Foods. Choose whole, minimally processed or unrefined foods, such as fruits and vegetables, legumes, whole grains, nuts and seeds.
Please choose high fiber. The more fiber you have, the less likely your food will cause a blood glucose response. This can be extremely helpful for diabetics. Choose foods such as berries, cruciferous vegetables, nuts, seeds, and lush greenery.
Upgrade your fat. Exchange healthy fats with highly processed saturated fats from whole plant sources such as avocados, olives, nuts and seeds. Limit fat from oils – more nutrients are obtained from eating whole foods.
Make a “Buddha bowl.” Place salad greens such as romaine, spinach, kale and other lush greens in a bowl, and put a variety of legumes and vegetables such as beans, peas, edamame, brussels sprouts and sauteed mushrooms.
Eat fruit for dessert. Enjoy a bowl of fresh berries, a crispy apple with peanut butter, or a “nice cream” blended banana to satisfy your sweet teeth after meals.
Please consult your doctor. As you change your diet, it is important to coordinate your insulin and medication with guidance from your healthcare team.
Final Thoughts
Eating the WFPB diet has many potential health benefits for people living with diabetes. However, you do not need to completely eliminate animal products from your diet to receive these benefits.
By definition, plant-based means that the foundation of your diet comes from plants, but that doesn’t mean that all animal products need to be removed completely from your diet.
Eating highly restrictive diets, such as those without animal products, can be difficult to maintain and can contribute to disrupting eating patterns in some people.
Therefore, if you decide to eat the WFPB diet, it should be considered a lifestyle, not an extreme meal that does not allow wiggling rooms.
