|Diet and Diabetes: Lessons from the Ruby Red Slippers|
|May 1, 2014|
By Caroline Trapp, MSN, CDE, Director of Diabetes
Education and Care for PCRM and speaker at the upcoming Enhancing Health with Plant-Based Nutrition Conference and Portland VegFest this September 26-28.
The 1939 film The Wizard of
Oz provides an interesting
metaphor for a discussion on
type 2 diabetes. In the story,
Dorothy, a young girl, is knocked
unconscious during a tornado.
She and her dog Toto are swept
up in the storm and dropped
into the land of oz, where she
is told that to get back home,
she must follow the yellow brick
road and seek out the magical
wizard. along the way, she meets
the scarecrow, the Tin man and
the cowardly lion, who join her,
hoping to receive what they lack
themselves (a brain, a heart, and
courage, respectively). Together,
they seek out the wizard, only to
learn that he has no answers.
Ultimately, they are rescued when Glinda, the Good Witch of the North, points out that
all along they had possessed exactly what was needed for
happiness. It seems that those dedicated to eradicating type 2
diabetes are on a similar journey.
Like Dorothy and her fellow travellers, we are seeking a road that will
lead us to what is needed: prevention
and reversal of obesity and diabetes.
Yet the road we have long been travel-
ling has not offered a cure. Increased
access to medical care and education,
new medications and bariatric surgery
(now approved as a treatment option
for morbidly obese people with diabetes(1) and currently one of the most com-
mon surgical procedures in the USA(2)
have brought us no closer to curing
diabetes – or preventing it from occurring in the first place. According to
the latest figures from the International
Diabetes Federation, more than 300
million people worldwide are living
with diabetes, a number that is set to
reach half a billion by 2030. If only the
Wizard could save us.
No place like home’s kitchen
But we may have our own version of
Dorothy’s ruby red slippers. In the
story, after a long and dangerous journey, Dorothy comes to
find out that she only needs to
click her heels together and say,
“There’s no place like home.” And
for us, we might heed the same,
slightly more focused lesson: there’s
no place like home’s kitchen.
A PubMed search on vegetarian or vegan
diets and diabetes shows an increasing
amount of research has been devoted to
this intervention, with noteworthy results.
Reducing or eliminating animal products
from the diet is an option that has always
been available, yet is just beginning to be
recognized for its potential in lowering rates of obesity(3), heart disease(4), and certain cancers(5). Population studies confirm
that around the globe diabetes was rare
among those who ate largely plant-based
diets.(6) Furthermore, when people from
those cultures and countries migrate to
wealthy developed countries or adopt a
more meatcentric diet, rates of diabetes
The Adventist Mortality Study demon-
strated that vegetarian men in the USA
had half the risk of developing diabetes,
compared to non-vegetarian men.(7)
2009, a study of 60,903 people showed
that the more animal protein in a diet –
whether from dairy and eggs, fish, fowl
or beef – the higher the risk of diabetes,
with an almost 3-fold difference in risk
between strict vegetarians and non-vegetarians.(8)
Processed meat intake (such as
hot dogs and lunch meats) has been found
to increase diabetes risk by 40%.(9)
Research published in Diabetes Care provides evidence on the effectiveness of a
dietary shift for those with diabetes.(10)
Compared to people following a commonly prescribed, low-cholesterol, portion-controlled diet, those who consumed
unrestricted amounts of whole grains,
vegetables, legumes and fruit (a vegan
or plant-based diet) lost twice as much
weight. Among those in both groups who
had no medication change, those in the
vegan group had a drop in HbA1c that
was three times greater;
43% of those
in the vegan
able to reduce their diabetes medications. Furthermore, the
vegan diet was found to be surprisingly
acceptable to those who were randomized
to it, largely because there were no portion or caloric restrictions and high fiber foods promote satiety.
Based on this research, a low-fat plant-
based diet has been determined to be
effective for people with type 2 diabetes, according to the 2010 American
Diabetes Association’s Clinical Practice
Recommendations: Standards of
Medical Care for Type 2 Diabetes.(11)
The American Dietetic Association has
stated that properly managed vegan diets have been shown to be nutritionally
adequate, safe across the lifespan, and
effective for preventing and treating
many chronic diseases.(5)
Dietary change is often difficult and
many barriers must be overcome for
individuals or groups to make and sustain any change in diet, including to a
plant-based diet. Clinicians, educational
institutions, NGOs and governments
can begin by simply promoting information about the effectiveness of this
approach. They can encourage people to
consume a diet of plant foods and warn
of the dangers of consuming animal fat
With the knowledge already available
to us, we can find a better path. The
solution to diabetes is not somewhere
“over the rainbow.” It may be found in
an effective, safe, affordable, and ecologically sustainable nutritional
approach: a diet comprised of
whole grains, fruits, vegetables,
Caroline Trapp is Director of Diabetes
Education and Care for the Physicians
Committee for Responsible Medicine in
Washington, USA (firstname.lastname@example.org).
The Physicians Committee for Responsible
Medicine (PCRM) is a USA-based not-for-profit organization. It offers support for
healthcare professionals and the general public
who want to learn more about or use plant-
based nutrition for diabetes, heart disease,
weight control, and other health concerns.
Diabetes education materials are available here.
1. Standards of medical care in diabetes – 2009.
Diabetes Care 2009; 32 Suppl 1: S13-61.
2. Anstett P. Experience in bariatric surgery lessens
problems. Detroit Free Press. July 28, 2010; A: 5.
3. Berkow SE, Barnard N. Vegetarian diets and
weight status. Nutr Rev Apr 2006; 64: 175-88.
4. Ornish D, Scherwitz LW, Billings JH, et al.
Intensive lifestyle changes for reversal of
coronary heart disease. JAMA 1998; 280: 2001-7.
5. Craig WJ, Mangels AR. Position of the
American Dietetic Association: vegetarian
diets. J Am Diet Assoc 2009; 109: 1266-82.
6. Campbell TC, Campbell TM. The China
study : the most comprehensive study of
nutrition ever conducted and the startling
implications for diet, weight loss and long-term
health. 1st BenBella Books. Dallas, 2005.
7. Snowdon DA, Phillips RL. Does a vegetarian
diet reduce the occurence of diabetes.
Am J Public Health 1985; 75: 507-12.
8. Tonstad S, Butler T, Yan R, Fraser GE. Type of
vegetarian diet, body weight, and prevalence of
type 2 diabetes. Diabetes Care 2009; 32: 791-6.
9. Aune D, De Stefani E, Ronco A, et al.
Meat consumption and cancer risk: a
case-control study in Uruguay. Asian
Pac J Cancer Prev 2009; 10: 429-36.
10. 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: 1777-83.
11. Standards of medical care in diabetes – 2010.
Diabetes Care 2010; 33 Suppl 1:S11-61.
Reprinted with kind permission from Caroline Trap and the Journal of the International Diabetes Federation.
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