When Christine Fallabel in Colorado noticed the long list of ingredients for "all-natural turkey" at a national sub sandwich shop, her first impulse was a reactive "yuck." Soon after, she began plant-based eating. That was at age 14, two years after her diagnosis with type 1 diabetes in 2000.
Ever since, Christine's been eating "clean" and hasn't looked back -- especially when it comes to life with diabetes and balancing the never-ending glucose roller coaster.
Meanwhile in Oklahoma, longtime type 1 Ryan Fightmaster began eating a plant-based diet a few years ago, mostly out of curiosity after hearing about general health benefits. What he found was that eating this way knocked his insulin needs down by roughly a third and led to better BG levels, so he's kept a up a "whole food" diet with fewer carbs.
Say hello to a trend that many in the Diabetes Community seem to be turning to: plant-based eating for better health and glucose control.
As with any special eating plan, the universal question remains: does it really make a difference? Or is this just another fad diet that will come and go?
While there were no specific sessions devoted solely to plant-based eating at the American Association of Diabetes Educators (AADE) annual meeting in Indianapolis in early August, the topic did come up a handful of times during related talks -- not surprising at an event jam-packed with dieticians and nutritionists, some living with diabetes and eating this way themselves.
In fact, this is a pivotal time for considering these healthier food choices. Canada just recently released draft guidance encouraging citizens to eat more plants and whole foods, while some European countries want the same, and the U.S. national dietary recommendations for 2015-2020 urge Americans to eat more plant-based foods and limit meats, while doing an overall better job of meal-planning than we traditionally have. All of this could be at play prompting more people -- especially PWDs and those at risk for developing diabetes -- to turn to this type of eating.
“It’s the perfect convergence of health concerns, environmental concerns and animal welfare concerns that are leading more and more people to adopt a plant-based diet,” says Michigan-based certified diabetes educator Caroline Trapp, who works with the Physicians Committee for Responsible Medicine (PCRM) group and presented on this topic at the AADE event. “It’s a crime that more don't know about this option, or have access to resources and support."
Defining 'Plant-Based Eating'
Generally speaking, "plant-based eaters are after food that closely resembles the plant(s) it came from. They avoid processed, packaged food and sometimes eschew white sugar, flour, and oils," according to food writer Morgan Childs at the popular food blog Kitchn.
That encompasses people who adhere to a strict vegetarian diet (no meat) and veganism, which avoids ALL animal-derived foods, including eggs, milk, cheese, or any dairy, along with not eating meat itself.
There are different flavors of vegetarianism, like lacto- or ovo-vegetarians who also avoid eggs or dairy for personal or religious reasons. And there are different levels, depending on how little animal-based food one may want to consume.
But overall, "plant-based eating" is a looser concept, often defined as: "A whole-food, plant-based diet is centered on whole, unrefined, or minimally refined plants. It’s based on fruits, vegetables, tubers, whole grains, and legumes; and it excludes or minimizes meat (including chicken and fish), dairy products, eggs, and highly-refined foods like bleached flour, refined sugar, and oils."
Science and Endorsements
There is enough scientific evidence of benefits for this type of eating to be endorsed by the health powers-that-be – from the American Diabetes Association and Academy of Nutrition and Dietetics, to the U.S. Department of Agriculture and Health and Human Services. All say a plant-based diet is a healthy choice for anyone, at any age and activity level and even endurance athletes, despite concerns that it might not offer enough protein or may be too high-carb.
At this summer's AADE conference, one scientific poster described a massive study of 96,000 adults from all 50 states and Canada, that showed more T2 diabetes is diagnosed in people consuming higher levels of animal food products. Those who ate more plant-based saw less body mass, had fewer health complications and D-complications such as heart disease and neuropathy and nephropy, and generally lived longer.
And during a session about how lifestyle factors and better meal-planning can lead to "de-prescribing" medications, Trapp discussed her own findings on how plant-based eating can help.
"Over and over, I have seen that when people with diabetes adopt a whole foods, plant-based diet, they see blood sugars come down, and need for medication is reduced or eliminated,” Trapp said.
Benefits for Type 1 Diabetes?
OK, hold on here -- perhaps this works for prediabetes or even type 2, but what about type 1? You can’t just eliminate the need for insulin. So is there really any true benefit for those with T1D?
Trapp says yes.
As a leading U.S. expert on this topic, she’s not aware of any specific studies focusing on plant-based eating and T1D effects. But she says she's heard a lot of anecdotal evidence through the years.
“I’ve learned from my patients that a plant-based diet is doable and powerful. It can help to improve insulin sensitivity. In fact, I’ve had patients get angry that no one told them about this earlier. So now I offer it as an option to all.”
Most importantly, Trapp says diabetes complications are a key in adopting this type of diet plan for PWDs.
“Consider that complications of type 1 are largely vascular, so the same artery-protecting plant-based foods would be beneficial,” she points out. “In my own experience, insulin needs can be reduced in T1. Absolutely worth a try.”
Trapp is also quick to note that insulin-to-carb ratios vary and can change, so a healthcare team’s support is crucial as one navigates this type of eating. She points to the California-based consultancy Mastering Diabetes, that has embraced this lifestyle, as well as a resource from the Physicians Committee that includes a four-page handout on plant-based diets for those with T1D.
Another big point she makes from her own experience, that of medical colleagues and those who’ve chosen this type of diet is: the less meat you eat, the less you’ll crave.
Potential Risks of Meatless Diets?
Whether any risks exist for PWDs shifting to this kind of diet is not quiet clear, but the general word is that sometimes medication changes and a lack of protein can lead people to not feel well – as in, weaker, after they’ve started on a plant-based eating for even a few days. This is often referred to as "Keto Flu," caused by an initial electrolyte imbalance.
Also, a plant-based diet may not be possible for those with gastroparesis, due to the higher fiber content, which further exacerbates digestion problems.
But Trapp says the overall “side effects” for most people are good – weight loss, improved blood pressure and cholesterol, resolution of constipation, joint pain, and so on. She does add that people on blood thinners who increase the amount of green leafy vegetables may need more frequent INR monitoring initially. Vitamin B12 is an important part of the diet and can be increased to help prevent nerve damage, anemia and memory issues.
“I am not aware of any studies in people with nerve damage to the gut to see how they do, so it is an area for research,” Trapp says. “Some people who have not been eating beans may initially find they have some gas or cramping. This is a sign that they need beans and more fiber in their diet! The body will adjust, given time. I recommend at first to have small servings, and use smaller beans, like lentils, which are well-tolerated. Some people do better with cooked vegetables over raw. Be sure to drink plenty of water too.”
What the Diabetes Community Says
So, what do real people living with diabetes say about plant-based eating? We were curious to hear their pros and cons, so we reached out to our community via social media to gather testimonials. (If you have anything to share, please leave us a comment below or shoot an email our way):
Lucia Maya in Makawao, Hawaii: “I eat a largely plant-based diet, and manage to eat quite low-carb too, about 100g/day. I do eat dairy, and if I'm out I may eat meat, but I don't buy or cook meat. My A1C is better than ever (5.9 last time) and I've had type 1 for 41 years. The lower-carb is what's made the difference, along with my pump, CGM and 'Sugar Surfing' concept that I’ve been using.”
Laura Brashear in Harrisburg, PA: “I’ve been a vegetarian since age 12, and was diagnosed with T1D at age 22 more than a decade ago. Being a vegetarian has not made my diabetes any easier or any harder to control, as I ate fairly clean before and never ate carb-heavy. The only real change I made to my diet was switching to whole grain breads and pasta, but I think everyone should do that. Overall, plant-based eating has been good for me. I eat clean overall so the refined sugars and hidden carbs in some foods are not relevant. I do stick to whole grains when eating breads or pastas. Fruits and vegetables have consistent effects whereas other foods do not. I would say that eating a clean, plant-based diet has helped me to be more stable.”
JJ Somerville in Virginia: “I am T2 and am doing this now. The only thing I changed at first was what I ate. Dropped my A1C roughly 12 to 7 the first six months. It has gone up a bit with some ‘cheating,’ but I am trying not to get too Nazi-ish about it.”
Christine Fallabel in Denver, CO: “I was dx at 12 in the year 2000 with a BG of 668, on family vacation in Virginia Beach. I've been eating plant-based since I was 14 years old, when I saw the ingredient list on a packet of Subway 'all natural turkey' -- yuck! I eat plant-based primarily for environmental and health reasons, and because it just makes sense! I've been a strict vegan for 15 years, but when I deviate it's only when traveling internationally, and that's usually only if I can't find anything else to eat. My current A1C is 6.1%. I find that when I'm eating a whole foods, plant-based diet, that my sugars are better. Fake meat substitutes and processed carbs are still bad for people with diabetes. I try to eat unprocessed foods as much as possible. It is not more expensive, especially if you sign up for a seasonal CSA (Community Supported Agriculture) or frequent farmers markets. Carb-counting doesn't vary, but I've noticed that sugar spikes happen more quickly, but end before I go to sleep, so I wake up with less morning highs -- from delayed onset of hyperglycemia. Sometimes that happens if someone eats high fat/high carb meals such as chicken with noodles, etc. Homemade hummus is my current favorite recipe. The secret is good tahini!"
Ryan Fightmaster in Oklahoma City, OK: "Honestly, just went on the diet out of curiosity. I was running and biking a lot back then, so I figured it might help out with performance. I ended up feeling better and stuck with it. Didn't understand the increased insulin sensitivity until a few weeks in. A nice bonus. I'd say I used about a third less insulin conservatively. Some people experience a 50% drop. I went from taking about 55 units of Novolog per day to 35 units per day."
There are many others out there too, of course. And Googling "plant based diet" and "diabetes" brings up great items like the inspiring story of former University of Michigan football player Marc Rivera (Go Blue!) who has T1D and has written about his very positive experience with plant-based eating at the Chickpea & Bean blog.
I myself have been focusing on eating lower-carb these days, as part of my efforts to 'be healthier' as I creep toward my 40s (yikes!) -- but also because of great advice from D-peeps like Adam Brown, who makes many great suggestions for healthier eating in the food chapter of his new book.
Still, I had not considered embracing plant-based eating in my own lifestyle until just the other day -- as I prepped this post.
I decided to start by trying a so-called Impossible Burger at a nearby Michigan restaurant, marketed as a "first in the Midwest" as it is a meatless burger that's supposed to taste the same as a regular beef patty. It contains wheat, coconut oil and potatoes, along with a specific ingredient called heme, found in plants that gives this burger a similar taste, aroma, color and sizzle as regular burgers. (It even 'bleeds' like a real burger.)
My takeaway on the heme burger: Meh. It certainly didn't wow me and was a little less flavorful than I usually prefer, but it wasn't bad, and I wouldn't be opposed to ordering it again -- as long as I could spice it up with extra condiments. Overall, I'm just really glad to see increased restaurant menu options for those who choose plant-based diets.
Resources: For Those Pondering A Plant-Based Diet
Here are some recommendations to get started, based on a smattering of online resources:
- Consider a 3-week trial -- The easiest way to orchestrate your own trial run is to use the free online program at www.21DayKickstart.org. Sign up anytime, and it goes live the first of every month, with meal ideas, grocery lists, recipes, and celebrity videos offering ideas and encouragement. Spanish, Mandarin Chinese and Hindu options are available too.
- Check out the resources at www.PCRM.org/diabetes. Invite a friend or family member, or go it alone, with enthusiasm, which is often contagious. Hopefully others in your household or workplace will follow your lead. It is nice when you can make a diet change with support, and sometimes people need to create their own support network.
- Forks Over Knives is a well-known, very active site offering lots of personal stories, recipes and other resources like a meal planner and cooking courses -- for those who've adopted plant-based eating or vegan diets, or may be curious.
- You can also use the Happy Cow app to find restaurants in your area that specifically serve vegetarian and vegan foods. Useful in both your home town and while traveling!
- Check out the Plant Based Nutrition Support Group online at PBNSG.org, which meets monthly in a particular area of Southeast Michigan but has lots of inspiring stories posted online for all to enjoy.
Having done all this research and dipped my toe in myself, I'm no longer so quick to roll my eyes whenever the notion of "plant-based eating" comes up. It seems that on top of ethical and moral considerations to avoid meat, there's some real diabetes benefit to be had here. Certainly, Your Diabetes May Vary... but as Trapp notes, "Absolutely worth a try!"
What do you think, Folks?