Cheeseburger vs Tofu Burger for Gut Health & Satiety

A January 2019 study 1 wanted to analyse how a specific number of postprandial (after eating) physiological indicators were affected in three different population groups by tucking in to either a typical processed-meat cheeseburger meal (CB) or a tofu burger meal (TB).

Study method

The three population groups were 20 each of:

  • men with type 2 diabetes (T2D)
  • obese men (OM)
  • healthy men (HM)

The two meals were matched in terms of energy and macronutrients:

The health indicators being tested were gastrointestinal hormones involved in the regulation of glucose metabolism and satiety (the feeling of feeling ‘full’ from eating food).

Glucose metabolism (how the body was responding to the meal) was assessed at 0, 30, 60, 120 and 180 minutes after the meal via an analysis of each participant’s blood plasma, to check levels of the following hormones:

  • glucagon-like peptide-1 (GLP-1) 2
  • amylin 3 , and
  • peptide YY (PYY) 4
  • satiety (the feeling of fullness itself) was assessed through what’s called a ‘visual analogue scale‘ 5

Study findings

After eating the tofu burger meal (when compared with the cheeseburger meal):

  • GLP-1 increased in T2D and HM
  • amylin increased in all groups
  • PYY increased only in HM
  • satiety increased in all groups
Charts showing postprandial results for GLP-1, amylin, PYY and satiety.

So what?

Well, this shows there’s a greater increase in glucose metabolising gut hormones and satiety following the consumption of a single plant-based meal with tofu when compared with an energy- and macronutrient-matched processed-meat meat and cheese meal. And what’s more, this happens in all three groups: diabetic, obese and healthy men.

By feeling more satiated, people eat less. By eating less, they avoid piling on extra weight as a result of foods (particularly processed, fatty, animal-based, salty, and sweet foods) ‘fooling’ the body into thinking it needs to consume more. The body treats plant-foods differently from processed and animal foods, releasing different hormones from the gut and affecting the brain differently (partly through satiety signalling).

Study discussion

The following points were raised within this study:

  • obesity substantially increases the risk of:
  • type 2 diabetes
  • cardiovascular disease, and
  • certain types of cancer 6
  • improving dietary choices represents a primary prevention tool 7 8
  • the influence of diet in the development of insulin resistance, prediabetes, and type 2 diabetes is well-established 9 10 11
  • gastrointestinal hormones are known to be involved in the regulation of glucose metabolism, energy homeostasis, satiety, and weight management 12
  • ingestion of food triggers secretion of the incretin hormone GLP-1 from the gastrointestinal tract, which enhances insulin secretion and helps maintain glucose homeostasis 13
  • the satiety hormones GLP-1 [9], peptide YY (PYY) [10], pancreatic polypeptide (PP) [11] and amylin [12] regulate appetite and energy homeostasis
  • the release of the satiety hormones GLP-1, PYY and amylin can depend on meal composition and differs between impaired and normal glycaemic status 14
  • consumption of red meat is associated (and the consumption of processed meat is very strongly associated) with risk of type 2 diabetes 15 16
  • consuming any processed meats increases (by 33%) the risk of developing  diabetes 17
  • saturated fatty acids from meat and other animal products impairs insulin resistance and glucose tolerance 18 9 , and increases the risk of cardiovascular disease 19
  •  following plant-based diets (vegetarian) reduces risk of diabetes by 50% 20
  • insulin sensitivity and glycaemic control in type 2 diabetics improves on a plant-based diet 21 22

Study conclusion

Our findings indicate that plant-based meals with tofu may be an effective tool to increase postprandial secretion of gastrointestinal hormones, as well as promote satiety, compared to processed meat and cheese, in healthy, obese, and diabetic men. These positive properties may have practical implications for the prevention of type 2 diabetes.

Final thoughts

The interesting subject of satiety has been covered previously, when we looked at the three mechanisms of satiety 23 .

The study covered in this blog is, of course, just of the many research projects which look at how plant-food compares with animal-food. If you’ve read some of the previous blogs on diabetes 24 25 26 27 28 29 30 31 and obesity 32 33 , you’ll already know that there’s a mountain of evidence that plant-based meals not only prevent, but also reverse these and many other non-communicable diseases.

The take-home message?

Ditch McDonald’s and get stuck into plant-based foods if, that is, you want optimal health and longevity. Your choice…

…if, that is, you’re lucky enough to be in a family or live in a society where there is any real choice.


  1. Nutrients. 2019 Jan 12;11(1). A Plant-Based Meal Increases Gastrointestinal Hormones and Satiety More Than an Energy- and Macronutrient-Matched Processed-Meat Meal in T2D, Obese, and Healthy Men: A Three-Group Randomized Crossover Study. Klementova M, Thieme L, Haluzik M, Pavlovicova R, Hill M, Pelikanova T, Kahleova H []
  2. Glucagon-like peptide-1 is a 30 amino acid long peptide hormone. GLP-1 is an incretin; thus, it has the ability to decrease blood sugar levels in a glucose-dependent manner by enhancing the secretion of insulin. Peripherally, GLP-1 is known to affect gut motility, inhibit gastric acid secretion, and inhibit glucagon secretion. In the central nervous system, GLP-1 induces satiety, leading to reduced weight gain. In the pancreas, GLP-1 is now known to induce expansion of insulin-secreting β-cell mass, in addition to its most well-characterised effect: the augmentation of glucose-stimulated insulin secretion. []
  3. Amylin is a peptide hormone secreted along with insulin from the pancreatic β-cells. It plays a role in glycaemic regulation by slowing gastric emptying and promoting satiety, thereby preventing postprandial spikes in blood glucose levels. peptide hormone that slows digestion. When carbohydrates stay in the stomach longer, they are converted to glucose and enter the bloodstream in a slower, more gradual manner. It helps to block glucagon secretion. Glucagon is a pancreatic hormone that raises the blood glucose level by stimulating the liver to release stored glucose. Without amylin, most people with diabetes produce extra glucagon when they eat; this can contribute to after-meal blood glucose spikes. By enhancing satiety, amylin helps to limit appetite and thus reduce the amount of food eaten during (and between) meals. []
  4. Peptide YY s a hormone secreted from endocrine cells called L-cells in the small intestine. It’s secreted alongside the hormone glucagon-like peptide 1. It’s released after eating, circulates in the blood and works by binding to receptors in the brain. Binding of peptide YY to brain receptors decreases appetite and makes people feel full after eating. It also acts in the stomach and intestine to slow down the movement of food through the digestive tract. []
  5. The visual analogue scale or visual analogue scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.  The following is a typical example: []
  6. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390, 1211–1259. []
  7. Evert, A.B.; Boucher, J.L.; Cypress, M.; Dunbar, S.A.; Franz, M.J.; Mayer-Davis, E.J.; Neumiller, J.J.; Nwankwo, R.; Verdi, C.L.; Urbanski, P.; et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014, 37 (Suppl. 1), S120–S143. []
  8. American Heart Association Nutrition Committee; Lichtenstein, A.H.; Appel, L.J.; Brands, M.; Carnethon, M.; Daniels, S.; Franch, H.A.; Franklin, B.; Kris-Etherton, P.; Harris, W.S.; et al. Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114, 82–96. []
  9. Feskens, E.J.; Virtanen, S.M.; Räsänen, L.; Tuomilehto, J.; Stengård, J.; Pekkanen, J.; Nissinen, A.; Kromhout, D. Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care 1995, 18, 1104–1112. [] []
  10. Fizelova, M.; Jauhiainen, R.; Stanˇcáková, A.; Kuusisto, J.; Laakso, M. Finnish Diabetes Risk Score Is Associated with Impaired Insulin Secretion and Insulin Sensitivity, Drug-Treated Hypertension and Cardiovascular Disease: A Follow-Up Study of the METSIM Cohort. PLoS ONE 2016, 11, e0166584. []
  11. Mann, J.I.; De Leeuw, I.; Hermansen, K.; Karamanos, B.; Karlström, B.; Katsilambros, N.; Riccardi, G.; Rivellese, A.A.; Rizkalla, S.; Slama, G.; et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr. Metab. Cardiovasc. Dis. 2004, 14, 373–394. []
  12. Perry, B.; Wang, Y. Appetite regulation and weight control: The role of gut hormones. Nutr. Diabetes 2012, 2, e26. []
  13. Meier, J.J. The contribution of incretin hormones to the pathogenesis of type 2 diabetes. Best Pract. Res. Clin. Endocrinol. Metab. 2009, 23, 433–441. []
  14. Belinova, L.; Kahleova, H.; Malinska, H.; Topolcan, O.; Vrzalova, J.; Oliyarnyk, O.; Kazdova, L.; Hill, M.; Pelikanova, T. Differential acute postprandial effects of processed meat and isocaloric vegan meals on the gastrointestinal hormone response in subjects suffering from type 2 diabetes and healthy controls:  A randomized crossover study. PLoS ONE 2014, 9, e107561. []
  15. Aune, D.; Ursin, G.; Veierød, M.B. Meat consumption and the risk of type 2 diabetes: A systematic review and meta-analysis of cohort studies. Diabetologia 2009, 52, 2277–2287. []
  16. Pan, A.; Sun, Q.; Bernstein, A.M.; Schulze, M.B.; Manson, J.E.; Willett, W.C.; Hu, F.B. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am. J. Clin. Nutr. 2011, 94, 1088–1096. []
  17. Vang, A.; Singh, P.N.; Lee, J.W.; Haddad, E.H.; Brinegar, C.H. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: Findings from Adventist Health Studies. Ann. Nutr. Metab. 2008, 52, 96–104. []
  18. Maron, D.J.; Fair, J.M.; Haskell, W.L. Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff. Circulation 1991, 84, 2020–2027. []
  19. Zong, G.; Li, Y.; Wanders, A.J.; Alssema, M.; Zock, P.L.; Willett, W.C.; Hu, F.B.; Sun, Q. Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: Two prospective longitudinal cohort studies. BMJ 2016, 355, i5796. []
  20. Tonstad, S.; Butler, T.; Yan, R.; Fraser, G.E. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care 2009, 32, 791–796. []
  21. Kahleova, H.; Matoulek, M.; Malinska, H.; Oliyarnik, O.; Kazdova, L.; Neskudla, T.; Skoch, A.; Hajek, M.; Hill, M.; Kahle, M.; 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. []
  22. Barnard, N.D.; Cohen, J.; Jenkins, D.J.A.; Turner-McGrievy, G.; Gloede, L.; Jaster, B.; Seidl, K.; Green, A.A.; Talpers, S. 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. []
  23. The Three Mechanisms of Satiety []
  24. Diet Reverses Type 2 Diabetes – How Long Have We Known This? []
  25. Diabetes – Wheat VS Chickpea & Lentil Pasta []
  26. Vegetarian Diets and the Risk of Diabetes []
  27. Current Diabetes Treatment – Practice or Malpractice? []
  28. Turmeric Proven To Fight Cancer & Diabetes []
  29. Plant-based Diets & Diabetes []
  30. Low-Fat Plant-Based Diets Help to Prevent Type 2 Diabetes []
  31. Diabetes – The Medical Facts. WARNING – Disturbing Images []
  32. Can The UK Government Really Combat Child Obesity? []
  33. England’s Obesity Hotspots []

Athletic Performance & Physical Damage on Plant-Based Diets

A January 2019 scientific review 1  by Dr Neal Barnard 2 and his team, entitled “Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports“, looked at whether endurance athletes, who are at a higher-than-average risk of developing atherosclerosis and myocardial damage, have reduced health risks and improved performance if they eat a plant-based diet. The results are pretty compelling and should be considered by anyone within any age group who engages in regular physical exercise, not just those who undertake endurance sports.

Diet & exercise

It’s well-accepted 3  that diet in general plays a significant role in maintaining the health and improving the performance of athletes. In previous blogs, we looked in some detail at how plant-based diets may improve sports performance and reduce injury 4 5 6 , as well as how options such as the paleo diet 7  and consuming whey products 8 appear to do quite the opposite. Interestingly, and in relation to cancer risk, some research even showed 9 that the blood of a ‘couch potato’ eating a healthier than standard diet is likely to have better cancer-fighting abilities than the blood of someone who exercises regularly and strenuously but eats the standard diet – thus suggesting that diet may play a more significant role in overall health than exercise.

The study covered below deals in more depth with how choosing a plant-based diet can improve athletic performance as well as help avoid, and even reverse, serious and long-term health risks that both athletes and non athletes face.

What the study covers

The study considers that there is sufficient evidence to claim that plant-based regimes can achieve the following:

  • reduce cardiovascular risk factors
    • reverse existing atherosclerotic lesions
  • reduce plasma lipid concentrations, thereby:
    • reduce blood viscosity, and
    • increase tissue oxygenation
  • improve glycaemic control 10
  • reduce body weight (obesity)
  • increase glycogen storage
  • reduce blood pressure
  • reduce oxidative stress
  • reduce inflammation

Individually, or in combination, it’s suggested that the above benefits, which may result from plant-based dietary regimes, both protect the health of the athlete and improve athletic performance. The latter are discussed in more detail below.

Cardiovascular risk & plant-based diets

Studies have shown plant-based dietary patterns have particular benefits for heart health:

  • being able to reverse arterial plaque 11 12 13
  • significantly reducing the likelihood of developing coronary heart disease compared with meat eaters 14

But surely, you’d think, athletes are more or less immune to developing atherosclerosis 15  because of all the exercise they do. However, this has been shown 16 not to be the case.  It may seem odd, but it’s been shown in several studies 17 18 19 20 that endurance athletes may have more advanced atherosclerosis and more myocardial damage than sedentary individuals, increasing as periods of sports endurance accumulate and as they age.

Even sudden sports-related sudden cardiac deaths among ostensibly ultra fit athletes have been shown 21 to be more common than you’d think, especially with increased age.

But is it the diet?

Of course, the question has to be answered: “Is the atherosclerosis and myocardial damage caused by the athletic activity itself or by the foods used to fuel it?”

This study considers that when consumption of animal products is increased, perhaps with the hope of supplying increased energy for increased athletic activity, the associated saturated fat and cholesterol (as well as the relative absence of antioxidants and fibre 22 ) may contribute to the atherosclerotic changes.

Atherosclerosis may also narrow arteries in the legs, brain, and other parts of the body which will reduce blood flow and potentially impair performance. This has certainly been shown 23 to be the case with diagnosed peripheral artery disease, and is considered as a factor for athletes with undiagnosed (i.e. subclinical) atherosclerotic disease.

Plant-based diets can address the key factors that cause atherosclerosis, namely:

  • dyslipidemia 24
  • elevated blood pressure
  • elevated body weight, and
  • diabetes

So it would appear that diet is key to protecting heart health and thus for enhancing athletic performance.

Atherosclerosis – exception or norm?

And while one may think that atherosclerotic disease is the exception rather than the rule, studies have shown 25 that in the modern Western world [with its modern Western diet] atherosclerosis can begin early in life, even in the womb.

A study 26 showed that the majority of American children have fatty streaks in the left anterior descending coronary artery by the age of 10 to 14 years.

Autopsies of U.S. soldiers with a mean age of 20.5 years who died in the Korean War showed that 6.4% of them had coronary atherosclerosis 27 .

Autopsies of soldiers with a mean age of 25.9 years who died in the Iraqi wars between 2001 and 2011 showed that 8.5% of them had coronary atherosclerosis 28 .

And it gets worse. In so-called ‘developed’ countries, by the age of 20, ~10% of the population have advanced atherosclerotic lesions in the abdominal aorta, which reduces blood flow and contributes to disc degeneration and lower back pain 29

So, if you’re from a country where the Western diet is the norm (and, of course, you’ve also eaten that diet), you’re very likely predisposed to such risks even before you run your first marathon.

Plasma lipid concentrations & plant-based diets

Diets rich in saturated fat and, to a lesser degree, dietary cholesterol promote dyslipidemia, and dyslipidemia is a major contributor to arterial disease. With dairy products and meat being the leading sources of saturated fat, removing these has predictably been shown 30 to improve plasma lipid profiles.

By including soluble fibre (e.g. oats, beans, barley), almonds, soy protein, and sterol-containing margarines [the latter being something no WFPB advocate would advocate!], it’s been shown 31 that low-density lipoprotein (LDL – the ‘bad’ cholesterol) can be reduced by around 30% in as little as 4 weeks.

It’s also important to point out that trans fats have detrimental effects on plasma lipids and, thus, increase cardiovascular risks 32 33 .

Blood viscosity/tissue oxygenation & plant-based diets

Blood viscosity is a key element in oxygen delivery to the muscles 34 – lowering viscosity improves both blood flow and athletic performance, increasing viscosity does the opposite 35 .

During athletic activity, fluid passing from the bloodstream into the tissues leads to haemoconcentration 36 . This gradual rise in blood viscosity results in progressive loss of tissue oxygenation which, of course in turn, degrades athletic performance 37 .

Diet affects this plasma viscosity. Because plants are typically low in saturated fat and have no cholesterol, plant-based diets are considered 30 38 to reduce plasma lipid concentrations, and hence reduce viscosity.

Reduced blood viscosity also improves tissue oxygenation, thereby potentially improving athletic performance. In one study 39 , brachial artery flow-mediated vasodilation 40 was assessed in a range of diets – low-fat vegetarian, low-carb/high-fat (Atkins), and high-fat (South Beach). The results were that the vegetarian diet improved brachial artery flow-mediated vasodilation compared with the other diets. Basically, the higher the saturated fat intake, the greater the impairment of flow-mediated vasodilation, with arterial compliance being impaired even by a single high-fat meal.

This impairment is not only caused through eating food high in animal fats, added oils appear 41 42 43 44 to have similar effects. The latter studies suggest that animal fats as well as meals made with added oils are harmful for arterial flexibility; on the other hand, they make it clear that there is benefit from consuming meals made from vegetables, grains, legumes, and fruits.

The food choices athletes make affect blood viscosity, arterial diameter, arterial compliance and arterial elasticity. All the latter factors can be expected to affect tissue oxygenation, endurance, and performance.

Glycaemic control & plant-based diets

Plant-based diets are known to boost insulin sensitivity 45 which, as we’ve seen 46 , is important for reducing the risk of type 2 diabetes and improving glycaemic control – a major contributor to atherosclerosis in individuals with diabetes. Indeed, even small amounts of animal food (such as just one cup of non-fat milk) are sufficient to reduce arterial diameter and can thus lead to major changes in blood flow.

Body weight (obesity) & plant-based diets

The risk of developing cardiovascular disease is, naturally, increased by becoming obese. Even when you ditch calorie-counting or portion-control altogether, vegetarian, and especially vegan, diets have been shown 47 to reduce body fat and thereby tackle obesity.

In a previous blog 48 , we looked at how plant-based diets are the easiest (and healthiest) way to lose weight and then maintain an optimal body weight. This study amplifies this point with reference to how plant-based diets are, thus, able to protect the health of athletes and improve athletic performance. This is achieved via a variety of mechanisms, including:

  • the low fat/high fibre content of plant-based diets reduces body fat (thereby reducing atherosclerotic risk and improving performance) 49
  • the reduced energy density of plant-based meals reduces energy intake (you get fuller quicker on less calories, partly because of the higher proportion of fibre in plants that doesn’t exist in animal-foods)
  • postprandial energy expenditure is shown 45 50 to be positively influenced by plant-based diets – possibly via changes in mitochondrial activity 51
  • the indirect effects of gut microbiome on cellular metabolism have been shown 52 to be negatively affected by a high-fat diet (such as is the norm with a meat-based diet) and positively affected by a low-fat diet (such as is the norm with a plant-based diet), partly through protecting the intestinal barrier and preventing the production of endotoxins which can then enter the bloodstream and, in turn, negatively influence cellular metabolism
  • plant-based (vegan more than vegetarian) diets have been shown 53 54 to increase sub-maximal/maximal aerobic capacity/endurance and reduce atherosclerotic/metabolic risk through eliminating excess body fat and, thereby, increasing max VO2 55 . This is important since it’s known 56 57 that an athlete with a higher VO2 max relative to their body weight will have better endurance and will outperform an athlete with a lower value, and that the effect of diet on VO2 max has a significant effect 58

Glycogen storage & plant-based diets

It’s known 59 that individuals who start plant-based diets typically increase intake of healthy carbohydrates (the primary energy source during moderate/high-intensity aerobic exercise) and it’s been shown 60 that endurance is enhanced by high-carbohydrate intake, not just immediately before athletic events, but also over the long term.

Blood pressure & plant-based diets

We’ve looked previously 61 at how the risk of atherosclerotic conditions reduces as blood pressure is reduced. This is good news for those on a plant-based diet, since both vegan and vegetarian diets have been shown 62 to reduce systolic and diastolic blood pressure. Reduced blood pressure is associated with three other ‘side-effects’ of a (healthy) plant-based diet:

  • a reduction in blood viscosity
  • an increase in blood potassium, and
  • a reduction in body weight

Oxidative stress & plant-based diets

When you exercise, your muscle tissue gets ‘damaged’ and produces reactive oxygen species (free radicals), partly as a result of the normal function of mitochondria and other intracellular organelles 63 64 . When your body is overwhelmed by these free radicals, and it can no longer neutralise them, the result is called oxidative stress.

This oxidative stress, in turn, boosts antioxidant defences and immune responses 65 66 .

If the amount of free radicals greatly exceeds the neutralising abilities of these defences, the following can occur 67 :

  • DNA damage – leading to mutations
  • plasma lipid damage – leading to atherosclerosis
  • protein damage – leading to cell damage and accelerated aging
  • muscle fatigue
  • reduced athletic performance
  • impaired recovery

How can being plant-based help?

When the physiological responses of omnivores and vegans/vegetarians were compared, it was found that vegans and vegetarians have increased antioxidant activity, due to:

  • higher intakes of beta-carotene (the precursor of vitamin A), vitamin C, vitamin E, and other antioxidants 68
  • higher antioxidant enzyme production 69

Whilst it’s the combination of plant foods that’s important, specific antioxidant foods have been found to have potentially beneficial effects, including:

  • beets 70 71
  • allium vegetables (e.g. onions, garlic, and leeks) 72
  • cherry juice 73

Inflammation & plant-based diets

Plant-based diets have been shown 74 to be helpful in reducing inflammation. This may be due to the following effects produced by plant consumption:

  • reduction in serum concentrations of C-reactive protein (a marker of inflammation)
  • increased antioxidant content
  • absence of products that may be inflammatory or sensitising [animal & processed food products]
  • absence of pro-inflammatory fats [mostly found in animal foods]

Again, whilst a healthy variety of plant foods provides the ideal diet, some studies have identified particularly high antioxidant ability within specific foods, including:

  • blackcurrants 75
  • blueberries76
  • pomegranates 77
  • tart cherries 78
  • watermelon 79

The above are all thought to decrease post-exercise inflammation and facilitate recovery.

Red meat & inflammation

A major study showed 80 that, as total red meat consumption increased, the following also increased:

  • C-reactive protein (a marker of inflammation)
  • haemoglobin A1c (an indicator of glycaemic control – raised blood sugar levels), and
  • stored iron (an excess of iron [specifically haem iron 81 ] is associated with heart disease, cancer, and diabetes)

Arthritis & plant-based diets

It used to be thought that osteoarthritis was attributable to simple “wear and tear”; however, it’s now known 82 that there’s an important inflammatory component which is aggravated by diabetes and by being overweight.

And it’s not just osteoarthritis that’s affected by diet – psoriatic arthritis 83 and many other similar conditions are also now known to be manifestations of inflammatory processes.

In one major ongoing study 84 , people who ate meat even once a week had higher levels of both degenerative arthritis and soft tissue disorders than individuals who avoided meat altogether.

A number of studies 85 86 87 88 89 on people suffering from rheumatoid arthritis have shown that changing to vegan and vegetarian diets can reduce C-reactive protein, as well as both subjective and objective signs of arthritis.

Whilst vegan diets, in particular, have been shown 90 91 92 to have anti-inflammatory effects by reducing C-reactive protein in patients with and without coronary artery disease.

Protein & plant-based diets

The usual red herring about plant-based diets being compromised in terms of protein and/or complete amino acid provision has been covered in considerable detail in previous blogs 93 94 ; however, it’s worth pointing out the following:

  • changing to plant-based has been shown 95 to provide an immediate improvement in nutrition levels (partly because fruits, vegetables, beans, and whole grains tend to be high in vitamins, minerals, and fibre, very low in saturated fat, and devoid of cholesterol)
  • pretty much every endurance athlete tested 96 met recommended protein intake
  • a varied plant-based diet is known 59  to easily provide adequate amounts of all essential amino acids for athletes

Calcium & plant-based diets

Another fallacy, addressed in previous blogs 97 98 , is that plant-based diets, because they don’t contain cow’s milk, will lack sufficient bone-building calcium for athletes and others.

However, calcium is abundant in many plant foods, especially green leafy vegetables and legumes 99 .

Iron and plant-based diets

As mentioned above, plants contain non-haem iron, which is considered to be a healthier form of iron than the haem iron in animal foods. It may come as a surprise that iron intake is often higher in those who eat plant-based diets than in those who eat meat-containing diets, with serum ferritin levels being typically within the normal range 100 . This is because of the large iron content of green vegetables and legumes. However, iron storage tends to be lower – a good thing since you don’t want rust inside your body! 101 102

Vitamin B12 & plant-based diets

Vitamin B12, covered in previous blogs 103 104 105 , is another area where confusion reigns. Whilst, of course, B12 is absolutely vital for nerve function and blood cell formation, and must be supplemented when on a plant-based diet 59 , B12 deficiency/insufficiency is surprisingly common throughout whole populations, regardless of their dietary regime. Thus, it’s advisable for everyone, particularly as we age 106 , to take B12 supplementation.

Study conclusions

Plant-based diets play a key role in cardiovascular health, which is critical for endurance athletes…and, as part of a healthful lifestyle, have been shown to reverse atherosclerosis. The possibility that such diets may also contribute to improved performance and accelerated recovery in endurance sports is raised by their effects on blood flow, body composition, antioxidant capacity, systemic inflammation, and glycogen storage. These attributes provide a scientific foundation for the increased use of plant-based diets by endurance athletes.

Final thoughts

When we looked at obesity and plant-based diets above, it was pointed out that calorie-counting and portion-control were not needed in order to reduce body fat and, thereby, reduce body weight and avoid the risk of becoming obese. In relation to this, there was a BBC documentary 107 recently by Hugh Fearnley-Whittingstall at the end of which he drew the unfortunate (in my opinion) conclusion that, whilst calorie-counting was not the way to go, the best way to keep the weight down was to apply strict control to portion size.

I tend to disagree with this approach. Just as it’s been shown that calorie-counting 108 and exercise alone 109 are ineffective means of maintaining a healthy body weight, I suspect that, in spite of some studies’ somewhat optimistic conclusions 110 , portion-control (or portion-sizing) is also a dietary method destined to fail in most cases 111 , albeit that it’s a whole lot better than doing nothing at all.

When you eat a non-SOS WFPB diet, you never need to worry about how many calories you are eating nor about what size your plate is. The very nature of the food itself will be regulated by your body’s appetite and requirement for nutrients, whether or not you’re an Olympic athlete.

Ever seen anyone becoming overweight who consistently eats a WFPB diet? If you do, let me know, since I haven’t come across one yet…


  1. Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports. Barnard ND, Goldman DM, Loomis JF, Kahleova H, Levin SM, Neabore S, Batts TC. Nutrients. 2019 Jan 10;11(1). pii: E130. doi: 10.3390/nu11010130. Review. PMID: 30634559. []
  2. Dr Barnard is the president of the Physicians Committee for Responsible Medicine and Barnard Medical Center []
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  4. WFPB Eating to Prevent Sports Injuries []
  5. Plant-Based Diet Improves All Aspects of Sports Performance & Recovery []
  6. Ginger Reduces Exercise-Induced Muscle Pain []
  7. How Do Paleo Diets Affect Health & Sports Performance? []
  8. No Whey Man says Robert Cheeke []
  9. Barnard RJ, Ngo TH, Leung PS, Aronson WJ, Golding LA. A low-fat diet and/ or strenuous exercise alters the IGF axis in vivo and reduces prostate tumor cell growth in vitro. Prostate. 2003;56( 3): 201– 6. []
  10. Glycaemic control involves the regulation and maintenance of blood glucose levels within normal ranges, and is the aim of the treatment of diabetes mellitus. Long-term glycaemic control reduces later incidence of secondary diabetic complications []
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  15. Atherosclerosis is a disease of the arteries characterised by the deposition of fatty material on their inner walls. []
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  40. Endothelial function is often quantified by flow-mediated dilation (FMD), which represents the endothelium-dependent relaxation of a conduit artery – typically the brachial artery – due to an increased blood flow a variety of diets. Brachial artery flow-mediated vasodilation can be assessed using high-frequency ultrasound assessment of changes in brachial artery diameter after a 5-minute blood pressure cuff arterial occlusion.We looked at some fascinating results of this in an earlier blog  (Olive Oil Injures Endothelial Cells) where the effects of consuming cornflakes were compared with eating McDonald’s hash browns and sausages. []
  41. Nicholls, S.J.; Lundman, P.; Harmer, J.A.; Cutri, B.; Griffiths, K.A.; Rye, K.-A.; Barter, P.J.; Celermajer, D.S. Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function. J. Am. Coll. Cardiol. 2006, 48, 715–720. []
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  48. Want to Lose Weight the Easy Way? []
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  51. Mitocondrial activity and diet: Mitochondrial numbers and activity within muscle cells and other body tissues are not constant – they vary with diet. For instance, in a study  (A high-fat diet coordinately downregulates genes required for mitochondrial oxidative phosphorylation in skeletal muscle.) where participants were fed a 50%-fat diet, mitochondrial biogenesis was significantly reduced within just 3 days. []
  52. Anderson, A.S.; Haynie, K.R.; McMillan, R.P.; Osterberg, K.L.; Boutagy, N.E.; Frisard, M.I.; Davy, B.M.; Davy, K.P.; Hulver, M.W. Early skeletal muscle adaptations to short-term high-fat diet in humans before changes in insulin sensitivity. Obesity 2015, 23, 720–724. []
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  59. Melina, V.; Craig, W.; Levin, S. Position of the academy of nutrition and dietetics: Vegetarian diets. J. Acad. Nutr. Diet. 2016, 116, 1970–1980. [] [] []
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  61. Plant Protein, Fibre & Nuts Lower Cholesterol & Blood Pressure []
  62. Yokoyama, Y.; Nishimura, K.; Barnard, N.D.; Takegami, M.; Watanabe, M.; Sekikawa, A.; Okamura, T.; Miyamoto, Y. Vegetarian diets and blood pressure: A meta-analysis. JAMA Int. Med. 2014, 174, 577–587. []
  63. Yavari, A.; Javadi, M.; Mirmiran, P.; Bahadoran, Z. Exercise-induced oxidative stress and dietary antioxidants. Asian J. Sports Med. 2015, 6. []
  64. Knez, W.L.; Coombes, J.S.; Jenkins, D.G. Ultra-endurance exercise and oxidative damage: Implications for cardiovascular health. Sports Med. 2006, 36, 429–441. []
  65. Gomez-Cabrera, M.-C.; Martínez, A.; Santangelo, G.; Pallardó, F.V.; Sastre, J.; Viña, J. Oxidative stress in marathon runners: Interest of antioxidant supplementation. Br. J. Nutr. 2006, 96, S31–S33. []
  66. Rauma, A.L.; Mykkänen, H. Antioxidant status in vegetarians versus omnivores. Nutrition 2000, 16, 111–119. []
  67. Powers, S.K.; Talbert, E.E.; Adhihetty, P.J. Reactive oxygen and nitrogen species as intracellular signals in skeletal muscle. J. Physiol. 2011, 589, 2129–2138. []
  68. Rauma, A.L.; Törrönen, R.; Hänninen, O.; Verhagen, H.; Mykkänen, H. Antioxidant status in long-term adherents to a strict uncooked vegan diet. Am. J. Clin. Nutr. 1995, 62, 1221–1227. []
  69. Kahleova, H.; Matoulek, M.; Malinska, H.; Oliyarnik, O.; Kazdova, L.; Neskudla, T.; Skoch, A.; Hajek, M.; Hill, M.; Kahle, M.; et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Med. 2011, 28, 549–559. []
  70. Domínguez, R.; Cuenca, E.; Maté-Muñoz, J.L.; García-Fernández, P.; Serra-Paya, N.; Estevan, M.C.L.; Herreros, P.V.; Garnacho-Castaño, M.V. Effects of beetroot juice supplementation on cardiorespiratory endurance in athletes. A systematic review. Nutrients 2017, 9, 43. []
  71. Which Athlete Ate the Most Nitrates… []
  72. İnce, D.İ.; SÖnmez, G.T.; İnce, M.L. Effects of garlic on aerobic performance. Turk. J. Med. Sci. 1999, 30, 557–561. []
  73. Bowtell, J.L.; Sumners, D.P.; Dyer, A.; Fox, P.; Mileva, K.N. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med. Sci. Sports Exercise 2011, 43, 1544–1551. []
  74. Haghighatdoost, F.; Bellissimo, N.; Totosy de Zepetnek, J.O.; Rouhani, M.H. Association of vegetarian diet with inflammatory biomarkers: A systematic review and meta-analysis of observational studies. Public Health Nutr. 2017, 20, 2713–2721. []
  75. Hutchison, A.T.; Flieller, E.B.; Dillon, K.J.; Leverett, B.D. Black currant nectar reduces muscle damage and inflammation following a bout of high-intensity eccentric contractions. J. Diet. Suppl. 2016, 13, 1–15. []
  76. McAnulty, L.S.; Nieman, D.C.; Dumke, C.L.; Shooter, L.A.; Henson, D.A.; Utter, A.C.; Milne, G.; McAnulty, S.R. Effect of blueberry ingestion on natural killer cell counts, oxidative stress, and inflammation prior to and after 2.5 h of running. Appl. Physiol. Nutr. Metab. 2011, 36, 976–984. []
  77. Trombold, J.R.; Reinfeld, A.S.; Casler, J.R.; Coyle, E.F. The effect of pomegranate juice supplementation on strength and soreness after eccentric exercise. J. Strength Cond. Res. 2011, 25, 1782–1788. []
  78. Howatson, G.; McHugh, M.P.; Hill, J.A.; Brouner, J.; Jewell, A.P.; van Someren, K.A.; Shave, R.E.; Howatson, S.A. Influence of tart cherry juice on indices of recovery following marathon running. Scand. J. Med. Sci. Sports 2010, 20, 843–852. []
  79. Tarazona-Díaz, M.P.; Alacid, F.; Carrasco, M.; Martínez, I.; Aguayo, E. Watermelon juice: Potential functional drink for sore muscle relief in athletes. J. Agric. Food Chem. 2013, 61, 7522–7528. []
  80. Ley, S.H.; Sun, Q.; Willett, W.C.; Eliassen, A.H.; Wu, K.; Pan, A.; Grodstein, F.; Hu, F.B. Associations between red meat intake and biomarkers of inflammation and glucose metabolism in women. Am. J. Clin. Nutr. 2014, 99, 352–360. []
  81. The Safety of Heme vs. Non-Heme Iron
    Michael Greger M.D. FACLM June 5th, 2015 Volume 25 []
  82. Berenbaum, F.; van den Berg, W.B. Inflammation in osteoarthritis: Changing views. Osteoarthritis Cartilage 2015, 23, 1823–1824. []
  83. Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear. []
  84. Hailu, A.; Knutsen, S.F.; Fraser, G.E. Associations between meat consumption and the prevalence of degenerative arthritis and soft tissue disorders in the adventist health study, California U.S.A. J. Nutr. Health Aging 2006, 10, 7–14. []
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  88. Hafström, I.; Ringertz, B.; Spångberg, A.; von Zweigbergk, L.; Brannemark, S.; Nylander, I.; Rönnelid, J.; Laasonen, L.; Klareskog, L. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: The effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology 2001, 40, 1175–1179. []
  89. McDougall, J.; Bruce, B.; Spiller, G.; Westerdahl, J.; McDougall, M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J. Altern. Complement. Med. 2002, 8, 71–75. []
  90. Driggin, E.; Ganguzza, L.; de Villa, V.B.; Farid, E.; Heffron, S.; Newman, J.; Slater, J.; Woolf, K.; Shah, B. Abstract P029: Factors associated with participation of patients with coronary artery disease in a randomized study of a vegan versus American heart association-recommended diet: Interim analysis. Circulation 2017, 135. []
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  93. Eat Enough Food & You Eat Enough Protein []
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  101. Vegan Pregnancy & Parenting []
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  104. Vegan Society Veg-1: Does It Contain Enough B12? []
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  106. How common is vitamin B-12 deficiency? Lindsay H Allen. The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 693S–696S. []
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Effects of High-Carb Diets on BMI & Insulin Resistance

A September 2018 16-week randomised controlled clinical trial by the Physician’s Committee for Responsible Medicine1 looked at whether a plant-based high-carbohydrate, low-fat diet in overweight individuals would have a more beneficial effect on body weight, body composition and insulin resistance when compared with a standard Western diet. Controversy in the media is rife about whether or not a carbohydrate-rich diet is healthy, so will this research study help settle the argument once and for all?

Study method

75 participants were randomised to follow either a plant-based high-carbohydrate, low-fat (vegan) diet or to maintain their current diet.

The intervention group was asked to follow a low-fat vegan diet consisting of vegetables, grains, legumes, and fruits, and avoiding animal products and added oils. There were no limits on energy or carbohydrate intake. The control group participants were asked to maintain their current diets, which included meat and dairy products, for the 16-week intervention period.

All study participants were asked not to alter their physical activity and to continue their preexisting medication regimens for the duration of the study, except as modified by their personal physicians.

Measurements were taken before and at the end of the trial.

Study results

The results can be seen in the charts below.

So, in the vegan group:

  • fat mass reduced
  • insulin resistance significantly reduced
    • and these results remained significant after adjustment for energy intake

The more total and insoluble fibre consumed, the greater the drop in the following:

  • BMI
  • fat mass
  • volume of visceral fat
    • again, these results remained significant even after adjustment for energy intake

Increased consumption of carbohydrate and fibre, as part of a plant-based high-carbohydrate, low-fat diet, were associated with beneficial effects on the following:

  • weight
  • body composition
  • insulin resistance


Obesity – a pandemic?

Percent of Adults with BMI ≥30. Source: WHO, Global Database on Body Mass Index.

The World Health Organisation estimates that more than 1.9 billion adults worldwide have excess body weight 2 3 .  Hence, obesity rates are rising rapidly. Since increased body weight is associated with a higher all-cause mortality 4 , it’s vital that sustainable and practical solutions are found.

Causes of obesity

It’s pretty obvious to anyone who does a little research: poor dietary habits (such as high intakes of processed meat products and sodium with low intakes of fruits and vegetables) are one of the leading contributors.  This single avoidable behavioural factor contributes to huge numbers of deaths through a range of chronic diseases – including around half of cardio-metabolic deaths in the United States alone 3 5 6 .

Solutions to obesity

In contrast to the above, plant-based diets have been shown repeatedly to represent an effective strategy for improving nutrient intake 7 , being clearly associated with decreased all-cause mortality and decreased risk of obesity, type 2 diabetes, and coronary heart disease 8 .

The following dietary elements of a plant-based diet have been shown to have independent advantages for weight loss and weight management:

  • whole grains 9 10
  • legumes 11
  • fruits and vegetables 12 13 14
  • high carbohydrate (low glycaemic index) intake 15 16
  • high fibre content 17

Final thoughts

Above, I asked whether this study would settle once and for all the question of whether or not a carbohydrate-rich diet is healthy. As long as the carbohydrates are what’s found in wholefood plants and not in processed junk food, it appears to me that this, as well as many other studies mentioned above, do indeed favour a positive answer to this question.

Naturally, however, the industries benefiting from producing, advertising and selling processed junk foods and animal products will continue in their attempts to deny/ignore/marginalise the facts with the aim of confusing the public. That, unfortunately, is the way business is done. But each of us can take responsibility for what foods we consume, and thus exert complete dietary control to help ourselves avoid so many chronic diet-related diseases.


  1. Nutrients. 2018 Sep 14;10(9). pii: E1302. doi: 10.3390/nu10091302. A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates. Kahleova H, Dort S, Holubkov R, Barnard ND. []
  2. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016, 387, 1377–1396. []
  3. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1659–1724. [] []
  4. Di Angelantonio, E.; Bhupathiraju, S.N.; Wormser, D.; Gao, P.; Kaptoge, S.; de Gonzalez, A.B.; Cairns, B.J.; Huxley, R.; Jackson, C.L.; Joshy, G.; et al. Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016, 388, 776–786. []
  5. Murray, C.J.L.; Atkinson, C.; Bhalla, K.; Birbeck, G.; Burstein, R.; Chou, D.; Dellavalle, R.; Danaei, G.; Ezzati, M.; Fahimi, A.; et al. Burden of Disease Collaborators The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA 2013, 310, 591–608. []
  6. Micha, R.; Peñalvo, J.L.; Cudhea, F.; Imamura, F.; Rehm, C.D.; Mozaffarian, D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017, 317, 912–924. []
  7. Rizzo, N.S.; Jaceldo-Siegl, K.; Sabate, J.; Fraser, G.E. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J. Acad. Nutr. Diet. 2013, 113, 1610–1619. []
  8. Fraser, G.E. Vegetarian diets: What do we know of their effects on common chronic diseases? Am. J. Clin. Nutr. 2009, 89, 1607S–1612S. []
  9. Pol, K.; Christensen, R.; Bartels, E.M.; Raben, A.; Tetens, I.; Kristensen, M. Whole grain and body weight changes in apparently healthy adults: A systematic review and meta-analysis of randomized controlled studies. Am. J. Clin. Nutr. 2013, 98, 872–884. []
  10. Harland, J.I.; Garton, L.E. Whole-grain intake as a marker of healthy body weight and adiposity. Public Health Nutr. 2008, 11, 554–563. []
  11. Kim, S.J.; de Souza, R.J.; Choo, V.L.; Ha, V.; Cozma, A.I.; Chiavaroli, L.; Mirrahimi, A.; Blanco Mejia, S.;
    Di Buono, M.; Bernstein, A.M.; et al. Effects of dietary pulse consumption on body weight: A systematic review and meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 2016, 103, 1213–1223. []
  12. Bertoia, M.L.; Mukamal, K.J.; Cahill, L.E.; Hou, T.; Ludwig, D.S.; Mozaffarian, D.; Willett, W.C.; Hu, F.B.; Rimm, E.B. Changes in intake of fruits and vegetables and weight change in United States men and women followed for up to 24 years: Analysis from three prospective cohort studies. PLoS Med. 2015, 12, e1001878. []
  13. Tapsell, L.C.; Batterham, M.J.; Thorne, R.L.; O’Shea, J.E.; Grafenauer, S.J.; Probst, Y.C. Weight loss effects from vegetable intake: A 12-month randomised controlled trial. Eur. J. Clin. Nutr. 2014, 68, 778–785. []
  14. Boeing, H.; Bechthold, A.; Bub, A.; Ellinger, S.; Haller, D.; Kroke, A.; Leschik-Bonnet, E.; Müller, M.J.; Oberritter, H.; Schulze, M.; et al. Critical review: Vegetables and fruit in the prevention of chronic diseases. Eur. J. Nutr. 2012, 51, 637–663. []
  15. Thomas, D.E.; Elliott, E.J.; Baur, L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst. Rev. 2007, CD005105 []
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Vegetarian Diets and the Risk of Diabetes

A September 2018 review 1 looked at whether the dramatic worldwide increase in cases of type 2 diabetes (T2DM – type 2 diabetes mellitus) could be slowed down if individuals made simple dietary changes rather than seeking solutions through medication.


The reviewers note that vegetarian diets are inversely associated with risk of developing diabetes, and this is independent of the positive association of meat consumption with diabetes development.

Range of diets

Vegetarian diets range* from:

  • vegan (no animal products)
  • lacto-ovo-vegetarian (no animal meat, but consumes milk and eggs)
  • pesco-vegetarian (consumes fish)
  • semi-vegetarian/flexitarian (occasional meat consumption)

*N.B. This review does not look at WFPB or non-SOS WFPB diets.

The most important aspects of any of these types of diets is the emphasis on:

  • whole grains
  • fruits and vegetables
  • legumes
  • nuts
  • reduction of saturated and trans fats

Problem – what problem?

Oh there’s a big problem, alright. Diabetes has now reached epidemic levels, with an estimated 451 million cases worldwide in 2017 – a number that is predicted 2  to increase to 693 million by 2045.

Where’s the evidence?

About 90% of diabetes diagnoses are type 2 (T2DM) – all of these appear to be lifestyle-related 3 . Additionally, the lifestyle factor most linked to improvements in protection against, treatment of and cure for is diet – with the take-home facts being that animal foods encourage whist plant foods discourage T2DM 4 .

As countries develop a more Westernised diet (also known as the SAD or Standard American Diet), the rates of diabetes within those countries increases 3 .

Omnivores vs Vegetarians

A diet differing from the typical Westernised diet is a vegetarian one.  The results of changing to a vegetarian diet is clear. For instance, research 3 shows that vegetarians in the US have a lower prevalence of diabetes than omnivores (that is, those who consume both plant and animal foods, although much more of the latter than the former foods in the case of modern Westernised diets). Other research 5 6 7 8 9  backs up the proposition that a vegetarian diet is significantly better for the prevention and treatment of diabetes than an omnivore diet.

To the heart of the matter

People with diabetes have a 2–4 times greater risk of suffering from CVD (cardio-vascular disease) 10  . Even those who just adhered to a lacto-ovo-vegetarian diet have been shown 11  to have significantly decreased CVD risk factors, specifically blood pressure, serum cholesterol, and blood glucose levels than those adhering to an omnivorous diet.

Another 2013 study 12  examined ischaemic heart disease risk of vegetarians versus non-vegetarians in a large British sample of 44,561 individuals. They found that vegetarians had a lower BMInon-HDL cholesterol, and systolic blood pressure than the non-vegetarians.

Other risks with diabetes

When looking at other diabetes risk factors and comorbidities, a 2015 study 13 found that those adhering to a vegan diet supplemented with vitamin B12 had a significantly larger decrease in neuropathic pain 14 than the control group receiving just B12 supplementation.

A 1988 study 15 examined patients who had diabetic neuropathy 16  and renal failure who followed a vegan diet for 12 months found significant improvements in the following:

  • creatinine clearance 17
  • urine protein levels
  • cholesterol levels
  • blood glucose levels

Is it too late for me?

Okay, if you’ve eaten a vegetarian diet from childhood, you are less likely to have developed diabetes; but what if you’ve been stuffing in the eggs and bacon, doughnuts and cream cakes for most of your life – is it too late? Another 2018 study 18 found that adopting a vegetarian diet later on in life can greatly reduce diabetes risk, showing the benefits of using a vegetarian diet in an intervention. Other research studies 19 20 21    show the same positive results of dietary changes later in life.

Medication vs diet

There’s also evidence 22 23 24 25 supporting the suggestion that adopting a vegetarian diet is more effective than at improving diabetes symptoms than traditional medication. Of course, packing in smoking and getting lots of exercise are also significantly important lifestyle factors that can prevent and treat diabetes.

Physical and mental benefits

A 2013 study 26 looked at the psychological effects of adopting a vegetarian diet. The investigators assessed the following:

  • quality of life
  • eating behaviour
  • depressive symptoms

They divided diabetic subjects into vegetarian and non-vegetarian groups and found an increase in quality of life and decrease in depressive symptoms in the vegetarian group. Regarding dietary restraint, the vegetarian group was was able to show an increased ability to resist the ‘temptation’ to eat more food and more unhealthy food than the non-vegetarian group.  This study showed that adopting a vegetarian diet has both physical and psychological benefits for T2DM patients.

Not all vegetarian diets are equal

Some vegetarians live on processed foods, crisps, chips and sweets. Some hate all vegetables (except fried white potatoes!) while others eat largely whole plant foods.

To examine the differences in type 2 diabetes risk of vegetarians who consume an unhealthy diet (characterised by refined grains, starchy foods, added sugars, low fruits and vegetables) or healthy diet (characterised by whole grains, fruits, vegetable, legumes), a 2016 review 27 categorised the latter as hPDI (a Healthful Plant-Based Diet) and uPDI (an Unhealthy Plant-Based Diet Index) in order to distinguish between healthy and unhealthy plant foods being eaten.

Thus, hPDI assigned positive scores to:

  • whole grains
  • fruits
  • vegetables
  • nuts
  • vegetable oils
  • tea and coffee

and reverse scores to:

  • fruit juices
  • sweetened beverages
  • refined grains
  • potatoes (white)
  • sweets
  • desserts
  • animal foods

The uPDI used the opposite approach.

The results were pretty clear: PDI and hPDI were inversely associated with T2DM, and the uPDI was positively associated with T2DM. This shows the benefit of following a vegetarian diet that is high in whole grains, vegetables, fruits, nuts, and legumes in preventing T2DM.

Study conclusions

The researchers in this September 2018 review 1 drew the following conclusions:

  • the role of all types of vegetarian diets in the prevention and treatment of diabetes is well established
  • clinicians and healthcare providers should feel confident in recommending a vegetarian diet to their patients who have pre-diabetes or T2DM
  • the type of foods that should be consumed while following this diet is critical to achieve the therapeutic effects
  • a vegetarian diet that is high in unhealthy foods such as refined grains, saturated fats, and added sugars is positively associated with T2DM
  • a vegetarian diet that is high in healthy foods such as whole grains, fruits, vegetables, nuts, legumes, and unsaturated fats is negatively associated with T2DM

Final thoughts

It’s pretty obvious to all reasonable people who’ve done even a bit of research that a significant solution to diabetes (prevention, management and cure) lies in simple dietary changes (as well as dropping the tobacco and picking up the weights instead).

However, while this review does look at different manifestations of vegetarian diets, it does not cover in detail how much more effective a completely WFPB (ideally a non-SOS WFPB) diet is when compared with the rest of the vegetarian offerings. Naturally, it hints at this through its mention of the above-mentioned 2016 review 27

If you look online or go to a vegetarian/vegan restaurant and look at what often goes into their recipes you will soon understand what I’m getting at. A quick glance at the menus of one vegan restaurant 28 local to me reveals the potentially unhealthy ingredients and cooking methods that can be both plant-based and unhealthy at the same time –  ‘double fried chips and a pot of garlic mayo‘  and ‘Sticky Toffee Pudding served with a caramel glaze‘ will only offer limited assistance, if any, to diabetic customers looking for the healthy alternative to bangers and mash!

Of course, as evidenced in this review, going plant-based rather than relying on pharmaceuticals is a move in the right direction – but for the greatest protection against diabetes, a non-SOS WFPD has been shown repeatedly in additional research studies 29 30   to trump the more watered-down veggie versions.


  1. Vegetarian Diets and the Risk of Diabetes. Olfert MD, Wattick RA. Curr Diab Rep. 2018 Sep 18;18(11):101. doi: 10.1007/s11892-018-1070-9. Review. [] []
  2. Cho N, Shaw J, Karuranga S, et al. IDF Diabetes Atlas: global
    estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. []
  3. Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010;10:152–8. [] [] []
  4. McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low-meat diets and health: a review. Public Health Nutr. 2012;15(12):2287–94. []
  5. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health. 1985;75(5):507–12. []
  6. Vang A, Singh PN, Lee JW, Haddad EH, Brinegar CH. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from adventist health studies. Ann Nutr Metab. 2008;52(2):96–104. []
  7. Fung TT, Schulze M, Manson JE, Willett WC, Hu FB. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004;164(20):2235–40. []
  8. Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67(5):255–63. []
  9. Chen Z, Zuurmond MG, van der Schaft N, Nano J, Wijnhoven HAH, Ikram MA, et al. Plant versus animal based diets and insulin resistance, prediabetes and type 2 diabetes: the Rotterdam Study. Eur J Epidemiol. 2018. []
  10. Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014;4(5):373–82. []
  11. Slavícek J, Kittnar O, Fraser GE, et al. Lifestyle decreases risk factors for cardiovascular diseases. Cent Eur J Public Health. 2008;16(4):161–4. []
  12. Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the ePIC-Oxford cohort study. Am J Clin Nutr. 2013;97(3):597–603. []
  13. Bunner AE, Wells CL, Gonzales J, Agarwal U, Bayat E, Barnard ND. A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study. Nutr Diabetes. 2015;5(5):e158. []
  14. What is neuropathic pain? Wikipedia. []
  15. Barsotti G, Navalesi R, Giampietro O, et al. Effects of a vegetarian, supplemented diet on renal function, proteinuria, and glucose metabolism in patients with ‘overt’ diabetic nephropathy and renal insufficiency. Contrib Nephrol. 1988;65:87–94. []
  16. What is diabetic neuropathy? Mayo Clinic. []
  17. What is creatinine and creatinine clearance? WedMD []
  18. Chiu THT, Pan W-H, Lin M-N, Lin C-L. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes. 2018;8:12. []
  19. Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning S. Toward improved management of NIDDM: a randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Prev Med. 1999;29:87–91. []
  20. Turner-McGrievy GM, Barnard ND, Scialli AR. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity (SilverSpring). 2007;15:2276–81. []
  21. 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. 2010;28:549–59. []
  22. Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32(11):2312–21. []
  23. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care. 1994;17: 1469–72. []
  24. 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(8):1777–83. []
  25. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791–6. []
  26. Kahleova H, Hrachovinova T, Hill M, Pelikanova T. Vegetarian diet in type 2 diabetes – improvement in quality of life, mood and eating behaviour. Diabet Med. 2013;30(1):127–9. []
  27. Satija A, Bhupathiraju SN, Rimm EB, et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med. 2016;13(6):e1002039. [] []
  28. The Green Room []
  29. Current Diabetes Treatment – Practice or Malpractice? []
  30. Plant-based Diets & Diabetes []

Weight Loss – Down to Exercise or Diet?

You have probably heard Michelle Obama and many others telling overweight people that they can drop their extra pounds by picking up their running shoes. But is this really the answer to the increasing epidemic of obesity spreading around the world?

An Instructor from T Colin Campbell’s Centre for Nutrition Studies considers that her personal experience suggests that this is simply NOT the answer…

Healthy Weight Loss = 80% Nutrition + 20% Exercise


 appeared in the 1998 edition of Shape magazine as one of their “Success Stories” for weight loss.

She was engaged in “an excruciating exercise program of power walking/jogging 35-40 miles per week, plus an additional 20 miles on the bike.” Of course she lost weight, but as the years passed she found that the unwelcome pounds came creeping back.

She read an article that, at the time, seemed to explain why this might be happening: “…as we age, our metabolism slows down due to natural muscle mass decreases, so we need to increase our calorie burning exercise. If we don’t, we gain 10 lbs every few years, even though we are still exercising.”

Discouraged by the thought of having to continually ramp up the extreme exercise as each year passed, she found that her health started to decline – “…high cholesterol, high blood pressure, swollen and painful joints, and hormonal issues. I was only in my forties, and my lack of health had become a source of great stress. I couldn’t imagine what I would be like in my 60’s. My joints already hurt so much!”

Eventually, she came across the landmark documentary film Forks Over Knives. Things changed from then on. And she was not alone. This very film revolutionised my life and the lives of many people I come across daily.

Terri, like many, many others, learned that optimal health was not about exercising more. Rather, it was about eating the right foods. “Not chicken and fish like I had thought, but whole grains, legumes, vegetables, and fruits!”

  • Leanest cut of beef ~28% calories from fat
  • Skinless chicken breast ~ 24% from fat
  • Tuna ~21% from fat
  • Salmon ~ 40% from fat
  • Eggs ~70% from fat!

Nutrition is Key

Even though she continued to consider that exercise and stress management are important “…the real key—80% of the equation—is nutrition – in particular, eating plants.

Now, her main exercise is walking the dog daily for around 30-45 minutes with some gentle yoga four days a week – without the dog, I guess!

She says that her cholesterol levels have dropped and she no longer suffers from inflammation or pain.

While exercise and stress management are “…very important pieces to the health puzzle; it’s not whole without them. But, nutrition is the biggest piece of the picture. “You can’t outrun your fork.” “

Some edited thoughts (1.) from Dr. Greger

The food industries like to blame inactivity as the prime cause of obesity, not the promotion and consumption of their calorie-rich products. (2.) On the contrary, however, research suggests that the level of physical activity may have actually increased in the United States over the past few decades. (3.) We know that obesity is rising even in areas where people are exercising more. (4.) This is likely explained by the fact that eating activity levels are outstripping physical activity levels. (5.)…Researchers who accept grants from the Coca-Cola Company (6.) call physical inactivity “the biggest public health problem of the 21st century.” (7.) Actually, physical inactivity ranks down at number five in terms of risk factors for death in the United States and number six in terms of risk factors for disability. (8.) And inactivity barely makes the top ten globally. (9.)

diet is by far our greatest killer, followed by smoking. (10.)

Of course, that doesn’t mean you should sit on the couch all day…. in addition to helping you enjoy a healthy body weight, exercise can also ward off and possibly reverse mild cognitive decline, boost your immune system, prevent and treat high blood pressure, and improve your mood and quality of sleep, among many other benefits.


  1. Greger, Michael; Stone, Gene. How Not To Die: Discover the foods scientifically proven to prevent and reverse disease (Air Side Edt) (p. 393). Pan Macmillan. Kindle Edition
  2. Freedhoff Y, Hébert PC. Partnerships between health organizations and the food industry risk derailing public health nutrition. CMAJ. 2011;183( 3): 291– 2.
  3. Westerterp KR, Speakman JR. Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. Int J Obes (Lond). 2008;32( 8): 1256– 63.
  4. Dwyer-Lindgren L, Freedman G, Engell RE, et al. Prevalence of physical activity and obesity in US counties, 2001– 2011: a road map for action. Popul Health Metr. 2013;11: 7.
  5. Laskowski ER. The role of exercise in the treatment of obesity. PMR. 2012;4( 11): 840– 4.
  6. Archer E, Hand GA, Blair SN. Correction: Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971– 2010. http:// plosone/ article? id = 10.1371/ annotation/ c313df3a-52bd-4cbe-af14-6676480d1a43. October 11, 2013. Accessed April 23, 2015.
  7. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43( 1): 1– 2.
  8. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990– 2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310( 6): 591– 608.
  9. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990– 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380( 9859): 2224– 60.
  10. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990– 2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310( 6): 591– 608.


Joe’s Final Comment

For many years I also considered that exercise was the main answer. I would train for marathons, work myself into the ground – pushing my body so hard that I repeatedly wrecked my muscles and joints; but still I would find that my unwanted weight crept back, and those damned “love handles”  would never disappear.

Now, at the age of 56, my body feels like it is at its optimal weight – the lowest level since I was in my teens. I never go hungry or actively control the quantity of food I eat – and I eat A LOT!

Before “going cold turkey” into a WFPB diet, I was starting to feel old and pretty pessimistic about my future, even though I was very conscious of my dietary intake and had been a vegetarian on and off for most of my life.

Now, my arthritis has all but disappeared. My joints no longer ache. I no longer get constipated or have the recurrent mouth ulcers and nose bleeds that I had for years. Getting in and out of the car, or up from sofas, no longer causes exclamations of pain. I feel like I have more energy now than I had years ago. My mental attitude is consistently positive and…I am really looking forward to the future.

Of course my and Terri’s claims about the health benefits of a WFPB diet are merely anecdotal; but without a personal experience of the power of plant-eating I would not be able to recommend it to other people. I just wish my parents had been able to enjoy its health benefits instead of the lingering and painful diet-related diseases that they endured.

If you have a personal story that you think would inspire others, let me know.