A long-term WFPB study conducted in the Marshall Islands has confirmed the value of a whole food plant-based diet over standard medical care in dealing with type 2 diabetes.
Those involved with the study included Brenda C Davis, Joan Sabate & John H. Kelly Jr, Cody Hanick and Courtney Peterson.
The 24-week study found that a whole-food, plant-based lifestyle intervention was more effective for improving glycaemic control than standard medical care. It also reduced the need for diabetes and cardiovascular medications and induced diabetes remission in some participants.
The study also recognised the value ketogenic diets can play in this regard and noted that, of the two approaches, low-carbohydrate diets, particularly ketogenic diets, are the most well-studied. Clinical trials suggest ketogenic diets lower HbA1c [1], reduce diabetes medications [2], and induce diabetes remission in some individuals. [3]
However, low-carbohydrate diets are also associated with increased mortality risk, can impair glucose tolerance and increase cholesterol and inflammation.
The study authors noted that “although promising, most studies examining WFPB diets and diabetes are small and short-term. Thus, we conducted the largest and longest randomised controlled trial to compare a WFPB intervention vs standard medical care in participants with type 2 diabetes.”
The clinical trial was conducted in the Republic of the Marshall Islands, which has the seventh-highest diabetes prevalence globally. Its high prevalence has been partially attributed to an increased reliance on imported foods, including white rice, refined flour, sugar-sweetened beverages and canned meats.
“To mirror other intensive lifestyle interventions, we paired a WFPB diet with moderate exercise and hypothesised that the combination would be more effective than standard medical care for improving glycaemic control and cardiovascular health and would reduce the need for glucose-lowering medications,” the authors said.
The strengths of this study include its innovative diet approach, large sample size, long duration, high male representation (50%), high-priority population, cultural adaptation and lifestyle intervention that progressively decreased in intensity.
“The latter factor provided us with a unique opportunity to test different ‘doses’ of the PB+Ex intervention. Interestingly, during the most intensive phase, participants experienced robust improvements in nearly every cardiometabolic endpoint, although the effects for fasting glucose, insulin, triglycerides, heart rate and blood pressure waned as intervention intensity decreased.
“This suggests that a WFPB diet with moderate exercise can improve most cardiometabolic risk factors, but the effects depend on the intervention intensity and/or level of adherence.”
The general conclusion was that a WFPB lifestyle intervention with moderate exercise was more effective than standard medical care at improving glycaemic control, body weight, waist circumference and inflammation.
It also lessened the need for glucose-lowering and cardiovascular medications and induced type 2 diabetes remission in some participants.
“Overall, our findings support the ‘food as medicine’ concept and suggest that WFPB interventions with moderate exercise may dramatically reduce the risk of comorbidities. A WFPB diet with moderate exercise can be offered as a highly effective, evidence-based lifestyle intervention for individuals with type 2 diabetes.”
Editorial note
In its introductory section, this study makes the following statement: WFPB diets include not only vegetarian and vegan diets but also other plant-predominant diets that incorporate meat and seafood.
Whole Food Living has always defined and still views WFPB eating as plant-only. It differs significantly from vegetarian eating, which contains animal products, and common vegan fare, which contains sugar, oil, salt and some highly processed products.
In its purest sense, WFPB eating contains no sugar, oil, or salt and accepts minimal food processing only, with no preservatives or highly refined products. Adherents of WFPB often call it the high-carb diet, which means it is high in complex carbohydrates and completely excludes refined/processed carbohydrates.
WFPB followers accept that this way of eating can be called a ‘diet’, especially where scientific distinction is required and discussion is involved. However, to many, this reference is somewhat cringeworthy as part of general public discourse.
Followers often baulk at the term because, as their knowledge deepens, they discover that optimal health involves much more than food alone.
References
1, 2 & 3: https://link.springer.com/article/10.1007/s00125-024-06272-8#ref-CR