Eur J Clin Nutr. 2004 Feb;58(2):312-6.
Insulin sensitivity in Chinese ovo-lactovegetarians compared with omnivores.
Kuo CS, Lai NS, Ho LT, Lin CL.
Division of Endocrinology and Metabolism, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital and School of Medicine, Chia-Yi, Taiwan.

  AIM: To compare the insulin sensitivity indices between Chinese vegetarians and omnivores.
  METHODS: The study included 36 healthy volunteers (vegetarian, n=19; omnivore, n=17) who had normal fasting plasma glucose levels. Each participant completed an insulin suppression test. We compared steady-state plasma glucose (SSPG), fasting insulin, the homeostasis model assessment for insulin sensitivity (HOMA-IR and HOMA %S) and beta-cell function (HOMA %beta) between the groups. We also tested the correlation of SSPG with years on a vegetarian diet.
  RESULTS: The omnivore subjects were younger than the vegetarians (55.7+/-3.7 vs 58.6+/-3.6 year of age, P=0.022). There was no difference between the two groups in sex, blood pressure, renal function tests and lipid profiles. The omnivores had higher serum uric acid levels than vegetarians (5.25+/-0.84 vs 4.54+/-0.75 mg/dl, P=0.011). The results of the indices were different between omnivores and vegetarians (SSPG (mean+/-s.d.) 105.4+/-10.2 vs 80.3+/-11.3 mg/dl, P<0.001; fasting insulin, 4.06+/-0.77 vs 3.02+/-1.19 microU/ml, P=0.004; HOMA-IR, 6.75+/-1.31 vs 4.78+/-2.07, P=0.002; HOMA %S, 159.2+/-31.7 vs 264.3+/-171.7%, P=0.018) except insulin secretion index, HOMA %beta (65.6+/-18.0 vs 58.6+/-14.8%, P=0.208). We found a clear linear relation between years on a vegetarian diet and SSPG (r=-0.541, P=0.017).
  CONCLUSIONS: The vegetarians were more insulin sensitive than the omnivore counterparts. The degree of insulin sensitivity appeared to be correlated with years on a vegetarian diet.

PMID: 14749752

Am J Clin Nutr. 2004 Jan; 79(1): 70-5.
Dietary iron intake and blood donations in relation to risk of type 2 diabetes in men: a prospective cohort study.
Jiang R, Ma J, Ascherio A, Stampfer MJ, Willett WC, Hu FB.
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. rjiang@hsph.harvard.edu

  BACKGROUND: Excessive iron stores may promote insulin resistance and lead to the development of type 2 diabetes. However, prospective data relating iron intake and blood donations (determinants of body iron stores) to diabetes incidence are limited.
  OBJECTIVE: We examined iron intake and blood donations in relation to the incidence of type 2 diabetes.
  DESIGN: We followed men aged 40-75 y who participated in the Health Professionals' Follow-up Study; were free of diabetes, cardiovascular disease, and cancer in 1986; and provided dietary data (n = 38 394). Of those participants, 33 541 also provided a history of blood donation during the past 30 y in 1992.
  RESULTS: During 12 y of follow-up, we ascertained 1168 new cases of type 2 diabetes. After adjustment for age, body mass index, and other diabetes risk factors, total iron intake was not associated with the risk of type 2 diabetes. Intakes of total heme iron [multivariate relative risk (RR) for extreme quintiles: 1.28; 95% CI: 1.02, 1.61; P for trend = 0.045] and of heme iron from red meat (RR: 1.63; 1.26, 2.10; P for trend < 0.001) were associated with an increased risk. However, heme-iron intake from sources other than red meat was not associated with diabetes risk (RR: 0.99; 0.81, 1.22). No significant associations were found between blood donation and the risk of type 2 diabetes.
  CONCLUSIONS: Heme-iron intake from red meat sources is positively associated with the risk of type 2 diabetes. Total iron intake, heme-iron intake from non-red meat sources, and blood donations are not related to the risk of type 2 diabetes.

PMID: 14684399

Eur J Clin Nutr. 2003 Aug;57(8):999-1008.
Oxidative stress status in patients with diabetes mellitus: relationship to diet.
Dierckx N, Horvath G, Van Gils C, Vertommen J, Van De Vliet J, De Leeuw I, Manuel-Y-Keenoy B.
Laboratory of Endocrinology, University of Antwerp, Belgium.

  OBJECTIVE:: To investigate the relationship between dietary intakes and in vivo oxidative stress (OS) status in diabetic patients.
  DESIGN:: Case-control study.
  SETTING:: Outpatient-Clinic and Laboratory Endocrinology, University Antwerp.
  SUBJECTS AND METHODS:: A total of 30 patients (24 type 1 diabetes mellitus (T1DM)/6 type 2 diabetes mellitus (T2DM) were asked to complete a 2 weekdays+1weekend day food consumption questionnaire during the week preceding their yearly diabetes control consultation, when samples were collected for the assay of oxidative stress (OS) (blood levels of antioxidants, peroxides, malondialdehyde (MDA) and minerals). Blood samples were also collected from 25 age- and sex-matched healthy controls.
  RESULTS:: Diabetic patients had lower glutathione (5.80+/-1.15 vs 6.75+/-1.03 micromol/g Hb in the controls, P=0.002) and higher MDA (0.687+/-0.212 vs 0.545+/-0.101 micromol/l, P=0.002). Although the group average intakes were within the Belgian RDA, intakes of fat >35% energy, fibre &<15 g/1000 kcal, fruit &<2 portions and vitamin E &<10 mg/day were seen in more than 20 patients. Blood antioxidants did not correlate with intakes of energy, fat, protein or fibres or of their respective antioxidant. Vitamins A and E correlated with serum lipids (r=0.58, P &<0.0005 between serum alpha-tocopherol and cholesterol). Blood peroxide levels were only related to intakes of saturated fat and cholesterol (P&<0.05). In diabetic subjects but not in controls (P&<0.05) MDA was related to glutathione and uric acid.
  CONCLUSIONS:: In diabetic patients, blood levels of antioxidants are not related to their dietary intakes but to serum lipids. Levels of oxidative damage products are only related to intakes of saturated fats and cholesterol and to levels of endogenous antioxidants.

PMID: 12879095

Diabetes, June 2003 v52 i6 pA556(1)
Acceptability of a low-fat, vegan diet compares favorably to a step II diet in a randomized, controlled trial. (Obesity--Clinical Treatment).
Neal Barnard; Anthony Scialli; Gabrielle Turner-Mcgrievy; Amy Lanou. Author's Abstract: COPYRIGHT 2003 American Diabetes Association

  Objective: Low-fat, vegetarian and vegan diets typically improve serum lipids, body weight, and other health measures, but their clinical use depends on their acceptability among patients. We therefore quantitatively assessed of the acceptability of a low-fat, vegan diet.
  Design: The study was a randomized, controlled, 14-week trial using a 3-d dietary record, Eating Inventory (EI), and Food Acceptability Questionnaire to assess dietary intake, behavior, and acceptability.
  Subjects/setting: Through newspaper advertisements, 64 overweight, post-menopausal women were recruited, of whom 59 completed the study, which occurred in an outpatient clinical setting.
  Intervention: Participants were randomly assigned to a low-fat, vegan diet or a National Cholesterol Education Program Step II diet.
  Main outcome measures: The 3-d dietary record assessed intake. The El measured dietary restraint, disinhibition, and hunger. The Food Acceptability Questionnaire measured diet acceptability. Statistical analyses performed: Paired comparison t-tests were calculated for within-group nutrient changes, and between-subject t-tests were calculated for between-groups differences. An alpha level of .05 was used. The independent samples Mann-Whitney U test compared the acceptability of the diets, and the related-samples Wilcoxon rank test assessed within-group changes.
  Results: Dietary restraint increased in the control group, but was unchanged in the intervention group. There were no differences between the diet groups on any acceptability measure.
  Applications/conclusions: In the context of a 14-week trial, reported acceptability of a low-fat vegen diet is not demonstrably different from that of a NCEP Step II diet. Diet acceptability is not a barrier to the use of low-fat, vegan diets in clinical settings.

J Peripher Nerv Syst. 2003 Jun;8(2):128-133.
Medical Hypotheses 58: 476-486, 2002.
Favorable Impact of a Vegan Diet with Exercise on Hemorheology: Implications for Control of Diabetic Neuropathy.
McCarty M.

  A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology - decreased blood viscosity and increased blood filterability - plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics - an important determinant of blood filterability - remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes - retinopathy, nephropathy, and macrovascular disease - independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, 'low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners.

PMID: 12795718

Can J Diet Pract Res. 2003 Summer;64(2):62-81.
Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets.
American Dietetic Association; Dietitians of Canada.

  It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life-cycle including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate, antioxidants such as vitamins C and E, and phytochemicals. Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease, lower blood cholesterol levels, lower blood pressure, and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. While a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes.

PMID: 12826028

J Nutr 2003 May;133(5 Suppl 2):1674S-1683S
Gestational diabetes and insulin resistance: role in short- and long-term implications for mother and fetus.
Catalano PM, Kirwan JP, Haugel-de Mouzon S, King J Department of Reproductive Biology, Schwartz Center for Metabolism and Nutrition, Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, OH 44109, USA. pcatalano@metrohealth.org

  Gestational diabetes and obesity are the common metabolic abnormalities occurring during pregnancy. [Note: these conditions occur only in the humans who mistakenly consume cultural diets, they are not seen in any other species of Life on this planet. - ljf] Decreased maternal pregravid insulin sensitivity (insulin resistance) coupled with an inadequate insulin response are the pathophysiological mechanisms underlying the development of gestational diabetes. Insulin-regulated carbohydrate, lipid and protein metabolism are all affected to a variable degree. Decreased maternal insulin sensitivity in women with gestational diabetes may increase nutrient availability to the fetus, possibly accounting for an increased risk of fetal overgrowth and adiposity. [Note: and the resulting painful delivery and "fat baby syndrome", again experienced only by cultural humans - ljf] Epidemiological studies from Europe show an increased risk of the insulin resistance syndrome in adults who were low birth weight at delivery. However, in the United States over the past 20 y there has been a significant 33% increase in the incidence of type 2 diabetes, which has been associated with a parallel increase in obesity. All age groups have been affected but the most dramatic increases have occurred in adolescents. [who get a little money and consume junk food - ljf] The relationship between decreased maternal insulin sensitivity and fetal overgrowth particularly in obese women and women with gestational diabetes may help explain the increased incidence of adolescent obesity and related glucose intolerance in the offspring of these women. In this review, we address 1) the pathophysiology of gestational diabetes, 2) the changes in maternal insulin sensitivity during pregnancy that effect maternal accretion of adipose tissue and energy expenditure, 3) the influence of maternal metabolic environment on fetal growth, 4) the life-long effect of being born at either extreme of the birth weight continuum and 5) micronutrients and decreased insulin sensitivity during pregnancy.

PMID: 12730484

Ethn Dis 2003 Winter;13(1):34-9
Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: preliminary results.
Brathwaite N, Fraser HS, Modeste N, Broome H, King R. Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA. brathwaitenoel@aol.com

  A population-based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status, body mass index (BMI), obesity, diabetes mellitus (DM), and hypertension, in order to gain a better understanding of factors influencing chronic diseases in Barbados. A systematic sampling from a random start technique was used to select participants for the study. A standard questionnaire was used to collect data on demographic and lifestyle characteristics, to record anthropometrics and blood pressure measurements, and to ascertain the hypertension and diabetes status of participants. The sample population consisted of 407 Barbadian Seventh-Day Adventists (SDAs), who ranged in age from 25 to 74 years. One hundred fifty-three (37.6%) participants were male, and 254 (62.4%) were female, and 43.5% were vegetarians. The prevalence rates of diabetes and hypertension were lower among long-term vegetarians, compared to non-vegetarians, and long-term vegetarians were, on average, leaner than non-vegetarians within the same cohort. A significant association was observed between a vegetarian diet and obesity [no doubt consumers of excess grain products - ljf] (vegetarian by definition P=.04, self-reported vegetarian P=.009) in this population. Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity, diabetes, and hypertension.

PMID: 12723010

Am J Clin Nutr 2003 Jun;77(6):1434-41
Dietary intakes and plasma concentrations of carotenoids and tocopherols in relation to glucose metabolism in subjects at high risk of type 2 diabetes: the Botnia Dietary Study.
Ylonen K, Alfthan G, Groop L, Saloranta C, Aro A, Virtanen SM Department of Applied Chemistry and Microbiology, Division of Nutrition, University of Helsinki (KY).

  BACKGROUND: The role of antioxidants in the pathogenesis of type 2 diabetes is uncertain.
  OBJECTIVE: We evaluated cross-sectional relations of dietary intakes and plasma concentrations of antioxidants with glucose metabolism in a high-risk population.
  DESIGN: The subjects were 81 male and 101 female first- and second-degree, nondiabetic relatives of patients with type 2 diabetes. Antioxidant intake data were based on 3-d food records. Subjects taking supplements containing beta-carotene or alpha-tocopherol were excluded. Plasma antioxidant concentrations were measured by HPLC. By using multiple linear regression analysis and adjusting for demographic, anthropometric, and lifestyle covariates, we studied whether dietary and plasma alpha- and beta-carotene, lycopene, and alpha- and gamma-tocopherol were related to fasting and 2-h concentrations of glucose and nonesterified fatty acids during an oral-glucose-tolerance test, to the homeostasis model assessment index of insulin resistance, and to measures of beta cell function (incremental 30-min serum insulin concentration during an oral-glucose-tolerance test and first-phase insulin secretion during an intravenous-glucose-tolerance test).
  RESULTS: In men, dietary carotenoids were inversely associated with fasting plasma glucose concentrations (P < 0.05), plasma beta-carotene concentrations were inversely associated with insulin resistance (P = 0.003), and dietary lycopene was directly related to baseline serum concentrations of nonesterified fatty acids (P = 0.034). In women, dietary alpha-tocopherol and plasma beta-carotene concentrations were inversely and directly associated, respectively, with fasting plasma glucose concentrations (P < 0.05). In both sexes, cholesterol-adjusted alpha-tocopherol concentrations were directly associated with 2-h plasma glucose concentrations (P < 0.05).
  CONCLUSION: The data suggest an advantageous association of carotenoids, which are markers of fruit and vegetable intake, with glucose metabolism in men at high risk of type 2 diabetes.

PMID: 12791620

Diabetes Care. 2000 Jun;23(6):726-32.
Vitamin C and hyperglycemia in the European Prospective Investigation into Cancer--Norfolk (EPIC-Norfolk) study: a population-based study.
Sargeant LA, Wareham NJ, Bingham S, Day NE, Luben RN, Oakes S, Welch A, Khaw KT. Department of Community Medicine, University of Cambridge, Institute of Public Health, UK. lincoln.sargeant@srl.cam.ac.uk

  OBJECTIVE: To examine the cross-sectional association between plasma vitamin C, self-reported diabetes, and HbA1c.
  RESEARCH DESIGN AND METHODS: Data from a population-based study of diet, cancer, and chronic disease were analyzed. A total of 2,898 men and 3,560 women 45-74 years of age who were registered with general practices in Norfolk, U.K., were recruited to the European Prospective Investigation Into Cancer-Norfolk study between 1995 and 1998.
  RESULTS: Mean plasma vitamin C levels were significantly higher in individuals with HbA1c levels < 7% than in those with self-reported diabetes or prevalent undiagnosed hyperglycemia (HbA1c > or = 7%). An inverse gradient of mean plasma vitamin C was found in both sexes across quintiles of HbA1c distribution < 7%. The odds ratio (95% CI) of having prevalent undiagnosed hyperglycemia per 20 micromol/l (or 1 SD) increase in plasma vitamin C was 0.70 (0.52-0.95) (adjusted for sex, age, BMI, waist-to-hip ratio, tertiary education, any use of dietary supplements, vegetarian diet, alcohol consumption, physical activity, dietary vitamin E, dietary fiber, dietary saturated fat, and smoking history). The unadjusted change in HbA1c per 20 micromol/l increase in vitamin C estimated by linear regression was -0.12% (-0.14 to -0.09) in men and -0.09% (-0.11 to -0.07) in women. After adjusting for the possible confounders, these values were -0.08% (-0.11 to -0.04) in men and -0.05% (-0.07 to -0.03) in women.
  CONCLUSIONS: An inverse association was found between plasma vitamin C and HbA1c. Dietary measures to increase plasma vitamin C may be an important public health strategy for reducing the prevalence of diabetes.

PMID: 10840986

Med Hypotheses 2002 Jun;58(6):476-86
Favorable impact of a vegan diet with exercise on hemorheology: implications for control of diabetic neuropathy.
McCarty MF. Pantox Laboratories, San Diego, California 92109, USA.

  A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology - decreased blood viscosity and increased blood filterability - plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics - an important determinant of blood filterability - remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes - retinopathy, nephropathy, and macrovascular disease - independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, 'low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners.

PMID: 12323113

Am J Clin Nutr 2002 May;75(5):848-55
Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults.
Pereira MA, Jacobs DR Jr, Pins JJ, Raatz SK, Gross MD, Slavin JL, Seaquist ER Department of Pediatrics, Harvard Medical School, and the Department of Medicine, Children's Hospital, Boston, MA, USA. mark.pereira@channing.harvard.edu

  BACKGROUND: Epidemiologic studies have found whole-grain intake to be inversely associated with the risk of type 2 diabetes and heart disease.
  OBJECTIVE: We tested the hypothesis that whole-grain consumption improves insulin sensitivity in overweight and obese adults.
  DESIGN: This controlled experiment compared insulin sensitivity between diets (55% carbohydrate, 30% fat) including 6-10 servings/d of breakfast cereal, bread, rice, pasta, muffins, cookies, and snacks of either whole or refined grains. Total energy needs were estimated to maintain body weight. Eleven overweight or obese [body mass index (in kg/m(2)): 27-36] hyperinsulinemic adults aged 25-56 y participated in a randomized crossover design. At the end of each 6-wk diet period, the subjects consumed 355 mL (12 oz) of a liquid mixed meal, and blood samples were taken over 2 h. The next day a euglycemic hyperinsulinemic clamp test was administered.
  RESULTS: Fasting insulin was 10% lower during consumption of the whole-grain than during consumption of the refined-grain diet (mean difference: -15 +/- 5.5 pmol/L; P = 0.03). After the whole-grain diet, the area under the 2-h insulin curve tended to be lower (-8832 pmol.min/L; 95% CI: -18720, 1062) than after the refined-grain diet. The rate of glucose infusion during the final 30 min of the clamp test was higher after the whole-grain diet (0.07 x 10(-4) mmol.kg(-1).min(-1) per pmol/L; 95% CI: 0.003 x 10(-4), 0.144 x 10(-4)).
  CONCLUSION: Insulin sensitivity may be an important mechanism whereby whole-grain foods reduce the risk of type 2 diabetes and heart disease.

PMID: 11976158

Am J Clin Nutr. 1999 Sep;70(3 Suppl):532S-538S.
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists.
Fraser GE. Center for Health Research and the Department of Epidemiology and Biostatistics, Loma Linda University, CA 92350, USA. gfraser@sph.llu.edu

  Results associating diet with chronic disease in a cohort of 34192 California Seventh-day Adventists are summarized. Most Seventh-day Adventists do not smoke cigarettes or drink alcohol, and there is a wide range of dietary exposures within the population. About 50% of those studied ate meat products <1 time/wk or not at all, and vegetarians consumed more tomatoes, legumes, nuts, and fruit, but less coffee, doughnuts, and eggs than did nonvegetarians. Multivariate analyses showed significant associations between beef consumption and fatal ischemic heart disease (IHD) in men [relative risk (RR) = 2.31 for subjects who ate beef > or =3 times/wk compared with vegetarians], significant protective associations between nut consumption and fatal and nonfatal IHD in both sexes (RR approximately 0.5 for subjects who ate nuts > or =5 times/wk compared with those who ate nuts <1 time/wk), and reduced risk of IHD in subjects preferring whole-grain to white bread. The lifetime risk of IHD was reduced by approximately 31% in those who consumed nuts frequently and by 37% in male vegetarians compared with nonvegetarians. Cancers of the colon and prostate were significantly more likely in nonvegetarians (RR of 1.88 and 1.54, respectively), and frequent beef consumers also had higher risk of bladder cancer. Intake of legumes was negatively associated with risk of colon cancer in nonvegetarians and risk of pancreatic cancer. Higher consumption of all fruit or dried fruit was associated with lower risks of lung, prostate, and pancreatic cancers. Cross-sectional data suggest vegetarian Seventh-day Adventists have lower risks of diabetes mellitus, hypertension, and arthritis than nonvegetarians. Thus, among Seventh-day Adventists, vegetarians are healthier than nonvegetarians but this cannot be ascribed only to the absence of meat.

PMID: 10479227

Prev Med 1999 Aug;29(2):87-91
Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet.
Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning S Physicians Committee for Responsible Medicine, Georgetown University Medical Center, Washington, DC, USA.

  OBJECTIVE: To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes (NIDDM) can be significantly improved using a low-fat, vegetarian (vegan) diet in the absence of recommendations regarding exercise or other lifestyle changes.
  METHODS: Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were randomly assigned to a low-fat vegan diet (seven subjects) or a conventional low-fat diet (four subjects). Two additional subjects assigned to the control group failed to complete the study. The diets were not designed to be isocaloric. Fasting serum glucose, body weight, medication use, and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks. Serum lipids, glycosylated hemoglobin, urinary albumin, and dietary macronutrients were assessed at baseline and 12 weeks.
  RESULTS: Although the sample was intentionally small in accordance with the pilot study design, the 28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was significantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dl), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, compared to 3.8 kg for the control group (P < 0.005). Of six experimental group subjects on oral hypoglycemic agents, medication use was discontinued in one and reduced in three. Insulin was reduced in both experimental group patients on insulin. No patient in the control group reduced medication use. Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance; however, high-density lipoprotein concentration fell more sharply (0.20 mmol/L) in the experimental group than in the control group (0.02 mmol/L) (P < 0.05).
  CONCLUSION: The use of a low-fat, vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise. A larger study is needed for confirmation. Copyright 1999 American Health Foundation and Academic Press.

PMID: 10446033

Prev Med. 1995 Nov;24(6):646-55. Comment in: Prev Med. 1995 Nov;24(6):565-7.
The medical costs attributable to meat consumption.
Barnard ND, Nicholson A, Howard JL.
Physicians Committee for Responsible Medicine, Washington, DC 20016, USA.

  OBJECTIVE. To estimate the medical costs that are attributable to the health effects of meat consumption.
  METHODS. The prevalence of hypertension, heart disease, cancer, diabetes, gallstones, obesity, and foodborne illness among omnivores and vegetarians are compared in studies that have controlled for other lifestyle factors, and the corresponding attributable medical costs are calculated in 1992 dollars.
  RESULTS. Direct health care costs attributable to meat consumption are estimated to be +2.8-8.5 billion for hypertension, +9.5 billion for heart disease, +0-16.5 billion for cancer, +14.0-17.1 billion for diabetes, +0.2-2.4 billion for gallbladder disease, +1.9 billion for obesity-related musculoskeletal disorders, and +0.2-5.5 billion for foodborne illness. The total direct medical costs attributable to meat consumption for 1992 are estimated at +28.6-61.4 billion.
  CONCLUSION. Health care costs attributable to meat consumption are quantifiable and substantial.

PMID: 8610089

Z Gesamte Inn Med. 1990 May 15;45(10):290-4.
New knowledge of diet therapy of type 2 (non-insulin-dependent) diabetes [Article in German]
Bruns W. Diabetiker-Sanatorium Bergfried, Saalfeld.

  The composition of the diet of the type II-diabetics should correspond to the principles of a lactovegetarian diet: relatively many carbohydrates, vegetables, fruits and little fat, in particular little animal fats. By such a pathogenetically orientated nutrition one is at the earliest able to treat successfully preventively and therapeutically the development of the arteriosclerosis which is connected with the type 2 diabetes and with metabolic syndrome. Thereby the weight reduction is of course integrated into such a dietary prescription. The number of meals a day should not routine-like be established to 5 to 6, and only in a bad metabolic condition the subdivision into many smaller meals is necessary. In the calculation of the food type 2 diabetics with overweight stabilised on diet alone should estimate the energy of food and reduce it. At this stage the calculation of carbohydrates is not necessary. Only when a blood sugar decreasing therapy is added (insulin and perhaps sulfonylureas) we have additionally to begin the calculation of carbohydrates. In order to obtain a useful compliance unnecessary reglementations must be removed so that only there where necessary a strict discipline is observed.

PMID: 2203210

Am J Public Health 1985 May;75(5):507-12
Does a vegetarian diet reduce the occurrence of diabetes?
Snowdon DA, Phillips RL.

  We propose the hypothesis that a vegetarian diet reduces the risk of developing diabetes. Findings that have generated this hypothesis are from a population of 25,698 adult White Seventh-day Adventists identified in 1960. During 21 years of follow-up, the risk of diabetes as an underlying cause of death in Adventists was approximately one-half the risk for all US Whites. Within the male Adventist population, vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death. Within both the male and female Adventist populations, the prevalence of self-reported diabetes also was lower in vegetarians than in non-vegetarians. The associations observed between diabetes and meat consumption were apparently not due to confounding by over- or under-weight, other selected dietary factors, or physical activity. All of the associations between meat consumption and diabetes were stronger in males than in females.

PMID: 3985239

Rinsho Byori 1999 Jun;47(6):566-70
[Urine C-peptide excretion in hypocaloric states and factors affecting its excretion]. [Article in Japanese]
Futamura A, Hashimoto Y, Okubo S, Aihara T, Watanabe H, Fujita A, Koda M, Nakahara K Department of Clinical Laboratory Medicine, University of Tokyo Hospital.

  Recent evidence suggests that hyperinsulinemia may contribute to the development of various risk factors of atherosclerosis. To examine the effects of energy intake on insulin secretion, 24-h urine C-peptide was measured in twelve women with rheumatoid arthritis who were not taking any medicine and stayed in Koda hospital for a diet therapy which lasted 55 days. They were basically placed on a 1200 kcal/day vegan diet combined with three 3-5-day fasting periods (200 kcal/day). Urine C-peptide excretion markedly decreased from 31-40 to 8-14 micrograms/day during the fasting periods. Among the anthropometric variables examined, the average level of urine C-peptide excretions measured in the fasting periods showed a significant correlation with the percentage and the amount of body fat. However, such correlation was not observed while the calorie intake was 1200 kcal. No clinical laboratory parameter showed a significant correlation with urinary C-peptide excretion. These results suggest that the major determinant of urine C-peptide excretion is food intake and that hyperinsulinemia could be easily improved by restricting energy intake.

PMID: 10434575

Diabetes Metab 2000 Jul;26 Suppl 4:45-53
Lipids, protein intake, and diabetic nephropathy.
Gin H, Rigalleau V, Aparicio M. Service de Nutrition-Diabetologie, Universite de Bordeaux II. Pessac Cedex, France.

  Progressive impairment of kidney function is one of the major problems in diabetic patients. Control of glycaemia and blood pressure is the main strategy for preventing or slowing impairment in renal function in this condition. However, contributing factors such as hyperlipidaemia and high protein intake have now been identified, and their control can be regarded as a complementary measure. The role of lipid abnormalities and hypercholesterolaemia in the pathogenesis of glomerular injury has been demonstrated in animal models, and a link between hypercholesterolaemia and diabetic nephropathy has been established in humans. To date, few intervention studies in diabetic patients have shown a slower decline in renal function. Nonetheless, in every study in which follow-up was long enough, cholesterol lowering had a beneficial effect on renal function. Although hypercholesterolaemia may not be the cause of renal injury, it represents an aggravating factor. High serum cholesterol seems to have a similar action on glomerular mesangial cells and endothelial cells. This appears to be analogous to the process of atherosclerosis, as mesangial cells possess binding sites for LDL and oxidised LDL, help recruit macrophages and secrete proliferative factors. Protein intake is another factor that can influence renal deterioration. Two meta-analyses have confirmed the beneficial effect of a low-protein diet in diabetic nephropathy, showing no adverse effects on the glycaemic control. Protein intake even seems to enhance the sensitivity of tissues and liver to insulin. Thus, there appear to be no contraindications to such diets in well-controlled diabetic patients. In short, although glycaemic and blood pressure control are still the main lines of treatment for diabetic patients, lowering blood cholesterol and restricting protein intake represent complementary measures that can help slow renal impairment.

PMID: 10922973

Am J Clin Nutr 1997 Dec;66(6):1470-4
Low dietary fiber and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community.
Wolever TM, Hamad S, Gittelsohn J, Gao J, Hanley AJ, Harris SB, Zinman B. Department of Nutritional Sciences and Medicine, University of Toronto, Ontario, Canada. thomas.wolever@utoronto.ca

  The high prevalence of diabetes mellitus in North American aboriginal populations may be due to recent changes in lifestyle, including the adoption of a high-fat, low-fiber diet. To determine whether fat or fiber intakes were associated with new cases of diabetes, we studied 72% (728/1018) of residents aged > 9 y from a remote aboriginal community in northern Ontario using the 75-g oral-glucose-tolerance test and 24-h dietary recall. The mean fat intake of this population (36% of energy) was typical for North America, but fiber intake (1.2 g/MJ) was very low. Logistic-regression analysis, adjusted for age, sex, and body mass index, showed that a 1-SD increase in fiber intake reduced the risk of having diabetes by 39% (P = 0.026) whereas the same increase in protein intake increased the risk by 38% (P = 0.027). There was no significant effect of energy, fat, starch, or simple sugars. These data support Trowell's original dietary-fiber hypothesis that "... dietary fiber depleted starchy foods are conducive to the development of diabetes mellitus in susceptible human genotypes."

PMID: 9394701

Am J Clin Nutr. 1988 Sep;48(3 Suppl):712-38.
Health aspects of vegetarian diets.
Dwyer JT. Tufts University School of Medicine, New England Medical Center Hospital, Boston, MA 02111.

  Recent studies of vegetarian diets and their effects on morbidity and mortality are reviewed. Vegetarian diets are heterogeneous as are their effects on nutritional status, health, and longevity. Mortality rates are similar or lower for vegetarians than for nonvegetarians. Risks of dietary deficiency disease are increased on vegan but not on all vegetarian diets. Evidence for decreased risks for certain chronic degenerative diseases varies. Both vegetarian dietary and lifestyle practices are involved. Data are strong that vegetarians are at lesser risk for obesity, atonic constipation, lung cancer, and alcoholism. Evidence is good that risks for hypertension, coronary artery disease, type II diabetes, and gallstones are lower. Data are only fair to poor that risks of breast cancer, diverticular disease of the colon, colonic cancer, calcium kidney stones, osteoporosis, dental erosion, and dental caries are lower among vegetarians. Reduced risks for chronic degenerative diseases can also be achieved by manipulations of omnivorous diets and lifestyles.

PMID: 3046302


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