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Type 2 Diabetes and Plant-Based Diets

Updated: Jun 28, 2022

When I tell patients they suffer from either diabetes or « borderline » diabetes, they all reply the same thing: « how could I have diabetes, I don’t eat lots of sugar or desserts ». Little do they know, type 2 diabetes, although it does manifest as high blood sugar, is caused by insulin resistance, not by eating carbs. There is one important nuance. Once in an insulin resistant state, blood sugar will potentially spike after a high carbohydrate meal. Of course this will depend on the amount and type of carbohydrate, a complex topic that I’ve broken down here. This is merely a manifestation of insulin resistance, not the cause. To understand how high carb plant-based diets can actually prevent and even reverse type 2 diabetes, it’s important to discuss the science and mechanisms behind the claims.

What Is Diabetes?

Diabetes is a devastating disease characterized by elevated blood sugar (glucose). This condition, when severe or prolonged, leads to complications that are highly likely to lead to disability, loss of quality of life or even premature death. Acute elevations in blood glucose, if high enough, will lead to the 3 P’s: polydipsia (extreme thirst), polyphagia (extreme hunger) and polyuria (frequent urination). Extremely high levels of blood glucose might cause more severe symptoms like blurred vision, dizziness, fainting or even altered mental status and coma if left untreated. If blood sugar levels are only moderately elevated, they may not give obvious symptoms over the short term. Long term elevations in glucose are almost certain to lead to toxic changes in blood vessels. When these changes occur in small blood vessels, we call them microvascular complications and these include numbness or pain/burning in hands and feet, called neuropathy. Altered sensations in feet can lead to altered biomechanics while walking, which can cause corn, callouses and ulcers that have trouble healing. Diabetes is the leading cause of toe or foot amputations. Microvascular complications affecting the kidneys are called nephropathy and are a leading cause of kidney failure requiring dialysis. This same condition tends to affect similar types of blood vessels in the eye’s retina, where it is called retinopathy, a world wide leading cause of blindness. High blood glucose is not only toxic for small blood vessels, but for larger ones as well. Macrovascular complications include heart attacks, strokes, vascular claudication and erectile dysfunction (which is a combination of micro and macrovascular disease). All that to say that diabetes can spell disaster when blood glucose remains too high, or moderately high for too long. Most deaths are directly related to the above mentioned complications which severely impact quality of life and life expectancy. Since many of these complications take years to develop, most people don’t see any urgency in improving their modifiable lifestyle risks. It’s not a matter of if diabetics will get these complications, but a matter of when. Most end up not changing at all, and will rely on a life sentence of drugs and injections to keep their blood sugar for spiking out of control. Medications do a great job of controlling the elevated blood sugar, but do not address the root cause of the disease: insulin resistance.