How Not to Die from Diabetes

We’ve known since the 1930s that type 2 diabetes can be prevented, arrested, and even reversed with a plant-based diet. Within five years of following the diet, about a quarter of the diabetic patients in that early study were able to get off insulin altogether.

Plant-based diets are relatively low in calories, though. Is it possible their diabetes just got better because they lost so much weight? To tease that out, we need a study where people are switched to a healthy diet but forced to eat so much food they don’t lose any weight. Then we could see if plant-based diets have specific benefits beyond all the easy weight loss. We had to wait 44 years for such a study, which I then discuss it in my video How Not to Die from Diabetes.

Subjects were weighed every day. If they started losing weight, they were made to eat more food—so much more food in fact that some of the participants had problems eating it all. They eventually adapted, though, so there was no significant weight change despite restricting meat, eggs, dairy, and junk.

Without any weight loss, did a plant-based diet still help? Overall insulin requirements were cut about 60 percent, and half the diabetics were able to get off their insulin altogether. How many years did that take? Not years. An average of 16 days. Only 16 days.

Let’s be clear: We’re talking about diabetics who had had diabetes as long as 20 years and injected 20 units of insulin a day. Then, as few as 13 days later, they were off their insulin altogether, thanks to less than two weeks on a plant-based diet—even with zero weight loss. It’s astonishing. Twenty years with diabetes, and then off all insulin in less than two weeks. Twenty years with diabetes because no one had told them about a plant-based diet. For decades they were just 13 days away at any time from being free.

In my video, I show data from patient #15: 32 units of insulin while on the control diet and then, 18 days later, after switching to the plant-based diet, on no insulin at all. None. Lower blood sugars on 32 units less insulin. That’s the power of plants. And that was without any weight loss. His body just started working that much better once it was provided with the right fuel.

As a bonus, their cholesterol dropped like a rock to under 150. Just as “moderate changes in diet usually result in only moderate reductions in LDL cholesterol levels,” how moderate do you want your diabetes?

“Everything in moderation” may be a truer statement than some people realize. Moderate changes in diet can leave diabetics with moderate blindness, moderate kidney failure, moderate amputations—maybe just a few toes or something. Moderation in all things is not necessarily a good thing.

Remember the study that purported to show that diets high in meat, eggs, and dairy could be as harmful to health as smoking, suggesting that people who eat lots of animal protein are four times as likely to die from cancer or diabetes? If you look at the actual study, you’ll see that’s simply not true. Those eating a lot of animal protein didn’t have just 4 times the risk of dying from diabetes, they had 73 times the risk of dying from diabetes! A 73-fold increase in risk. And those who chose moderation, only eating a “moderate” amount of animal protein, had 23 times the risk of death from diabetes.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

The other videos in this series are:

Inspired to learn more about the role diet may play in preventing and treating diabetes? Check out some of these other popular videos on the topic:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

What Happens if You Add Milk to Tea?

Our endothelium, the inner lining of our blood vessels that controls the function of every artery in our body, “appears to play a critical role in a variety of human disorders, including peripheral vascular disease, stroke, heart disease, diabetes, insulin resistance, chronic kidney failure, [cancer, and blood clots]….” Unfortunately, endothelial cells only live about 30 years, and their replacements don’t seem to function as well. So, “[a]s men and women approach the ages of 40 and 50, there is a progressive decline in endothelial function.” At age 50 or 60, we “can no longer tolerate this risk-factor burden that [we] were once able to tolerate at age 10 or 20,” thanks to this progressive decline in endothelial function.

Or, at least, that’s what we used to think.

As I discuss in my video Tea and Artery Function, there are increasing data to suggest that age is not an immutable risk factor—the decline in artery function is not just an inevitable consequence of aging Researchers did not see the same progressive decline in a Chinese population studied. The older Chinese people in their 60s had the arterial function of young folks in their 20s. “These data suggest that progressive endothelial dysfunction is not an inevitable consequence of aging but might be related to prolonged exposure to environmental factors more prevalent in westernized countries than in China.” What could it be? Traditional Chinese diets include green tea, which has been shown to have a beneficial effect on endothelial function within 30 minutes of consumption, lasting about two hours. It wasn’t the caffeine, which alone had no effect. They suspect it was the flavonoid phytonutrients in the leaves.

Black tea appears to work about just as well as green tea, but then why is green tea associated with lower heart disease risk while black tea is not? In fact, in two British studies, tea consumption was associated with an increased risk of coronary artery disease. Maybe it’s because the Brits commonly drink their tea with milk, whereas green tea is typically drank straight? If only there were a country that drank black tea, but without milk. There is. The Netherlands. In those studies, black tea was associated with the same drop in risk as the green tea studies. So, maybe it is the milk. But you can’t really know until you put it to the test.

Researchers found the “addition of milk to black tea completely prevents the biological activity of tea in terms of improvement of endothelial function.” So, that could explain it. It appears the milk protein casein is the culprit, though soy protein was recently found to have the same nutrient binding effect. The European Society of Cardiology issued a press release about the study showing the protective effect of tea “is totally wiped out by adding milk” and suggested consumers should consider cutting down. Milk-drinkers were not amused: “As long as the reported results are not confirmed in a fair number of humans who drink their tea outside the lab setting, we will continue to add milk to ours.” The researchers responded, challenging the notion that their study wasn’t big enough. They had 16 subjects, and the results were highly significant. Across those 16 people, the “addition of milk to tea not only reduced, but completely blunted the effects of tea….The rationale for drinking tea in a lab setting was that only under these conditions could the influence of other beverages and food be controlled for.” They were doing an experiment after all. Were they supposed to drag the equipment to a Starbucks or something?

“As doctors,” the milky tea drinkers asserted, “we would not prescribe a new drug to patients if it was studied only in one small study. In analogy, milk abstinence should not be recommended to tea drinkers…” They apparently were forgetting that the reason we don’t prescribe drugs without overwhelming evidence is that drugs can kill. So the benefits better outweigh the risks, but what’s the downside of a little milk abstinence?


If this is what one plant can do, imagine the effects of a whole diet centered around plant foods. That’s the subject of my video Plant-Based Diets and Artery Function.

Do be careful about green tea from China if you eat the leaves, though. See Lead Contamination of Tea.

I answer other questions you may have about tea in these videos:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Reverse Type 2 Diabetes

 

Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. Type 2 diabetes can be reversed not only with an extremely low calorie diet, but it can  also be reversed with an extremely healthy diet. Could it be because an extremely healthy diet is also low in calories? This is the topic of my video Diabetes Reversal: Is It the Calories or the Food 

Study subjects lost as much weight on a green, leafy vegetable-packed plant-based diet as those who were on a semi-starvation diet based on liquid meal replacements. So, does it matter what we’re eating as long as we’re eating few enough calories to lose 15 pounds a month?

Even if diabetes reversal is just about calorie restriction, instead of subsisting off largely sugar, powdered milk, corn syrup, and oil (common ingredients in some liquid diet drinks) on the plant-based diet at least one can real food—in fact, as many low-cal veggies as desired. So, even if it only works because it’s just another type of calorie-restricted diet, it’s certainly a healthier version. But, even participants in the study who did not lose weight—or even gained weight eating enormous quantities of whole healthy plant foods—appeared to improve their diabetes. Thus, the beneficial effects of this kind of diet appear to extend beyond weight loss.

The successful treatment of type 2 diabetes with a plant-based diet goes back to the 1930s, providing “incontestable evidence” that a diet centered around vegetables, fruits, grains, and beans was more effective in controlling diabetes than any other dietary treatment. In a randomized controlled trial, insulin needs were cut in half and a quarter of the subjects ended up off insulin altogether. But, again, this was a low-calorie diet. Walter Kempner at Duke University School of Medicine reported similar results 20 years later with his rice and fruit diet studies, showing for the first time documented reversal of diabetic retinopathy in a quarter of his patients, something never even thought possible. One patient, for example, was a 60-year-old diabetic woman already blind in one eye and who could only see contours of large objects with the other. Five years later, while on the diet, instead of her vision getting worse, it got better. She “could make out faces and read signs and large newspaper print,” and got off insulin, had normal blood sugars, and had a 100-point drop in her cholesterol. Another patient went from only being able to read big headlines to being able to read newsprint four months later. What was behind these remarkable reversals? Was it because the diet was extremely low-fat or because there was no animal protein or animal fat? Or, was it because the diet was so restrictive and monotonous that the patients lost weight and improved their diabetes that way?

To tease this out, we needed a study where researchers switched people to a healthy diet, but forced them to eat so much they didn’t lose any weight. Then, we could see if a plant-based diet has unique benefits independent of all the weight loss. For that, we had to wait another 20 years until a study in the 1970s. In it, diets were designed to be weight-maintaining. Participants were weighed every day, and, if they started losing weight, the researchers made them eat more food—in fact, so much food that some of the participants had trouble eating it all, but they eventually adapted. Thus, there were no significant alterations in body weight despite restrictions of meat, dairy, eggs and processed junk, and there were enough whole plant foods—whole grains, beans, vegetables, and fruit—to provide 65 grams of fiber a day, four times what the Standard American Diet provides.

The control diet they used was the conventional diabetic diet, which actually had nearly twice the fiber content of the Standard American Diet, so it was probably healthier than what they had been used to eating. So, how did the even healthier diet group do? With zero weight loss, did the dietary intervention still help? The study compared the number of units of insulin with which subjects had to inject themselves daily before and after going on the plant-based diet. Overall, despite no change in weight, insulin requirements were cut about 60 percent, and half of the diabetics  were able to get off insulin altogether. Was this after five years, or after seven months, as had been the case in the other studies discussed above? No.

It was after 16 days.

To be clear, we’re talking about diabetics who had had diabetes as long as 20 years, injecting 20 units of insulin a day, getting off insulin altogether in as few as 13 days, thanks to less than two weeks on a plant-based diet. Patient 15, for example, had injected 32 units of insulin while on the control diet, and then, 18 days later, none. Lower blood sugars on 32 units less insulin.

That’s the power of plants.

As a bonus, their cholesterol dropped like a rock to under 150 on average in 16 days, making them nearly heart attack proof as well. Just as “moderate changes in diet usually result in only modest reductions” in cholesterol, asking people with diabetes to make moderate changes often achieves equally moderate results, which is one possible reason why most end up on oral drugs, injections, or both. Everything in moderation may be a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, moderate amputations. Moderation in all things is not necessarily a good thing.

The more we, as physicians, ask from our patients, the more we—and they—get. The old adage, “shoot for the moon,” seems to apply. It “may be more effective than limiting patients to small steps that may sound more manageable but are not sufficient to actually prevent disease progression.”


Although I have dozens of videos about diabetes, I think Diabetes Reversal: Is It the Calories or the Food may be the single most powerful one I‘ve made. Please share this life-changing, life-saving video with anyone you know who has type 2 diabetes or is at risk for the dreaded disease. As far as I’m concerned, it should be required viewing for every healthcare practitioner. I wish I had seen it when I was a medical student!

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This is the final installment of a three-part series. If you missed the first two, check out Reversing Diabetes with Surgery and Reversing Diabetes with Food.

For more on the remarkable work of Dr. Kempner, see:

For more related videos, give one of these a try!

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: