With commentary by Cameron Wells, MPH, RD, acting director of nutrition education for the Physicians Committee for Responsible Medicine
The combination of a low-fat and vegan diet can reduce nerve pain in people with type 2 diabetes, according to new research published in the journal Nutrition & Diabetes.
Nerve pain is a common symptom of type 2 diabetes, with few good treatments. Diabetic neuropathy can also cause numbness, oversensitivity and can lead to serious complications like balance and gait disturbances, and reduced quality of life. “We thought that diet might play a role in improving these symptoms,” says Wells.
The main goal of the diet was to lower fat. “When you accumulate excess fat inside cells, the fat gums up the locks that insulin uses to open the door to the cell,” explains Wells. When insulin can’t open the "doors," glucose can’t get into the cells and remains in the bloodstream leading to high blood sugar levels. A lower fat diet can reduce insulin resistance and blood sugar levels," she says.
Researchers wanted to test a plant-based diet because plant foods tend to be naturally low in fat, they’re less likely to cause blood sugar spikes, and are high in fiber. “It’s hard to achieve a truly low fat diet when you’re consuming cheese and meats because they’re naturally high in fat,” says Wells. By going vegan, you can eliminate those sources of fat and cholesterol. The added fiber helps maintain fullness, so you’re less likely to overeat, and it also helps pull excess fat from your system.
The study randomly assigned 34 adults with type 2 diabetes and neuropathy to either a low-fat, vegan diet for 20 weeks or to a control group that was asked to maintain their usual diet. The intervention group also attended weekly nutrition classes, which provided support for their diet.
Those on the vegan diet saw significant improvements in nerve pain. They also lost an average of about 15 pounds over the 20 weeks, and had improvements in cholesterol and blood glucose levels. Some even had to adjust their medications to compensate for the decline in blood glucose.
The low-fat vegan diet had no animal products and limited fat intake to 20 to 30 g day, and relied heavily on low-glycemic index foods. The diet included lots of fruits, vegetables, grains and legumes. “One of the beauties of the diet is that it doesn't require that you focus on one grain over another. You have the option of sticking to the classics like oatmeal, pasta and rice, or trying grains that may be new to you like bulgur and quinoa,” says Wells. You don’t have to count your carbs either, as long as you’re leaning on low-glycemic index foods. Example meals included oatmeal with raisins, pasta with marinara sauce, vegetable stir-fry with rice and lentil stew.
To make the switch yourself, or to lower the amount of animal products you consume, look at the types of foods you like to eat and see how you can modify them by using vegetables, beans and whole grains in place of meat and cheese. Adding vegetables is the easier part. The hardest part is looking for low-fat versions of pre-packaged foods. The goal is to limit foods that contain more than 3 grams of fat per serving.
Wells recommends doing a one-week trial period, looking at ways you can modify your daily meals. After that week, dedicate yourself to three weeks. You’ll likely need this much time to start to see a reduction in pain. For ideas, recipes and motivation, you can join PCRM’s 21-day kickstart program.
If you’re going totally vegan, it’s important to know that “going vegan is a real commitment and it may not be sustainable long-term for people. So, while this pilot study shows positive results, I would like to see further studies with varying degrees of vegetarianism and still controlling for variations in low fat,” says Amy Hess-Fischl, MS, RDN, LDN, BC-ADM, CDE. She points out that 20 to 30 grams of fat per day is very low and the research on long-term adherence is not favorable. “It would be great to see future studies focus on 40 to 50 g per day,” she adds.
Switching to a vegan diet also means making sure that you get enough vitamin B12, which is critical for healthy nerve function. In this study, participants (both control and intervention group) took 1,000 micrograms of B12.
To gauge whether your diet is working, Wells recommends keeping a pain log. Rate your pain on a scale of 1 to 10 before you modify your diet, and then rate it every few days. “When you see the benefits, that’s a great motivator,” says Wells.