Plant-based diet according to the NFI protocol in patients with type 2 diabetes mellitus: pilot study
Authors:
Emil Martinka 1; Janka Lejavová 2; Marián Mokáň 3; Ivan Tkáč 4; Peter Galajda 3; David Hickman 5
Authors‘ workplace:
Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
1; ALFA DIA, s. r. o., Liptovský Mikuláš
2; I. Interná klinika JLF UK a UN Martin
3; IV. interná klinika UPJŠ LF a UN LP v Košiciach
4; NFI s. r. o., Liptovský Mikuláš
5
Published in:
Forum Diab 2020; 9(1): 54-60
Category:
Overview
Introduction: The results of multiple studies have shown the importance of plant based diet and, conversely, of the elimination of food of animal origin in the prevention and treatment of type 2 diabetes mellitus (T2DM). These diets have also shown their benefits in relation to the reduction of obesity risk, arterial hypertension, dyslipidemia, cardiovascular and cancer morbidity and mortality as well as microvascular complications. Eating according to the NFI-protocol, similarly to the vegan diet, consists of legumes, nuts, seeds, fruit and vegetables and excludes any foods of animal origin. As a sophisticated characteristic of the diet according to the NFI-protocol, mutual and balanced interactions of chemicals contained in foods of plant origin are assumed, which should initiate reversible chemical reactions and subsequently affect multiple metabolic processes primarily targeting fat loss in the body, their metabolism and finally modification of insulin resistance.
Goal: The effect of a “plant based diet” according to the NFI (Natural Food Interactions) -protocol adhered to for a period of 3–6 months on the basic metabolic parameters relating to insulin resistance, tolerance of the diet and complications or adverse effects in patients with type 2 diabetes mellitus.
Cohorts and methods: The study included 19 males and 19 females with DM2T at an average age of 58.4 ± 8.6 years and duration of T2DM for 9.4 ± 5.6 years.
Results: After 3–6 months of adherence to the diet according to the NFI-protocol a statistically significant decrease was recorded in HbA1c, fasting glycemia (FPG), body weight, BMI, waist circumference, total and LDL-cholesterol, triglycerides and HDL/triglycerides ratio. It was needed to adjust pharmacological antidiabetic and antihypertensive treatment for multiple patients, which always involved its reduction up to discontinuation. Tolerance of and adherence to the diet was satisfactory. During the whole period of implementation there were no adverse effects, reactions or complications recorded. Temporary mild headaches were reported in 11 patients during the initial 2–3 days. Temporary gastrointestinal (GIT) problems in connection with a virus disease occurred in one patient for approx. 2–3 days. During that time the NFI-protocol was interrupted and then resumed three days after the GIT-related problems passed without coming back.
Summary: The diet according to the NFI-protocol in this pilot study has been shown as highly effective, safe and well tolerated. The decrease in HbA1c with an average of 1.98% of the DCCT standard occurred in all patients except for one, while the greatest decreases in HbA1c reached up to 3.8%. All patients recorded a body weight i.e. BMI decrease, in the range of 4 to 28 kg, or 1.6 to 10.1 kg/m2. Most patients also reached an improvement with regard to total cholesterol (78.6% patients), LDL- cholesterol (77.4% patients), triglycerides (87.1% patients) and HDL/TAG ratio (69.4% patients). Although the results are favourable and convincing, it is needed to verify them with a larger cohort and greater scope of the monitored indicators, including the follow-up on maintaining of the results.
Keywords:
diabetes mellitus – food interactions – NFI-protocol – plant based diet
Sources
- Adrian J. Nutritional and physiological consequences of the Maillard reaction. World Rev Nutr Diet 1974; 19: 71–122. Dostupné z DOI: <http://dx.doi.org/10.1159/000394766>.
- [American Diabetes Association]. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes 2020. Diabetes Care 2020; 43(Suppl 1): S14-S31. Dostupné z DOI: <https://doi.org/10.2337/dc20-S002>.
- Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia 2009; 52(11): 2277–2287. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–009–1481-x>.
- Bach Knudsen KE. Microbial degradation of whole-grain complex carbohydrates and impact on short-chain fatty acids and health. Adv Nutr 2015; 6(2): 206–213. Dostupné z DOI: <http://dx.doi.org/10.3945/an.114.007450>.
- Baothman OA, Zamzami MA, Taher I et al. The role of gut microbiota in the development of obesity and diabetes. Lipids Health Dis 2016; 15: 108. Dostupné z DOI: <http://dx.doi.org/10.1186/s12944–016–0278–4>.
- Bao W, Rong Y, Rong S et al. Dietary iron intake, body iron stores, and the risk of type 2 diabetes: a systematic review and meta-analysis. BMC Med 2012; 10: 119. Dostupné z DOI: <http://dx.doi.org/10.1186/1741–7015–10–119>.
- Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet 2015; 115(6): 954–969. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jand.2014.11.016>.
- Barnard ND, Katcher HI, Jenkins DJ et al. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev 2009; 67(5): 255–263. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1753–4887.2009.00198.x>.
- Barnard ND, Cohen J, Jenkins DJ et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006; 29(8): 1777–1783. Dostupné z DOI: <http://dx.doi.org/10.2337/dc06–0606>.
- Boucher JL. Mediterranean eating pattern. Diabetes Spectr 2017; 30(2):72–76. Dostupné z DOI: <http://dx.doi.org/10.2337/ds16–0074>.
- Brownlee M, Cerami A. The biochemistry of the complications of diabetes mellitus. Ann Rev Biochem 1081; 50: 385–432. Dostupné z DOI: <http://dx.doi.org/10.1146/annurev.bi.50.070181.002125>.
- Cooper AJ, Forouhi NG, Ye Z et al. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur J Clin Nutr 2012; 66(10): 1082–1092. Dostupné z DOI: <http://dx.doi.org/10.1038/ejcn.2012.85>.
- Dinu M, Abbate R, Gensini GF et al. Vegetarian, vegan diets and multiple health outcomes: a systematic review with metaanalysis of observational studies. Crit Rev Food Sci Nutr 2017; 57(17): 3640–3649. Dostupné z DOI: <http://dx.doi.org/10.1080/10408398.2016.1138447>.
- Dietary Guidelines for Americans 2015–2020. Chapter 1: Key elements of healthy eating patterns. Dostupné z WWW: <https://health.gov/our-work/food-nutrition/2015–2020-dietary-guidelines/guidelines/chapter-1/>.
- Estadella D, da Penha Oller do Nascimento CM, Oyama LM et al. Lipotoxicity: effects of dietary saturated and transfatty acids. Mediators Inflamm 2013; 2013: 137579. Dostupné z DOI: <http://dx.doi.org/10.1155/2013/137579>.
- Hosseinpour-Niazi S, Mirmiran P, Hedayati M et al. Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial. Eur J Clin Nutr 2015; 69(5): 592–597. Dostupné z DOI: <http://dx.doi.org/10.1038/ejcn.2014.228>.
- Huang T, Yang B, Zheng J et al. Cardiovascular disease mortality and cancer incidence in vegetarians: a metaanalysis and systematic review. Ann Nutr Metab 2012; 60(4): 233–240. Dostupné z DOI: <http://dx.doi.org/10.1159/000337301>.
- Huang RY, Huang CC, Hu FB et al. Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. J Gen Intern Med 2016; 31(1): 109–116. Dostupné z DOI: <http://dx.doi.org/10.1007/s11606–015–3390–7>.
- Jenkins DJ, Kendall CW, Augustin LS et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2012; 172(21): 1653–1660. Dostupné z DOI: <http://dx.doi.org/10.1001/2013.jamainternmed.70>.
- Kahleova H, Matoulek M, Malinska H et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med 2011; 28(5): 549–559. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2010.03209.x>.
- Kim Y, Keogh JB, Clifton PM. Polyphenols and glycemic control. Nutrients 2016; 8(1): 17. Dostupné z DOI: <http://dx.doi.org/10.3390/nu8010017>.
- Kitessa SM, Abeywardena MY. Lipid-induced insulin resistance in skeletal muscle: the chase for the culprit goes from total intramuscular fat to lipid intermediates, and finally to species of lipid intermediates. Nutrients 2016; 8: 466. Dostupné z DOI: <http://dx.doi.org/10.3390/nu8080466>.
- Kunutsor SK, Apekey TA, Walley J et al. Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence. Diabetes Metab Res Rev 2013; 29(4): 308–318. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.2394>.
- Knowler WC, Barrett-Connor E, Fowler SE et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393–403. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa012512>.
- Lattimer JM, Haub MD. Effects of dietary fiber and its components on metabolic health. Nutrients 2010; 2(12): 1266–1289. Dostupné z DOI: <http://dx.doi.org/10.3390/nu2121266>.
- Li D, Kirsop J, Tang WH. Listening to our gut: contribution of gut microbiota and cardiovascular risk in diabetes pathogenesis. Curr Diab Rep 2015; 15(9): 63. Dostupné z DOI: <http://dx.doi.org/10.1007/s11892–015–0634–1>.
- Lee YM, Kim SA, Lee IK et al. Effect of a brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12-week randomized clinical trial. PLoS One 2016; 11(6): e0155918. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0155918>.
- Lejavová J, Hickman D, Plevová Z. Diabetes remission in type 2 diabetes through the NFI diet (Protocol). XXIX. Diabetologické dni s medzinárodnou účasťou. Štrbské Pleso, 30. 5.-1. 6. 2019. Abstrakt.
- Lim EL, Hollingsworth KG, Aribisala BS et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011; 54(10): 2506–2514. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–011–2204–7>.
- Ley SH, Hamdy O, Mohan V et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383(9933): 1999–2007. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(14)60613–9>.
- McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetesJournal of Geriatric Cardiology 2017; 14(5): 342–354. Dostupné z DOI: <http://dx.doi.org/10.11909/j.issn.1671–5411.2017.05.009>.
- Martinka E, Hickman D, Dókušová S et al. Prvé skúsenosti s "Natural Food Interactions (NFI) diet" v projekte NEDU Ľubochňa. XXIX. Diabetologické dni s medzinárodnou účasťou. Štrbské Pleso, 30. 5.-1. 6. 2019. Abstrakt.
- Martins AR, Nachbar RT, Gorjao R et al. Mechanisms underlying skeletal muscle insulin resistance induced by fatty acids: importance of the mitochondrial function. Lipids Health Dis 2012; 11: 30. Dostupné z DOI: <http://dx.doi.org/10.1186/1476–511X-11–30>.
- McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol 2017; 14(5): 342–354. Dostupné z DOI: <http://dx.doi.org/10.11909/j.issn.1671–5411.2017.05.009>.
- Muraki I, Imamura F, Manson JE et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013; 347: f5001. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.f5001>.
- Nolan CJ, Larter CZ. Lipotoxicity: why do saturated fatty acids cause and monounsaturates protect against it? J Gastroenterol Hepatol 2009; 24(5): 703–706. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1440–1746.2009.05823.x>.
- Orban E, Schwab S, Thorand B et al. Association of iron indices and type 2 diabetes: a meta-analysis of observational studies. Diabetes Metab Res Rev 2014; 30(5): 372–394. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.2506>.
- Pan A, Sun Q, Bernstein AM et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr 2011; 94(4): 1088–1096. Dostupné z DOI: <http://dx.doi.org/10.3945/ajcn.111.018978>.
- Pawlak R. Vegetarian diets in the prevention and management of diabetes and its complications. Diabetes Spectr 2017; 30(2): 82–88. Dostupné z DOI: <http://dx.doi.org/10.2337/ds16–0057>.
- Polak R, Phillips EM, Campbell A. Legumes: Health Benefits and Culinary Approaches to Increase Intake. Clin Diabetes 2015; 33(4): 198–205. Dostupné z DOI: <http://dx.doi.org/10.2337/diaclin.33.4.198>.
- Rinaldi S, Campbell EE, Fournier J et al. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes 2016; 40(5): 471–477. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jcjd.2016.02.011>.
- Schulze MB, Schulz M, Heidemann C et al. Fiber and magnesium intake and incidence of type 2 diabetes: a prospective study and meta-analysis. Arch Intern Med 2007; 167(9): 956–965. Dostupné z DOI: <http://dx.doi.org/10.1001/archinte.167.9.95>.
- Satija A, Bhupathiraju SN, Rimm EB et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med 2016; 13(6): e1002039. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pmed.1002039>.
- Snorgaard O, Poulsen GM, Andersen HK et al. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2017; 5(1): e000354. Dostupné z DOI: <http://dx.doi.org/10.1136/bmjdrc-2016–000354>.
- Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med 2014; 371(12): 1131–1141. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra1011035>.
- Spencer EA, Appleby PN, Davey GK et al. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord 2003; 27(6): 728–734. Dostupné z DOI: <http://dx.doi.org/10.1038/sj.ijo.0802300>.
- [InterAct Consortium]. Dietary fibre and incidence of type 2 diabetes in eight European countries: the EPIC-InterAct Study and a meta-analysis of prospective studies. Diabetologia 2915; 58(7), 1394–1408. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–015–3585–9>.
- Tonstad S, Butler T, Yan R et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009; 32(5): 791–796. Dostupné z DOI: <http://dx.doi.org/10.2337/dc08–1886>.
- Tonstad S, Stewart K, Oda K et al. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis 2013; 23(4): 292–299. Dostupné z DOI: <http://dx.doi.org/10.1016/j.numecd.2011.07.004>.
- Turner-McGrievy GM, Davidson CR, Wingard EE et al. Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. Nutrition 2015; 31(2): 350–358. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2014.09.002>.
- Uribarri J, Woodruff S, Goodman S, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc 2010; 110(6): 911–916. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jada.2010.03.018>.
- Uribarri J, Cai W, Ramdas M, et al. Restriction of advanced glycation end products improves insulin resistance in human type 2 diabetes: potential role of AGER1 and SIRT1. Diabetes Care 2011; 34(7): 1610–1616. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11–0091>.
- Vang A, Singh PN, Lee JW, et al. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab 2008; 52(2): 96–104. Dostupné z DOI: <http://dx.doi.org/10.1159/000121365>. Erratum in Ann Nutr Metab 2010; 56(3): 232.
- Viguiliouk E, Stewart SE, Jayalath VH et al. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2015; 7(12): 9804–9824. Dostupné z DOI: <http://dx.doi.org/10.3390/nu7125509>.
- Xiao C, Giacca A, Carpentier A et al. Differential effects of monounsaturated, polyunsaturated and saturated fat ingestion on glucose-stimulated insulin secretion, sensitivity and clearance in overweight and obese, non-diabetic humans. Diabetologia 2006; 49(6): 1371–1379. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–006–0211-x>.
- Yokoyama Y, Barnard ND, Levin SM et al. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther 2014; 4(5): 373–382. Dostupné z DOI: <http://dx.doi.org/10.3978/j.issn.2223–3652.2014.10.04>.
- Zhao Z, Li S, Liu G et al. Body iron stores and heme-iron intake in relation to risk of type 2 diabetes: a systematic review and meta-analysis. PLoS One 2012; 7(7): e41641. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0041641>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2020 Issue 1
Most read in this issue
- Plant-based diet according to the NFI protocol in patients with type 2 diabetes mellitus: pilot study
- Hypoglycemia and sport
- Education of patients with hypoglycemia
- Insulin pump therapy and hypoglycemia