Plant-based eating is one of the most effective ways for people who are overweight, who struggle with diabetes, who struggle with cardiovascular disease, and other chronic conditions. So, the role of us as physicians is let them know that this is an option. Hi everybody. My name is Hana Kahleova. I’m an endocrinologist and my specialty is nutrition interventions in people with diabetes and other metabolic disease. My affiliation is at the Institute for Clinical and Experimental Medicine in Prague, the Czech Republic. And I’m also Director of Clinical Research at the Physicians Committee for Responsible Medicine in Washington, D.C. And in my current position, I just focus on finding the most effective nutrition interventions for people with diabetes, and for people who are overweight, and with other health conditions. Plant-based eating has been found to be effective in the prevention and treatment of diabetes, also of overweight and obesity, and of cardiovascular disease , and other chronic conditions. What’s the scientific basis for this? When we conduct studies with plant-based nutrition, we always look at the underlying mechanisms, and what we found is really fascinating. Sometimes people, when they want to lose weight, they focus on the calories that they’re eating. But plant-based eating is different. We use ad libitum plant-based diet for people with overweight and with diabetes and they still lose weight. Why is it? Not only will fibre fill you up, and so independent of the caloric intake, the fibre intake will help with weight loss and also with glycaemic control. But also, plant-based eating has been found to increase the thermic effect of food, which is the amount of energy that’s released after a meal in the form of heat. Wouldn’t that be wonderful to just burn off all the calories that we’re eating in excess in the form of heat and get rid of them? And that’s exactly what we’re seeing in our study in overweight people. We found that plant-based eating was able to increase the thermic effect of food by 14 %. Now, 14 % may seem like a small number, but imagine this is happening after each meal you eat, and imagine the impact over decades of your life. So, this may be one of the mechanisms why plant-based eating helps people who are overweight. Another mechanism that plays a role is the reduced intake of the so-called dietary advanced glycation end-products or the AGEs. The AGEs are compounds that build up in our body. It’s the metabolic trash that builds up in our body as we age. And we know that increased intake of the AGEs in the diet may increase the risk of diabetes and metabolic disease. Now many people focus on the cooking methods to limit their AGE intake. Instead of dry heat such as grilling or baking, it’s good when you just cook or stew your food. But what’s even more powerful is what kind of food are you consuming. So, compared with, let’s say meat, vegetables and fruits are a few hundred times less in dietary AGE content. That means without limiting calories, you can eat as much as you’d like and you will limit your AGE intake. So, these are just a few mechanisms that may help understand the benefits of plant-based eating. One of the mechanisms that helps explain the benefits of planning plant-based eating is the gut microbiome. We know that we have the good guys and also the bad guys. The good guys feed on fibre, and they produce the short-chain fatty acids that improve insulin sensitivity, and also help our heart health. So how can we increase these bacteria? Well, by feeding them the fibre that they love. So, in a study that we conducted, we took 244 overweight people and we randomly assigned them to follow either a vegan diet or stay on their usual diet for 16 weeks and we measured the gut microbiome composition. And after 16 weeks on the plant-based diet, we found that a specific bacteria increased which is called the Faecalibacterium prausnitzii. This bacterium feeds on fibre, and it really increased on the plant-based diet. This bacteria is super low in people with diabetes and the low count has been also associated with increased inflammation and increased insulin resistance in people with diabetes. So, an increase on the plant-based diet is actually super helpful because it’s in the direction of preventing diabetes to develop in the first place. Plant-based eating has been shown to be helpful not only for people with type 2 diabetes but also in type 1 diabetes. We conducted a randomised clinical trial with 58 people with type 1 diabetes, and we randomly assigned them to follow either a low-fat vegan diet, which consisted of fruits and vegetables, and whole grains, and legumes. And we kept the fat content low, under 30 grams a day, or the other half followed a portion-controlled carbohydrate-restricted diet for 12 weeks. After 12 weeks, we found that on the portion-control diet, people’s A1c was reduced by 0.6 % on average, and their cholesterol also came down. But these were the only outcomes that improved on the portion-control diet. On the vegan diet, not only A1c dropped by 0.8 % on average, and also cholesterol, and even the kidney function tests improved on the vegan diet, but people also lost weight. We know that more than 50 % of people with type 1 diabetes are overweight nowadays, so they need to lose weight. So, people lost over five kilograms on the vegan diet on average. Their insulin sensitivity increased, and their total need for insulin, the total daily insulin dose, decreased by 12 units a day or by 28 % on average. Their insulin sensitivity increased by 144 %. So that’s really remarkable. But it also raises the question: Were the improvements observed because of the weight loss or were they at least partially independent of the weight loss? So, we adjusted the total insulin dose per kilogram of body weight, and we found that the findings were still significant. The average reduction was 0.15 units per kilogram per day on the vegan diet, or the reduction was 24 % per person per day on average. So, in summary, plant-based eating offers benefits even for people with type 1 diabetes. It increases the insulin sensitivity, it helps improve all the cardiometabolic outcomes, and it also reduces the insulin dose that people need to use. Food choices are individual. Everybody needs to decide for themselves what they want to eat. At the same time, as physicians, it’s our responsibility to bring the science to our patients, to inform them about the effectiveness of different approaches. And plant-based eating is one of the most effective ways for people who are overweight, who struggle with diabetes, who struggle with cardiovascular disease, and other chronic conditions. So, the role of us as physicians is let them know that this is an option, and many people will decide to do it. We have many people who come to us based on our studies that we published, and they wish they had learned about it from their personal physicians. So, let’s just inform people, and let’s leave the decision up to them.