Diabetes has a long and fascinating history.  For centuries, it was common, untreatable, and a horrible way to die.  Credible medical research over the last century has shown how to cure this terrible condition, to reverse the disease and prevent its devastating side effects, such as neuropathy, blindness, and lower limb amputations.  I find the history of that research interesting; here is an overview.

The sections below are dated and arranged chronologically, to give an idea of progress toward a cure.  But the actual science progression was nowhere near this tidy.  Researchers would start down various paths, often with small studies, whenever they had a hypothesis to test.  Large studies might take years to set up, perform, and analyze, even though the kernel of the study idea formed years before publication. 

Unless specified otherwise, I am using "diabetes" to mean Type 2 Diabetes Mellitus (T2DM).

1875

During the Siege of Paris in 1870, doctors noted that many diabetic patients saw a full or partial reversal of symptoms.  After the siege was lifted and their previous diet resumed, many of these same patients saw a return of symptoms.  This led doctors to conclude that some aspect of the diet was promoting the condition.

Pierre Piorry and other doctors of the time seemed to think the key to treating diabetes was to gain weight.  So Piorry pushed sugar intake as a means of gaining the needed weight.  Unfortunately, his lab assistant, a diabetic, took Piorry's advice and died as a result.

Others held the belief that carbohydrates were likely the triggering component, and the standard became to reduce intake of carbs.

The French doctor, Apollinaire Bouchardat, revered today as the founder of modern Diabetology, felt that limiting carbohydrates could reduce blood glucose, as measured by the presence of sugar in the patient's urine.

Bouchardat published his De la glycosurie ou diabète sucré (1875) and described his version of a diet intended to treat diabetes.  Researchers at the University of Athens published an historical note (2014) regarding Bouchardat's work and provide the following comments on his diabetic diet:

In the list of forbidden foods he includes starches and sugars and anything which contains “all fruits” and “jams of all kinds”. Also prohibited are bread, regardless of the cereal, carrots, turnips, rape and other farinaceous roots, or sweet onions, radishes, beans, peas, lentils, beans and chestnuts.

Concerning meat, he said: “...all the meats and deli meats, smoked or salted, are acceptable; they can be served dry in slices or with olive oil and herbs on them”.

In general, the recommended foods were meat (beef, lamb, veal), fish fried or with sauce, cheese, eggs, cream. Preference was given to animal and vegetable fats, in order to replace banned carbohydrates, and alcohols.

Research over the intervening years has shown Bouchardat's diet is about as wrong as it is possible to be.  Granted, he didn't have a lot of medical test equipment; it was common practice for a patient to test glucose levels by tasting their own urine.  And he is hardly to blame that it took decades before robust research revealed the serious flaws in this diet.  Still, adherence to Bouchardat's recommendations likely led to millions of needless deaths from diabetes.

1927

Researcher Dr. J. Shirley Sweeney ran a series of short interventional tests on medical students at Baylor University in 1927.  She divided healthy, young male medical students into four different diet groups.  The tested diet groups were high protein, high fat, high carbohydrate, and water-only starvation.  Each group ate the selected diet over a two-day span, then were given an oral sucrose challenge.  She then sampled blood glucose levels of all students just before challenge (fasting) and 30, 60, and 120 minutes after challenge.

Results showed subjects on a high carbohydrate diet had significantly lower glucose response to the challenge, but those eating high fat showed a nearly doubling of blood glucose level 120 minutes after challenge.

Sweeney's research hardly constitutes a cure of diabetes.  The study was very short duration and with a very small population.  But it offered a tantalizing hint that a rigorous diet could impact insulin sensitivity and, by implication, diabetes.

She concluded her study with the comment: It is further suggested that some of the dextrose tolerance curves believed to be peculiar to different pathologic conditions might result from the diets indicated or taken in such conditions.

1935

Researcher Israel. M. Rabinowitch reported, in The Canadian Medical Association Journal, on a study conducted with 100 diabetics over a period of five years.  Fifty subjects were fed a diet that Rabinowitch termed high-carbohydrate, low-calorie (he called this the "new" diet) and 50 subjects were fed a diet he termed low-carbohydrate, high-fat ("old" diet; see Table VI in report).  The new diet contained 35-50 gms of fat.  The old diet contained about 140-150 gms of fat and 50-60 gms of protein.

He points out that previous studies all used under-nutrition as a foundation for study.  But in those studies, under-nutrition meant near-starvation.  A diabetic kept under-nutrition was nearly an invalid and the physical condition was not sustainable.  In his study, Rabinowitch redefined under-nutrition to mean: ...keeping the diabetic about 5 to 10 pounds under weight according to height, age and sex. This degree of under-nutrition, it should be observed, is very common amongst perfectly normal individuals, and life insurance companies do not rate such people as "sub-standard".

After five years on the old diet, average insulin usage remained essentially unchanged (32.2 units at start vs. 31.8 units at end), while average insulin usage on new-diet subjects dropped from 24.6 units to 10.6 units.  Additionally, four patients on the old diet were off insulin at the end of five years and 12 patients on the new diet were similarly off insulin after five years.

Rabinowitch begins his summary with the statement: I believe that in the data presented here there is incontestable evidence that the high carbohydrate-low calorie diet is more effective in controlling diabetes than all other methods of treatment reported hitherto.

He continues by pointing out other benefits to his high-carbohydrate, low-calorie diet, such as economy with regard to insulin cost and the simplicity of treatment.  He felt the simplicity was especially important, as it increased the odds that patients would continue the diet.

 

1979

Interest grew in the notion that a simple dietary intervention could favorably impact the daily lives of long-term diabetics.  J. W. Anderson and K. Ward ran a clinic-based study (abstract) of 20 diabetic patients currently using insulin treatments.  The patients were first put on a reference diet for one week to stabilize their condition, then switched to a high plant fiber (HCF) diet for about 16 days. 

The two diets were designed to maintain weight, to avoid any confusion caused by weight loss.  I got a kick out of how the researchers managed this.  According to Dr. Michael Greger, in his book How Not to Die, the researchers weighed the subjects daily; anyone found to have lost weight on the HCF diet (and that happens a lot!) was simply forced to eat more food, until they regained the weight.

After 16 days, all patients had switched to lower levels of insulin.  The average insulin use dropped from 26 units to 11.  Nine patients receiving 15 to 20 units/day dropped insulin entirely.  Two patients receiving 32 units/day also dropped insulin entirely.  As a side benefit, study patients dropped their LDL an average of almost 60 mg/dl.

The abstract for this study concludes with:  These studies suggest that HCF diets may be the dietary therapy of choice for certain patients with the maturity-onset type of diabetes.

Yes, this was a small study, but its implications are profound.  In less than three weeks, some long-term diabetics were able to stop insulin treatments and drop their A1c to non-diabetic levels, using only diet.  Later research would confirm these findings and provide better understanding of the dynamics involved, but the bottom line is: Simple dietary intervention reversed diabetes.

For all practical purposes, medical science now had a tool that could effectively prevent and reverse one of America's most dreaded chronic diseases.  From this point forward, the vast majority of deaths from diabetes need not have happened.

1985

For over a century, the Seventh Day Adventists have followed a scripture-based vegan diet: “And God said, Behold, I have given you every herb bearing seed, which is upon the face of all the earth, and every tree, in the which is the fruit of a tree yielding seed; to you it shall be for meat.” Genesis 1:29

The Adventists have also become, through the decades, the most studied dietary population group in history.  In 1985, David Snowdon (PhD, MPH) and Roland L. Phillips (MD, DrPH), studied a group of over 25,000 Adventists by analyzing death certificates from the California death certificate file (years 1960-1980).  They were looking specifically for mortality associated with diabetes across several age ranges compared to a similar white American population.

They found significant lower rates in observed versus expected deaths due to diabetes, with the Adventists living much longer than those presumed to be eating a Standard American Diet.

In their study's conclusion, they cite three possible explanations for the increased diabetes mortality among those eating non-vegetarian diets.  One possible reason is that: Saturated fat consumption may increase insulin secretion, and possibly lead to insulin insensitivity.  Another possibility they raise is that: Saturated fat intake may alter fecal microbial enzyme activity and steroid production which might increase the synthesis of estrogens which could impair insulin sensitivity.

2017

By the end of the 20th century, interest in a diet-related therapy for diabetes had grown significantly and meta-analyses were becoming common.  Michelle McMacken and Sapana Shah, of the New York University School of Medicine, published a survey of research on plant-based diets for the prevention and treatment of diabetes.  Their study referenced over 150 other published papers on the benefits of a whole food, plant-based diet for treating not just diabetes but other illnesses as well, including cardiovascular disease and hypertension.

One entry in their survey referenced research by Sargrad, et al, that compared a high-carbohydrate diet versus a high-protein diet and their impacts on insulin sensitivity and A1c, among much else.  Weight loss for both groups was equivalent, but the high carbohydrate group saw an average drop in A1c from 8.2% to 6.9% over an eight-week period; there was no change in A1c for those in the high-protein group.

A1c summarizes your sugar levels over the previous three months or so.  An average drop of 1.3% after just eight weeks is huge.  I wish the study had continued out to six months or more.  Dropping at that rate, I bet a lot of the high carb group would have ended up with A1c down in the non-diabetic range (below 6.0%).  Oh well...

McMacken and Shah conclude their study with the comment:  While larger interventional studies on plant-based diets carried out for longer periods of time would add even more weight to the already mounting evidence, the case for using a plant-based diet to reduce the burden of diabetes and improve overall health has never been stronger.

2021

In June of 2021, the journal Advances in Nutrition published a paper by several authors, including Dr. Neal Barnard, examining the efficacy, mechanisms, and practical considerations of using a plant-based diet to prevent and treat diabetes.  They noted several large studies, including the Health Professionals Follow-Up Study (1986-2006, 26k men), Nurses' Health Study (1986-2006, 48k women), and the EPIC study (11 years, 340k subjects).  All studies concluded that plant-based diets provided a strong reduction in the risk of developing diabetes.

This paper continues by examining the clinical benefits of a plant-based diet on other health issues, include cardiovascular disease and neuropathy.  I'm more interested in curing diabetes, but the info is worth reading through.

2025

American diabetes mortality figures from the CDC and summarized by the Center for Advancing Health (cfah.org) are a bit discouraging, frankly.  From 1999 to 2020, nearly 74,000 people died each year from diabetes and its complications.  The death toll in 2020 marked a milestone, of sorts; it was the first year over 100k Americans died from diabetes.  Remember, this is a disease that medicine had shown 45 years ago could be prevented and reversed with proper nutrition.

As a reference, the death toll in 2020 amounts to a fully loaded airliner plowing into the ground not quite every single day.  Imagine the headlines if that were to happen!  Oh, wait...it effectively does.  Looks like it's not news.

So where are we now?  A lot of websites promote a whole food, plant-based (WFPB) diet as a way to prevent, treat, or often reverse diabetes.  I've noticed that some clinics and organizations hesitate to talk of curing diabetes; often, the farthest they will go is talk of reversing it.

Still, some of the heavy hitters out there are supporting a plant-based diet as a possible treatment for diabetes.  For example, the American Diabetes Association (ADA) has a page on vegan meal plans.  The ADA also has a nice commentary by Dariush Mozaffarian on current (2024) views regarding plant-based and animal-based diets.

But the web is filled with sites dedicated to WFPB diets, particularly as a way to treat or reverse diabetes.  Some of these sites are selling products, so you have to allow for that.  Others are hosted by some of the strongest proponents of WFPB diets, based on their personal experience or accumulated research.  Here is a list of some of my go-to sites:

Dr. Michael Greger's site, nutritionfacts.org, supports his books and his ongoing research in all aspects of evidence-based nutrition.  He releases nutrition-based videos daily and has a large library of searchable information, including recipes and his Daily Dozen meal planner app.

The site nutritionstudies.org is run by the T. Colin Campbell Center for Nutrition Studies.  Dr. Campbell is one of the giants in the field of nutritional science, being one of the authors of the massive China Study.  The site has a lot of information, all well organized and well written, and includes articles and recipes to help with adopting a WFPB diet.

The 2011 documentary Forks Over Knives has a related website called, naturally, forksoverknives.com.  This site provides everything from success stories to recipes and offers a multi-day course to a program you can take to become a "plant-based home chef."

Specific to diabetes, the site masteringdiabetes.org promotes the book, Mastering Diabetes, by Cyrus Khambatta and Robby Barbaro.  I would normally avoid a website with what at first looks like a strong commercial push, but the book's forward was written by Dr. Neal Barnard, for whom I have great respect.  When I scrolled down further, I saw endorsements by Dr. Greger, Dr. Joel Fuhrman, and Brian Wendell, all of them top dogs in the WFPB movement.  So I added this site to my favorites list.  And I like their cloud of success stories you can click on.

Conclusion

The attempts to prevent and reverse diabetes date back centuries.  Progress has been accelerating in recent decades, to the point that many people with T2DM have a real shot at reversing their disease simply by changing their diet.  I don't have diabetes so I can't relate to living with the disease, but I gotta think most diabetics would at least consider a dietary change if it gave them a real chance to end this disease.

Note that I have focused on diabetes here, but heart disease, kidney disease, most blood and organ cancers, and other chronic diseases all have the same underlying pathology; poor nutrition.  Dietary changes you make to treat or reverse your diabetes could well treat or reverse other long-term issues.

Thanks for reading...

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