The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.
A Low-Fat Vegan Diet Elicits Greater Macronutrient Changes, but Is Comparable in Adherence and Acceptability, Compared with a More Conventional Diabetes Diet among Individuals with Type 2 Diabetes
Open accessAbstract
Background Although therapeutic diets are critical to diabetes management, their acceptability to patients is largely unstudied.Objective To quantify adherence and acceptability for two types of diets for diabetes.Design Controlled trial conducted between 2004 and 2006.Subjects/setting Individuals with type 2 diabetes (n=99) at a community-based research facility. Participants were randomly assigned to a diet following 2003 American Diabetes Association guidelines or a low-fat, vegan diet for 74 weeks.Main outcome measures Attrition, adherence, dietary behavior, diet acceptability, and cravings.Statistical analyses For nutrient intake and questionnaire scores, t tests determined between-group differences. For diet-acceptability measures, the related samples Wilcoxon sum rank test assessed within-group changes; the independent samples Mann-Whitney U test compared the diet groups. Changes in reported symptoms among the groups was compared using chi(2) for independent samples.Results All participants completed the initial 22 weeks; 90% (45/50) of American Diabetes Association guidelines diet group and 86% (42/49) of the vegan diet group participants completed 74 weeks. Fat and cholesterol intake fell more and carbohydrate and fiber intake increased more in the vegan group. At 22 weeks, group-specific diet adherence criteria were met by 44% (22/50) of members of the American Diabetes Association diet group and 67% (33/49) of vegan-group participants (P=0.019); the American Diabetes Association guidelines diet group reported a greater increase in dietary restraint; this difference was not significant at 74 weeks. Both groups reported reduced hunger and reduced disinhibition. Questionnaire responses rated both diets as satisfactory, with no significant differences between groups, except for ease of preparation, for which the 22-week ratings marginally favored the American Diabetes Association guideline group. Cravings for fatty foods diminished more in the vegan group at 22 weeks, with no significant difference at 74 weeks.Conclusions Despite its greater influence on macronutrient intake, a low-fat, vegan diet has an acceptability similar to that of a more conventional diabetes diet. Acceptability appears to be no barrier to its use in medical nutrition therapy.
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“Very low-fat patterns are characterized predominantly by having ≤10% energy from fat. 37,[39][40][41]57,58”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [57]
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Cites
The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger
Stunkard, A. J., & Messick, S. (1985) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(85)90010-8 · Cited by 4,687 · cited 2×
“Restraint, disinhibition, and hunger, as reported using the Eating Inventory instrutment (10), indicating changes from baseline to 22”
BackgroundMethodBantle (2008) · doi:10.2337/dc08-s061 · Cited by 1,795
Intensive Lifestyle Changes for Reversal of Coronary Heart Disease
Ornish, D. (1998) · JAMA · doi:10.1001/jama.280.23.2001 · Cited by 1,730 · cited 2×
“Vegetarian and vegan diets have demonstrated efficacy in the management of cardiovascular disease (22), weight problems (26), and diabetes (4).”
BackgroundFranz, M. J., Bantle, J. P., Beebe, C. A., Brunzell, J. D., Chiasson, J.-L., Garg, A., Holzmeister, L. A., Hoogwerf, B., Mayer-Davis, E., Mooradian, A. D., et al. (2002) · Diabetes Care · doi:10.2337/diacare.25.1.148 · Cited by 1,165
Sources of data for developing and maintaining a nutrient database.
Schakel, S., Sievert, Y. A., & Buzzard, I. M. (1988) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(21)07997-9 · Cited by 757 · cited 2×
“0, Food and Nutrient Database 35, 2004, Nutrition Coordinating Center, University of Minnesota, Minneapolis) (9) and reported instances of poor dietary adherence to the RDs responsible for the initial dietary instruction for additional dietary counseling as needed.”
BackgroundInfluentialDevelopment and Validation of the Food‐Craving Inventory
White, M. A., Whisenhunt, B. L., Williamson, D. A., Greenway, F. L., & Netemeyer, R. G. (2002) · Obesity Research · doi:10.1038/oby.2002.17 · Cited by 471 · cited 5×
“Cravings, as reported using the Food-Craving Inventory (12), indicating changes from baseline to 22 weeks and from baseline to 74”
BackgroundMethodInfluentialBarnard, N. D., Cohen, J., Jenkins, D. J. A., Turner-McGrievy, G., Gloede, L., Jaster, B., Seidl, K., Green, A. A., & Talpers, S. (2006) · Diabetes Care · doi:10.2337/dc06-0606 · Cited by 468
Self-citationPosition of the American Dietetic Association and Dietitians of Canada: Vegetarian diets
(2003) · Journal of the American Dietetic Association · doi:10.1053/jada.2003.50142 · Cited by 414
Assessment of Group Versus Individual Diabetes Education
Rickheim, P., Weaver, T. W., Flader, J. L., & Kendall, D. M. (2002) · Diabetes Care · doi:10.2337/diacare.25.2.269 · Cited by 400
Johansson, G. K., Wikman, Å., Åhrén, A.-M., Hallmans, G., & Johansson, I. (2001) · Public Health Nutrition · doi:10.1079/phn2001124 · Cited by 389 · cited 1×
“Dietary intake was based on self-report, which is vulnerable to distortion based on participants’ tendency to provide socially desirable responses and to underreporting, especially in individuals with higher body mass indexes (28).”
Background
Flagged first, then by citations
Research works printed but not linked: 5
- 2008, Nutrition recommendations and interventions for diabetes, Diabetes Care, 31, S61
- Ziemer, 2003, A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes, Diabetes Care, 26, 1719, 10.2337/diacare.26.6.1719 · DOI · Paper page
- Barnard, 2000, Acceptability of a therapeutic low-fat, vegan diet in premenopausal women, J Nutr Educ, 32, 314, 10.1016/S0022-3182(00)70590-5 · DOI
- Barnard, 2004, Acceptability of a very-low-fat, vegan diet compares favorably to a more moderate low-fat diet in a randomized, controlled trial, J Cardiopulm Rehab, 24, 229, 10.1097/00008483-200407000-00004 · DOI
- Smith, 1999, Young adults remain on vegetarian diet longer than on weight loss diets, Ann Behav Med, 21, S90
Cited by
Sorted by citations
Items 101–155 of 155
Kahleová, H., Berrien-Lopez, R., Holtz, D. N., Green, A., Sheinberg, R. B., Gujral, H., Holubkov, R., & Barnard, N. D. (2021) · American Journal of Lifestyle Medicine · doi:10.1177/15598276211050339 · Cited by 7
“insurance company, a plant-based diet decreased anxiety, depression, and job absenteeism.(29) Acceptability of the low-fat vegan diet was comparable to the participants’ usual diets, confirming the findings of previous studies.”
BackgroundResultSelf-citationKahleová, H., Rembert, E., Alwarith, J., Nowak, A., Agnello, M., Chutkan, R. K., Holubkov, R., & Barnard, N. D. (2021) · Research Square · doi:10.21203/rs.3.rs-427495/v1 · Cited by 5
Self-citationPlant based diet and cardio-metabolic disease
Dąbrowska, J., Wójcik, M., Borowik, J., Kuśmierczuk, K., & Piecewicz‐Szczęsna, H. (2020) · Journal of Education Health and Sport · doi:10.12775/jehs.2020.10.05.015 · Cited by 4
“Moreover, the vegan diet was not viewed as less acceptable [55].”
BackgroundA pilot study of a low glycemic load diet in patients with stage I-III colorectal cancer
Treasure, M. E., Thomas, A., Ganocy, S. J., Hong, A., Krishnamurthi, S., Bajor, D. L., Berger, N. A., & Meropol, N. J. (2021) · Journal of Gastrointestinal Oncology · doi:10.21037/jgo-20-330 · Cited by 4
Zeitlin, A. B., Ward, C., Cooper, A. O. M., Landry, M. J., Krenek, A. M., Durand, L. R., Cunanan, K. M., Robinson, J. L., Dant, C. C., & Gardner, C. D. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.107549 · Cited by 3
“Other intervention studies also reported similar acceptability and greater adherence for those assigned to a plant-based diet compared to those assigned to an omnivorous diet or control diet [38 – 40].”
van Dongen, J. M., Bernaers, L., Wagenaar, C. A., van der Leeden, M., Turkstra, F., Boers, M., van Middendorp, H., Weijs, P. J. M., van Schaardenburg, D., & Walrabenstein, W. (2025) · Scandinavian Journal of Rheumatology · doi:10.1080/03009742.2025.2550133 · Cited by 3
“This included a whole-food, plant-based dietary plan based on the protocols by Ornish et al (26) and Barnard et al (27), slightly adapted to align with the 2015 Guidelines on Healthy Nutrition from the Health Council of the Netherlands; personal physical activity goals in accordance with the 2017 Dutch physical activi…”
The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake: The Rockford CHIP
Englert, H., Dieh, H., Greenlaw, R., & Aldana, S. (2012) · InTech eBooks · doi:10.5772/38182 · Cited by 10
“In a 22- week clinical trial, Barnard and coworkers were able to show that such a very low-fat plant based, high carbohydrate (70% of calories) diet improved significantly not only the levels of glycemia, but also the levels of lipids and kidney function but clearly exceeded the clinical results of the other intervent…”
ResultInfluentialProvider Responses to Patients With Chronic Conditions Who Follow a Plant-Based Diet
van Zyl, M. A., & Harris, L. M. (2018) · Families in Society The Journal of Contemporary Social Services · doi:10.1177/1044389418810239 · Cited by 3
“…offered as part of the treatment of chronic diseases such as high blood pressure, diabetes, cardiovascular disease, and obesity is that the eating plan is too strict and adherence will therefore be low (Barnard et al., 2009; Chapman et al., 2016; Wofford, Greenlund, Croft, & Labarthe, 2007).”
BackgroundKlowak, M., & Boggild, A. K. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1196470 · Cited by 3
“1 Current literature suggests high acceptability, and a limited risk profile associated with a WFPBD (19, 21, 22, 47, 55, 56).”
BackgroundIsaacs, S., Bogardus, M., Thompson, M. P., Wu, S., & Howell, M. (2024) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2024.11.003 · Cited by 4
The effect of low-fat diets on appetite: a systematic review of randomized clinical trials
Razmpoosh, E., Abdollahi, S., Sikaroudi, M. K., Sangsefidi, Z. S., Zeraattalab-Motlagh, S., Torabinasab, K., Hejazi, M., Meshkini, F., Motallaei, M., & Soltani, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-23454-0 · Cited by 4
“Three studies applied either an alternate-day fasting diet [28], an energy-deficit diet [25], or a vegan diet [26] along with the LF (25% fat) and HF (45% fat) dietary interventions with a standard daily protein intake (15% protein).”
InfluentialSmokovski, I. (2020) · Springer eBooks · doi:10.1007/978-3-030-51469-3_8 · Cited by 2
Turner‐McGrievy, G. M., Wilcox, S., Frongillo, E. A., Kim, Y., Okpara, N., & Wilson, M. J. (2024) · Appetite · doi:10.1016/j.appet.2024.107280 · Cited by 2
Self-citationFiber and sugar contents in vegetables prescribed and consumed by diabetics in Kisangani
François, L. M., Elumbu, B. S., Kayisu, K., Utshudienyema, N., Ikolonga, P., Mango, B. M., Likwela, L., & Agasa, B. (2015) · Journal of Experimental Biology and Agricultural Sciences · doi:10.18006/2015.3(3).275.280 · Cited by 2
Implications of the Glycemic Index in Obesity
Wong, J. M., Josse, A. R., Augustin, L. S. A., Saxena, N., Chiavaroli, L., Kendall, C. W. C., & Jenkins, D. J. A. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-374387-9.00017-9 · Cited by 2
Self-citationFatouros, I. G., & Mitrakou, A. (2012) · CRC Press eBooks · doi:10.1201/b12085-16 · Cited by 2
Pierzak, M. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.44.01.009 · Cited by 2
Turner-McGrievy, G., Wilcox, S., Frongillo, E., Murphy, E. A., Kim, Y., Hu, E. A., Okpara, N., & Bailey, S. (2024) · Obesity Science & Practice · doi:10.1002/osp4.70009 · Cited by 1
“3,4 Prior research has found that PBDs are rated as acceptable and have similar adherence compared to other therapeutic diets, 5–7 but most previous studies were among predominantly white populations.”
BackgroundSelf-citationThoms, T. (2012) · Cited by 1
Vegetarian Diets in People With Type 2 Diabetes
Kahleová, H., & Pelikánová, T. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803968-7.00021-6 · Cited by 1
Olsen, S. U. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2010.08.016 · Cited by 1
Ensuring good nutritional status in patients with Parkinson's disease: challenges and solutions
Baroni, L., & Zuliani, C. (2014) · Journal of Parkinsonism and Restless Legs Syndrome · doi:10.2147/jprls.s49186
“diets in clinical studies were found to be comparable to the other therapeutic nutritional regimens.(163,164)”
Lanou, A. J., & Svenson, B. (2009) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-009-0075-y
“Vegetarian and vegan dietary patterns tend to result in nutrient profiles conducive to cardiovascular disease and diabetes risk reduction compared with conventional healthy eating patterns [20, 21, 25–27], are acceptable [32], and are supported by the American Dietetic Association (provided they are appropriately plan…”
BackgroundAcharya, S. D. (2010) · D-Scholarship@Pitt (University of Pittsburgh)
From the Editor Medicine's Response to Lifestyle-Related Preventable Illness 283
Weinberg, J. L., & Katz, D. L. (2013)
Metabolic Effects of Low-Carbohydrate Diet in the Type 2 Diabetes Mellitus
Şanlıer, N., & İşgüzar, Y. (2016) · Turkiye Klinikleri Journal of Health Sciences · doi:10.5336/healthsci.2015-46760
A Plant-Food Diet in the Risk and Management of Parkinson’s Disease
Baroni, L., & Zuliani, C. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-411462-3.00043-6
Ketogenic Diets as an Adjuvant Therapy for Patients with Glioblastoma
Martin-Mcgill, K. (2019) · University of Liverpool · doi:10.17638/03052121
Mandes, T. (2014) · UEF eRepo (University of Eastern Finland)
Maiya, M., Cartagenova, A., Fitko, K. A., Roa, S., Law, C., & Patterson, M. A. (2022) · Research Square · doi:10.21203/rs.3.rs-1247087/v1
Smokovski, I. (2023) · Springer eBooks · doi:10.1007/978-3-031-27793-1_8
“PLANT BASED-DIET”: TRATAMENTO PARA DIABETES MELLITUS 2
Oliveira, L. M. M. D., Teixeira, B. B. D. S., & Leão, F. M. (2023) · Revista Contemporânea · doi:10.56083/rcv3n12-101
Kini, R. B. S. (2019) · International Journal of Physiology · doi:10.37506/ijop.v7i4.94
Does Eating Disorders and Flexible Dietary Control Effects the Food Craving Arise?
Ayhan, B., Mortas, H., Kose, S., Varlı, S. N., & Bilici, S. (2024) · Food Science & Nutrition · doi:10.24966/fsn-1076/100197
Lam, T., Gruzmark, F. S., Ondreyka, J., Lenczowski, J., Harris-Tryon, T. A., Frew, J. W., & Lev‐Tov, H. A. (2025) · Integrative and Complementary Therapies · doi:10.1177/27683192251376656
Impact of a Vegetarian Diet upon Premature Aging, Metabolic Syndrome, and Health
Miloicov-Bacean, O. C., Sitaru, G. P., Vacaru, G. C., Borca, C. I., Simbrac, M. C., Folescu, R., Gurguş, D., & Ursadan, M. A. (2025) · Obesities · doi:10.3390/obesities5040077
“%) is comparable to that reported by Barnard et al. [24], who found a 22% reduction in LDL levels after three weeks of a low-fat, plant-based diet combined with exercise.”
Walrabenstein, W., van der Leeden, M., Weijs, P. J. M., van Middendorp, H., Wagenaar, C. A., van Dongen, J. M., Nieuwdorp, M., de Jonge, C. S., van Boheemen, L., & van Schaardenburg, D. (2021) · Figshare · doi:10.6084/m9.figshare.16829908
Walrabenstein, W., van der Leeden, M., Weijs, P. J. M., van Middendorp, H., Wagenaar, C. A., van Dongen, J. M., Nieuwdorp, M., de Jonge, C. S., van Boheemen, L., & van Schaardenburg, D. (2021) · Figshare · doi:10.6084/m9.figshare.16829896
Walrabenstein, W., van der Leeden, M., Weijs, P. J. M., van Middendorp, H., Wagenaar, C. A., van Dongen, J. M., Nieuwdorp, M., de Jonge, C. S., van Boheemen, L., & van Schaardenburg, D. (2021) · Figshare · doi:10.6084/m9.figshare.16829902
Roberts, A. K., Busque, V., Robinson, J. L., Landry, M. J., & Gardner, C. D. (2022) · Figshare · doi:10.6084/m9.figshare.21582374
Walrabenstein, W., van der Leeden, M., Weijs, P. J. M., van Middendorp, H., Wagenaar, C. A., van Dongen, J. M., Nieuwdorp, M., de Jonge, C. S., van Boheemen, L., & van Schaardenburg, D. (2021) · Figshare · doi:10.6084/m9.figshare.16829905
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706204
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706201
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706189
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706195
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706192
Walrabenstein, W., van der Leeden, M., Weijs, P. J. M., van Middendorp, H., Wagenaar, C. A., van Dongen, J. M., Nieuwdorp, M., de Jonge, C. S., van Boheemen, L., & van Schaardenburg, D. (2021) · Figshare · doi:10.6084/m9.figshare.16829899
Wagenaar, C. A., Toonstra, A., Walrabenstein, W., van Schaardenburg, D., & van Nassau, F. (2024) · Figshare · doi:10.6084/m9.figshare.26706198
Winckler, M., & Slywitch, E. (2026) · Royal Society of Chemistry eBooks · doi:10.1039/9781837678907-00042
Smillie, L., Minehan, M., Knight-Agarwal, C. R., & Farshid, A. (2026) · Clinical Cardiology · doi:10.1002/clc.70438
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Menhardt, S., Herby, A., Barnard, N. D., & Forbes, E. (2026) · American Journal of Lifestyle Medicine · doi:10.1177/15598276261480005
Self-citationA plant-based diet for the prevention and treatment of type 2 diabetes.
(2017) · Europe PMC (PubMed Central) · doi:10.11909/j.issn.1671-5411.2017.05.009 · Cited by 320
Metadata
- Authors
- Barnard, N. D., Gloede, L., Cohen, J., Jenkins, D. J. A., Turner-McGrievy, G., Green, A. A., & Ferdowsian, H.
- Affiliations
- Physicians Committee for Responsible Medicine (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Barnard, Neal D.
- Venue
- Journal of the American Dietetic Association
- Publisher
- Elsevier BV
- Published
- 2009-02
- Volume
- 109
- Issue
- 2
- Pages
- 263-272
- ISSN
- 0002-8223 (ISSN-L)
- PMC
- PMC2680723
- OpenAlex
- W2153632139
- Cited by
- 154
- References
- 23
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 15 · 2020: 7 · 2019: 13 · 2018: 11 · 2017: 8 · 2016: 5 · 2015: 8 · 2014: 11 · 2013: 6 · 2012: 7
- FWCI
- 8.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Dietetic Association (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01dk059362-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK059362-01A2, R01 DK059362)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Keywords
- type 2 diabetes, vegan diet, low-fat diet, dietary adherence, diet acceptability, macronutrient intake, dietary restraint, hunger, food cravings, American Diabetes Association guidelines, medical nutrition therapy, dietary fat and cholesterol
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Glucose, Cholesterol, Dietary, Diabetes Mellitus, Type 2, Diet, Diabetic, Diet, Reducing, Dietary Carbohydrates, Dietary Fats, Dietary Fiber, Dietary Proteins, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Obesity, Patient Acceptance of Health Care, Patient Compliance, Surveys and Questionnaires, Diet, Vegetarian, Weight Loss, Chi-Square Distribution, Treatment Outcome, Patient Satisfaction, Diet, Fat-Restricted
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