A STUDY ON THE PLANT-BASED DIET AND ITS

APPRAISAL AMONG VEGETARIAN INDIVIDUALS WITH

TYPE 2 DIABETES (20-45 YEARS)

DISSERTATION
Submitted to Amity University Haryana

For the Partial fulfilment of the award of the degree of

MASTER OF SCIENCE IN DIETETICS AND APPLIED NUTRITION

Submitted to: Dr. Luxita Sharma Submitted by: Ms Rashmi Arya

Head of Institute & M.Sc. Semester IV
Head of the Department Dietetics and Applied Nutrition
Dietetics and Applied Nutrition Amity Medical School
Amity Medical School

Department Of Dietetics and Applied Nutrition

AMITY UNIVERSITY HARYANA

2023

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 CERTIFICATE

This is to certify that this project entitled " A STUDY ON THE PLANT-BASED DIET AND
ITS APPRAISAL AMONG VEGETARIAN INDIVIDUALS WITH TYPE 2 DIABETES
(20-45 YEARS)" being submitted to Amity University, Haryana in partial fulfilment of the
requirement for the degree of Master of Science (Dietetics & Applied Nutrition), is a
Bonafede research work carried out by Ms. Rashmi Arya under my supervision and no part of
it has been submitted elsewhere for any other degree. The assistance and help received during
investigation have been appropriately acknowledged.

Date:

Dr. Luxita Sharma

Head of Institute &
Head of the Department
Dietetics and Applied Nutrition
Amity Medical School

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 ACKNOWLEDGEMENT

I thank the Almighty God for the blessings. He bestowed upon me to begin and complete
my dissertation.

I would like to express my profound gratitude and sincere indebtedness to my supervisor and
mentor Dr. Luxita Sharma, Head of Institute & Head of the Department, Dietetics and
Applied Nutrition, Amity Medical School, Amity university Haryana, who with so much
patience, support and tutoring guided me throughout. I take this opportunity to thank her for
all the corrections, appreciations, guidance and encouragements, without which I would not
have been able to complete my work and course as a whole in time. Ma'am, your criticisms,
and comments are well taken.

I place my sincere thanks to my entire faculty for their knowledge, encouragements and
support they shared and showed me. I am also thankful to all my friends, classmates and
juniors of the Dietetics and Applied Nutrition Department for their support and words of
encouragement.

Finally, thank you all for your consistent support & it is my fortune to have you all in my
life.

________________________ ______________________

Dr. Luxita Sharma Ms Rashmi Arya

Project Supervisor M.Sc. Semester IV
Head of Institute & Dietetics and Applied Nutrition
Head of the Department
Dietetics and Applied Nutrition

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 ABSTRACT

The rising global incidence of type 2 diabetes poses significant challenges in both disease
treatment and the prevention of its detrimental consequences. In recent years, the plant-based
diet has gained popularity as a potential therapeutic approach for individuals with type 2
diabetes. This thesis aims to conduct a comprehensive investigation into the effectiveness
and acceptance of a plant-based diet among vegetarians diagnosed with type 2 diabetes. The
research seeks to explore the impact of a plant-based diet on glycaemic management,
cardiovascular risk factors, and overall health outcomes in this specific population. To
achieve this, a mixed-methods approach will be employed, involving quantitative analysis of
clinical data and qualitative exploration of participants’ perspectives. By combining
objective clinical measurements with subjective experiences, this study aims to provide a
comprehensive evaluation of the effects of a plant-based diet in vegetarians with type 2
diabetes.

Key factors such blood glucose levels, glycated haemoglobin (HbA1c), lipid profiles, body
weight, and blood pressure are evaluated during quantitative data analysis. Interviews and
focus groups are used to collect qualitative data that might shed light on the participants'
thoughts, feelings, and experiences with going plant-based. This research adds significantly
to our understanding of how vegetarians with type 2 diabetes may successfully adopt a plant-
based diet. The quantitative study's objectives are to ascertain whether or if the plant-based
diet is beneficial for controlling blood sugar levels, decreasing cardiovascular risk factors,
and enhancing general well-being. A more nuanced picture of the participants' experiences is
provided by the qualitative analysis, which draws attention to the elements that affect dietary
adherence, satisfaction, and possible obstacles.

Implications for healthcare providers, politicians, and vegetarians with type 2 diabetes are
substantial based on the findings of this study. The findings will help in the establishment of
individual diabetes treatment plans by providing evidence-based recommendations for
dietary modifications. Improve health outcomes and quality of life by providing
individualized counsel and assistance to this demographic by first understanding the
advantages and disadvantages of adopting a plant-based diet.

Overall, this thesis seeks to fill in knowledge gaps by conducting an in-depth study of the
effectiveness and acceptability of a plant-based diet among vegetarians with type 2 diabetes.

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The results will have far-reaching implications for clinical practice, diabetes management
research, and the creation of effective, population-specific treatments to improve health.

It is observed that there is heterogeneity across the literature collected. In this regard, the
study collects a total of 19 journal papers in order to address the review made in
consideration of the “implication of plant-based diet” among individuals with type 2
diabetes. However, the homogeneous methods applied in the results takes a dig into a critical
approach to methodological approaches based on the relevance of the current study.
According to Trautwein and McKay (2020), predominately the plant-based dietary pattern is
vegetable fat, dietary fibers and phytosterol or phytonutrients, and all these are macro and
micro components. Plant-based proteins have important antioxidants, minerals, and vitamins
that benefit human heal compared to animal proteins. Vegan diets are important for the
improvement of immunity levels for T2D patients and helps them to suffer from serious
conditions that occur because of irregular insulin sensitivity.

Keywords: Plant-based diet, Vegetarian, Type 2 diabetes, Efficacy, Appraisal, Glycaemic

control etc.

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 Table of Contents
INTRODUCTION....................................................................................................................10
1.1 Type 2 Diabetes...........................................................................................................10

1.2 Plant-Based Diet Help Weight Loss.............................................................................11

1.3 Consuming High Fibre Foods.......................................................................................11

1.4 The Primary Cause of Insulin Resistance and Weight Gain.........................................12

CHAPTER 02.........................................................................................................................14
LITERATURE REVIEW..........................................................................................................14
2.1 Type 2 Diabetes...........................................................................................................14

2.2 Epidemiology................................................................................................................15

2.3 Lifestyle, Genetics and Medical Conditions..................................................................16

2.4 Pathophysiology...........................................................................................................18

2.5 Screening and Diagnosis..............................................................................................19

2.6 Complications...............................................................................................................20

2.7 Management.................................................................................................................22

2.8 Origin of Plant Based Diet............................................................................................26

2.9 Conceptual Framework................................................................................................27

2.10 The importance of a plant-based diet for a healthy diet.............................................29

2.11 The effectiveness of a plant-based diet for individuals of the 20-45 age group who are
suffering from Type 2 diabetes...........................................................................................31

2.12 Benefits of a plant-based diet.....................................................................................32

2.13 Main Plant Protein and its Effect on the Prevention of Type 2 Disease.....................34

2.14 Different types of Plant-based diets in order to promote well-being...........................36

2.15 Comparison of Selected Diets....................................................................................41

2.16 Vegetarian Etymology................................................................................................42

2.17 Environmental and Diet..............................................................................................42

2.18 Ethical and Environment Benefits...............................................................................43

2.19 Is The Vegan Gut Profile Unique................................................................................43

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 2.20 Advantages of Plants Based Diet...............................................................................45

2.21 Benefits of Plant-Based Diet.......................................................................................45

2.22 Low Fat Diet...............................................................................................................47

2.23 Plant Based Diet reduce the risk of diseases.............................................................47

3.1 Methodology Article......................................................................................................49

3.2 Collection......................................................................................................................50

RESULTS...............................................................................................................................68
CONCLUSION.......................................................................................................................95
Bibliography...........................................................................................................................98

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 List of Figures & Tables

Figure 2.1: Conceptual framework...........................................................................................29

Figure 2.2: The value of the global plant-based food market from 2020 to 2026 by the
product types............................................................................................................................30
Figure 2.3: Managerial pathway that shows antidiabetic actions of different metallic
nanoparticles.............................................................................................................................33
Figure 2.4: Types of common vegetarian diet..........................................................................37
Figure 2.5: The impact of plant-based intake on acid-based homeostasis in individuals with
low glomerular.........................................................................................................................38
Table 1: The effect of protein beneficial through plant micronutrients...................................39
Table 2: The Key Barriers and attitude toward avoiding animal-based diet............................40
Figure 1: PRISMA model........................................................................................................50
Table 3: Characteristics of the Included Data..........................................................................65

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 CHAPTER :01
INTRODUCTION

9
 CHAPTER 1

INTRODUCTION

The rising prevalence of diabetes and the potential benefits of plant-based diets for managing
this condition have garnered significant interest. However, there is limited research on the
specific experiences and perceptions of vegetarian individuals following a plant-based diet.
By examining their dietary choices, adherence, and overall appraisal of the plant-based
approach, this study seeks to contribute to the existing literature and provide valuable insights
for healthcare professionals working with this demographic. Type 2 diabetes is a chronic
metabolic disorder affecting millions of individuals worldwide. Lifestyle modifications,
including dietary interventions, play a crucial role in managing and preventing complications
associated with the disease. Plant-based diets, characterized by high consumption of fruits,
vegetables, whole grains, legumes, nuts, and seeds, have shown promise in improving
glycaemic control and reducing cardiovascular risk factors. However, limited research has
focused on vegetarian individuals with Type 2 diabetes and their experiences with a plant-
based diet.

1.1 Type 2 Diabetes

Type 2 diabetes is a prevalent chronic metabolic disorder characterized by insulin resistance
and impaired glucose regulation. It affects millions of individuals worldwide and poses a
significant burden on healthcare systems. Lifestyle interventions, particularly dietary
modifications, are crucial for managing and preventing complications associated with Type 2
diabetes. In recent years, there has been growing interest in the potential benefits of plant-
based diets for individuals with Type 2 diabetes. A plant-based diet emphasizes the
consumption of plant-derived foods such as fruits, vegetables, whole grains, legumes, nuts,
and seeds, while minimizing or eliminating animal products. This dietary approach has
gained attention due to its potential to improve glycemic control, reduce cardiovascular risk
factors, and promote overall health.

Plant-based diets offer a natural abundance of fiber, antioxidants, and phytochemicals,

which have been linked to various health benefits. Fiber plays a vital role in regulating blood
sugar levels and enhancing insulin sensitivity.The consumption of plant-based proteins, such
as legumes and tofu, can be advantageous for individuals with diabetes as they are
generally lower in saturated fat compared to animal-based protein sources. Moreover, plant-
based diets are typically lower in cholesterol and saturated fat, which are known risk factors
for cardiovascular disease, a common comorbidity in individuals with Type 2 diabetes.
Despite the potential advantages, there is still a need for more research on the effectiveness
and acceptance of plant-based diets among individuals with Type 2 diabetes. Existing

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studies have primarily focused on general populations or have included limited samples of
vegetarian individuals. Therefore, it is essential to specifically examine the experiences and
perceptions of vegetarian individuals with Type 2 diabetes who follow a plant-based diet.

Understanding the specific challenges, motivations, and outcomes associated with adopting a
plant-based diet in this population can provide valuable insights for healthcare professionals.
By tailoring dietary recommendations to align with individual beliefs, preferences, and
cultural considerations, healthcare professionals can enhance patient adherence to dietary
interventions and improve diabetes management outcomes.

This study aims to address this research gap by investigating the impact and appraisal of a
plant-based diet among vegetarian individuals aged 20-45 years with Type 2 diabetes. By
examining their dietary choices, adherence, and overall experiences, this study seeks to
contribute to the existing literature and provide evidence-based recommendations for
healthcare professionals working with this demographic.

1.2 Plant-Based Diet Help Weight Loss

Numerous factors can make weight loss difficult, but one thing is certain: Calorie restriction
is the only method to reduce weight. Since a plant-based diet has less calories per serving
than an animal-based one, it may be more practical. An average of 600 to 800 calories are
included in one pound of lean beef. When you eat more plant-based foods, you can consume
the same amount of food for less calories while keeping the same caloric density. Siapco and
Associates, as an illustration A study indicated that participants on plant-based, low-fat diets
consumed 700 fewer calories per day than those on keto diets based on animal products when
they were free to eat as much as they wished.

1.3 Consuming High Fibre Foods

Diets high in fibre are recommended for weight loss since it is thought that they improve
satiety. Eating big quantities of plant foods rich in fibre may be more practical and
sustainable than reducing portion sizes of higher-calorie foods. Fibre, however, might also
help people lose weight in other ways. When you consume high-fibre foods, your gut bacteria
produce short-chain fatty acids that lead to the release of hormones that suppress your
hunger.2019 (Willett et al.) This implies that foods high in fibre exert twice as much effort to

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save your appetite. Numerous individuals fail to meet their daily fibre goals of 25 grammes
for women and 38 grammes for men.

1.4 The Primary Cause of Insulin Resistance and Weight Gain

Insulin transfers glucose from the bloodstream to your cells, where it may be used as energy
for your body's cells. It also supplies a backup plan in the case that your cells run out of the
fast-acting source of energy. Some of the fuel is stored as fat as part of this strategy. Rather of
facilitating the breakdown of fat, high insulin levels stimulate the accumulation of fat in cells.
Insulin resistance may induce weight gain for a variety of reasons, including a lack of insulin
in the blood. (Herforth et al, 2019). There is a common belief that carbs are the primary cause
of insulin resistance and weight gain, however this is not always the case. A heavy diet in
plant-based, fibre-rich carbohydrates may help reduce insulin resistance and maintain a
healthy weight, according to studies.

Objectives of the study:

 To study the popularity of plant-based diet.

 To study the complication of diabetes and health benefits of plant-based diet among
them.
 Develop a questionnaire on plant-based diet and diabetes on vegan individuals.
 To study the effectiveness of Vegan Diet Among Diabetic adult individuals.

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 CHAPTER :02
LITERATURE REVIEW

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 CHAPTER 02

LITERATURE REVIEW

2.1 Type 2 Diabetes

Type 2 diabetes, also referred to as adult-onset diabetes or non-insulin dependent diabetes

mellitus (NIDDM), is a chronic metabolic disorder characterized by elevated levels of
glucose in the bloodstream (hyperglycemia). It arises when the body develops resistance to
the actions of insulin, a hormone produced by the pancreas responsible for regulating blood
sugar levels,

In type 2 diabetes, there is a decrease in the responsiveness of the body's cells to insulin,
which impairs their ability to uptake glucose from the bloodstream. This condition is
commonly referred to as insulin resistance. At first, the pancreas compensates by producing
additional insulin in an attempt to overcome this resistance. However, as time goes on, the
pancreas may progressively lose its ability to secrete an adequate amount of insulin, leading
to a relative insulin deficiency.
Type 2 diabetes typically develops gradually, often without noticeable symptoms in the early
stages. Some common risk factors for developing type 2 diabetes include:

Obesity or being overweight: Excess body fat, particularly around the abdomen, increases
the risk.

Sedentary lifestyle: Lack of physical activity and prolonged sitting can contribute to insulin
resistance.

Family history: Having a close family member with type 2 diabetes increases the risk.

Age: The risk of developing type 2 diabetes increases with age, particularly after the age of
45.

Ethnicity: People of certain ethnic backgrounds, such as African, Hispanic, Asian, or Native
American, have a higher risk.

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Gestational diabetes: Women who experience gestational diabetes during pregnancy face an
elevated risk of developing type 2 diabetes in the future.

Polycystic ovary syndrome (PCOS): Women with PCOS have a higher likelihood of
developing insulin resistance and type 2 diabetes.
Common symptoms of type 2 diabetes may consist of excessive thirst, frequent urination,
unexplained weight loss, fatigue, blurry vision, delayed wound healing, and recurring
infections. Nevertheless, certain individuals may not exhibit apparent symptoms, particularly
during the initial phases of the condition.
Failure to treat or inadequately manage type 2 diabetes can result in a range of complications.
Prolonged elevated blood glucose levels can harm blood vessels and nerves, heightening the
chances of cardiovascular ailments, kidney disease, diabetic retinopathy (eye issues),
neuropathy (nerve damage), and foot ulcers. It is vital to diagnose and effectively manage
type 2 diabetes to prevent or delay the onset of these complications.

The management of type 2 diabetes typically entails making lifestyle changes, including
adopting a nutritious diet, engaging in regular physical activity, shedding excess weight (if
overweight), and quitting smoking. In certain instances, medication or insulin therapy may be
recommended to regulate blood sugar levels. Regular monitoring of blood glucose levels,
periodic medical appointments, and continuous diabetes education form integral aspects of
successful management.

2.2 Epidemiology

Epidemiology plays a significant role in understanding the prevalence, risk factors, and
impact of diabetes in populations. Epidemiological studies provide estimates of the
prevalence of diabetes, both globally and within specific populations. These studies help
identify the burden of the disease and its trends over time. These risk factors may include
genetic predisposition, obesity, sedentary lifestyle, unhealthy diet, age, ethnicity, and
socioeconomic status. Understanding these risk factors helps in developing strategies for
prevention and management of diabetes.

Epidemiology helps differentiate between type 1 and type 2 diabetes by studying their
respective patterns in different populations. Type 1 diabetes is believed to have a stronger

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genetic component, while type 2 diabetes is primarily associated with lifestyle factors.
Epidemiological studies help quantify the prevalence of each type and explore their
respective risk factors. Epidemiological research focuses on studying the complications and
co-morbidities associated with diabetes. These complications can include cardiovascular
diseases, kidney disease, neuropathy, retinopathy, and more. Understanding the frequency
and impact of these complications helps guide healthcare interventions and preventive
measures.

Epidemiologists work on establishing surveillance systems to monitor the incidence,

prevalence, and trends of diabetes. These systems collect data from various sources, such as
medical records, surveys, and registries, to track the burden of diabetes and assess the
effectiveness of public health interventions. Randomized controlled trials and other study
designs are used to assess the impact of lifestyle modifications, medications, and healthcare
interventions on diabetes outcomes.

2.3 Lifestyle, Genetics and Medical Conditions

Diabetes is a multifaceted condition influenced by a blend of lifestyle choices, genetic

predisposition, and medical factors. Let's delve deeper into the role of each of these elements
in the onset and control of diabetes:
Lifestyle Factors: The choices individuals make regarding their lifestyle significantly
influence the development and progression of type 2 diabetes. Unhealthy eating habits, lack
of physical activity, and being overweight are major contributors to its onset. Consuming a
diet abundant in processed foods, sugary drinks, and saturated fats leads to weight gain,
insulin resistance, and compromised glucose regulation. Conversely, adopting a well-
balanced diet comprising whole grains, fruits, vegetables, lean proteins, and healthy fats can
aid in the prevention and management of diabetes. This type of diet promotes weight control,
enhances insulin sensitivity, and supports overall well-being.
Physical activity is another essential lifestyle factor. Regular exercise enhances insulin
sensitivity, aids in weight management, and reduces the risk of type 2 diabetes. Engaging in
aerobic exercises, strength training, or even simple activities like walking can have
significant benefits. Sedentary behavior, on the other hand, is associated with an increased
risk of developing type 2 diabetes. Prolonged sitting or inactivity negatively affects insulin
sensitivity and metabolic health.

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Obesity- Obesity stands as a significant risk factor for type 2 diabetes. The presence of
surplus body fat, particularly visceral fat surrounding the abdomen, exhibits a strong
correlation with insulin resistance. Lifestyle decisions play a direct role in the development of
obesity. Consuming excessive calories, particularly from unhealthy food choices, and
leading a sedentary lifestyle contribute to weight gain and heighten the likelihood of
developing diabetes. It is essential for individuals with obesity to focus on weight
management through adopting a healthy diet and engaging in regular physical activity. This
approach is crucial in preventing or managing type 2 diabetes.

Genetic Factors: The development of type 2 diabetes involves genetic factors. Specific
genes are linked to impaired insulin production or function, increasing an individual's
susceptibility to the disease. However, genetics alone is not the sole determinant of type 2
diabetes. Environmental factors and lifestyle choices play a crucial role in its development as
well. Studies indicate that the interaction between genetic and environmental factors accounts
for the majority of type 2 diabetes cases.
A significant genetic risk factor for type 2 diabetes is having a family history of the
condition, particularly among first-degree relatives. However, it's crucial to understand that
genetic predisposition does not guarantee the development of diabetes. Lifestyle choices have
the potential to modify one's risk, and individuals with a family history of diabetes should
adopt healthy practices to minimize their susceptibility. Genetic testing can offer valuable
insights into an individual's risk profile, enabling personalized preventive strategies and early
interventions.
Medical Conditions:
Several medical conditions are closely linked to the development and management of type 2
diabetes. For instance, polycystic ovary syndrome (PCOS) is a hormonal disorder prevalent
in women that can result in insulin resistance and an elevated risk of diabetes. Women
diagnosed with PCOS should actively monitor their metabolic health and implement suitable
lifestyle adjustments to mitigate their risk.

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Metabolic syndrome represents another condition closely associated with type 2 diabetes. It is
characterized by a combination of factors including high blood pressure, elevated cholesterol
levels, abdominal obesity, and impaired glucose metabolism. The presence of metabolic
syndrome significantly heightens the risk of developing diabetes. Effective management of
both metabolic syndrome and type 2 diabetes necessitates lifestyle modifications such as
weight management, regular exercise, and a healthy diet. Additionally, certain medications
can impact the development or management of type 2 diabetes. Prolonged use of
corticosteroids, often prescribed for conditions like asthma or autoimmune disorders, can
induce insulin resistance and hyperglycemia. Similarly, antipsychotic medications used in the
treatment of mental health disorders can contribute to weight gain and insulin resistance,
thereby increasing the risk of type 2 diabetes. It is crucial for individuals taking these
medications to closely collaborate with their healthcare providers to monitor their metabolic
health and adopt preventive measures.

2.4 Pathophysiology

The pathophysiology of diabetes pertains to the fundamental mechanisms and physiological

alterations that take place in the body, resulting in the onset and advancement of the disease.
Diabetes is classified into two primary types: type 1 diabetes and type 2 diabetes, each
characterized by unique pathophysiological pathways.
Type 1 Diabetes: Type 1 diabetes is an autoimmune disorder marked by the destruction of
insulin-producing beta cells in the pancreas. Genetic factors play a role in the predisposition
to type 1 diabetes, with certain human leukocyte antigen (HLA) genes, including HLA-DQ
and HLA-DR, linked to an elevated risk. The immune system erroneously targets the beta
cells as foreign entities, initiating an autoimmune assault that results in their destruction.
While the precise trigger for this autoimmune response remains not fully comprehended, it is
believed to involve viral infections or environmental factors.
Type 2 Diabetes: Type 2 diabetes is characterized by a condition called insulin resistance,
where the body's cells display reduced responsiveness to the effects of insulin, alongside
impaired insulin secretion by the pancreas. Insulin resistance arises when cells, particularly
those in muscle, liver, and adipose tissue, become less sensitive to the actions of insulin. As a
consequence, glucose uptake by the cells diminishes, resulting in elevated blood glucose
levels. Several factors contribute to the development of insulin resistance, including obesity,
sedentary lifestyle, and genetic factors. Initially, in type 2 diabetes, the pancreas compensates

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for insulin resistance by producing more insulin. However, with time, the beta cells may
become dysfunctional and fail to secrete sufficient insulin, ultimately leading to a relative
insulin deficiency.

Insulin resistance and insufficient insulin secretion disrupt the normal regulation of glucose in
the body. The liver's excessive glucose production and reduced uptake by muscle cells
contribute to sustained hyperglycemia. In type 2 diabetes, there may be impaired production
or reduced effectiveness of incretins, which exacerbates hyperglycemia. Chronic low-grade
inflammation and the buildup of fatty acids in tissues, referred to as lipotoxicity, are involved
in insulin resistance and beta cell dysfunction in type 2 diabetes.

2.5 Screening and Diagnosis

The screening and diagnosis of type 2 diabetes typically involve several steps and tests.
Here's an overview of the process:

Risk Assessment: When evaluating an individual's risk for type 2 diabetes, healthcare
providers typically begin by assessing various factors. Common risk factors include obesity, a
sedentary lifestyle, family history of diabetes, hypertension, elevated cholesterol levels, and a
history of gestational diabetes in women.
Symptoms Evaluation: When individuals display symptoms associated with diabetes, such
as increased thirst, frequent urination, unexplained weight loss, fatigue, or blurred vision,
healthcare providers may proceed with diagnostic tests, regardless of the presence or absence
of established risk factors.

Fasting Plasma Glucose Test (FPG): The diagnostic test measures blood glucose levels
following an overnight fasting period. A diagnosis of diabetes is commonly established if the
fasting blood glucose level is equal to or exceeds 126 milligrams per deciliter (mg/dL) on two
separate occasions.

Oral Glucose Tolerance Test (OGTT): The diagnostic test measures blood glucose levels
following an overnight fasting period. A diagnosis of diabetes is commonly established if the

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fasting blood glucose level is equal to or exceeds 126 milligrams per deciliter (mg/dL) on two
separate occasions.
Haemoglobin A1c (HbA1c) Test: The blood test in question evaluates the average blood
glucose levels over the previous two to three months. A diagnosis of diabetes is confirmed if
the HbA1c level is equal to or exceeds 6.5% (48 mmol/mol) on two separate occasions.

It's important to note that the diagnostic criteria may vary slightly between different countries
and medical organizations. Additionally, if the results from any one of these tests are
indicative of diabetes, it is generally recommended to confirm the diagnosis with a repeat test
on a different day.

If a person is diagnosed with type 2 diabetes, further assessments may be conducted to

evaluate complications and associated risk factors. This may involve additional blood tests,
such as lipid profile, kidney function tests, and assessment of liver function.

It's crucial to consult a healthcare professional for an accurate diagnosis and appropriate
management of diabetes. They can guide you through the screening process, interpret the
results, and develop an individualized treatment plan.

2.6 Complications

Diabetes can cause several complications that can damage different organ systems if it is not
adequately treated. Some such issues include:

Cardiovascular Complications:
Cardiovascular diseases are the leading cause of morbidity and mortality in individuals with
type 2 diabetes. The condition increases the risk of developing atherosclerosis, which can
lead to coronary artery disease, heart attacks, and strokes. The presence of diabetes also
exacerbates other risk factors, such as hypertension and dyslipidaemia. Individuals with type
2 diabetes should closely monitor their blood pressure and cholesterol levels and adopt

20
lifestyle modifications, including a heart-healthy diet and regular exercise, to reduce the risk
of cardiovascular complications.

Diabetic Retinopathy:
Diabetic retinopathy is a common complication of type 2 diabetes and the leading cause of
blindness in adults. Prolonged exposure to high blood sugar levels damages the blood vessels
in the retina, leading to vision problems and, in severe cases, vision loss. Regular eye
examinations and early intervention, including laser therapy or surgical interventions, can
help prevent or delay the progression of diabetic retinopathy.

Diabetic Neuropathy:
Diabetic neuropathy refers to nerve damage that occurs due to high blood sugar levels. It
commonly affects the peripheral nerves, causing symptoms such as numbness, tingling, and
pain in the hands and feet. Diabetic neuropathy can also affect autonomic nerves, leading to
complications in the gastrointestinal tract, urinary system, and cardiovascular system. Proper
blood sugar control, along with medications to manage pain and symptoms, is essential in
preventing or slowing the progression of diabetic neuropathy.

Diabetic Nephropathy:
Diabetic nephropathy is a kidney complication associated with type 2 diabetes. Prolonged
exposure to high blood sugar levels damages the blood vessels and filtration units of the
kidneys, leading to impaired kidney function and eventually kidney failure. Individuals with
type 2 diabetes should undergo regular screenings for kidney function, including tests for
albuminuria and estimated glomerular filtration rate (eGFR). Blood pressure control, blood
sugar management, and medications that protect kidney function (such as angiotensin-
converting enzyme inhibitors or angiotensin receptor blockers) are vital in preventing or
delaying the progression of diabetic nephropathy.

Peripheral Arterial Disease:

Peripheral arterial disease (PAD) is a condition characterized by reduced blood flow to the
limbs, particularly the legs. Individuals with type 2 diabetes are at a higher risk of developing
PAD due to a combination of factors, including atherosclerosis and damaged blood vessels.
PAD can lead to pain, ulcers, infections, and, in severe cases, gangrene and amputation.
Lifestyle modifications, such as smoking cessation, regular exercise, and proper foot care,

21
along with medications to manage cholesterol and blood pressure, are important in preventing
or managing PAD in individuals with type 2 diabetes.

Increased Infection Risk:

High blood sugar levels impair the immune system's ability to fight off infections, making
individuals with type 2 diabetes more susceptible to various infections. Common infections
include urinary tract infections, skin infections, and fungal infections. It is essential for
individuals with type 2 diabetes to maintain good hygiene, manage blood sugar levels, and
promptly seek medical attention if any signs of infection arise.
Slow Wound Healing:
Impaired blood circulation, nerve damage, and compromised immune function in individuals
with type 2 diabetes can result in slow wound healing. Even minor cuts or abrasions can take
longer to heal, increasing the risk of infection and complications. Proper wound care,
including keeping the wound clean, applying appropriate dressings, and seeking medical
attention for any non-healing or infected wounds, is crucial for individuals with type 2
diabetes.

Increased Risk of Alzheimer's Disease:

Recent research suggests a link between type 2 diabetes and an increased risk of developing
Alzheimer's disease and other forms of dementia. The exact mechanisms behind this
association are still being studied, but it is believed that the shared risk factors, such as insulin
resistance, inflammation, and vascular damage, contribute to the development of cognitive
decline. Individuals with type 2 diabetes should prioritize lifestyle modifications, including a
healthy diet and regular exercise, to reduce the risk of cognitive impairment.

Complications during Pregnancy:

Pregnant women with type 2 diabetes face specific challenges and increased risks for both
themselves and their babies. Poorly controlled blood sugar levels during pregnancy can lead
to complications such as preeclampsia, preterm birth, macrosomia (large birth weight), and
birth defects. Close monitoring of blood sugar levels, regular prenatal care, and collaboration
between the woman, her healthcare team, and a diabetes specialist are crucial to managing
type 2 diabetes during pregnancy and minimizing the risks to both mother and child.

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2.7 Management

Most of the time, blood tests that measure blood glucose levels are used to make the
diagnosis of diabetes. These tests include glycated haemoglobin (HbA1c), the oral glucose
tolerance test (OGTT), and fasting plasma glucose (FPG). Achieving and maintaining target
blood glucose levels, controlling blood pressure and cholesterol levels, adopting a balanced
diet, getting regular exercise, and, where necessary, using medication such as insulin or oral
antidiabetic medications are all part of managing diabetes. The objectives of ongoing
research are to better comprehend the underlying mechanisms of diabetes, create better
diagnostic tools, and identify novel therapeutic approaches. Researchers are looking into
possible genetic markers, cutting-edge drugs, and improvements in insulin delivery methods.
Additionally, there is a rising focus on personalised medicine, which adjusts therapies based
on individual variances in response to treatment.
we will explore the various aspects of managing type 2 diabetes, including lifestyle
modifications, medication, blood sugar monitoring, and self-care practices.

Lifestyle Modifications:
Lifestyle plays a significant role in managing type 2 diabetes. Healthy eating, regular
physical activity, weight management, and stress reduction are key components of a
comprehensive management plan.

a. Healthy Eating:
Adopting a balanced diet is essential for individuals with type 2 diabetes. Focus on
consuming whole, unprocessed foods that are low in added sugars and saturated fats. Include
a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats in your meals.
Portion control and carbohydrate counting can help regulate blood sugar levels. Consulting
with a registered dietitian or diabetes educator can provide personalized guidance and meal
planning.

b. Regular Physical Activity:

Engaging in regular physical activity helps improve insulin sensitivity, manage weight, and
lower blood sugar levels. Aim for at least 150 minutes of moderate-intensity aerobic exercise,

23
such as brisk walking or cycling, per week. Additionally, include strength training exercises
to build muscle and improve overall fitness. Consult with your healthcare provider before
starting an exercise program to ensure safety and receive personalized recommendations.

c. Weight Management:
Maintaining a healthy weight or working towards weight loss (if overweight) is beneficial in
managing type 2 diabetes. Even modest weight loss can improve insulin sensitivity and
glycemic control. Combining a healthy diet with regular physical activity is key to achieving
and maintaining a healthy weight. Set realistic goals and seek support from healthcare
professionals or support groups for long-term success.

d. Stress Reduction:
Chronic stress can impact blood sugar levels and overall well-being. Finding effective stress
management techniques, such as meditation, deep breathing exercises, yoga, or engaging in
hobbies, is essential. Adequate sleep and social support also contribute to stress reduction and
better diabetes management.

Medication:
In addition to lifestyle modifications, medication may be necessary to manage type 2
diabetes. Several classes of medications are available, and the choice depends on individual
needs and goals. Medications for type 2 diabetes include:
a. Oral Medications:
These medications help lower blood sugar levels by various mechanisms. Examples include
metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors,
sodium-glucose cotransporter-2 (SGLT2) inhibitors, and alpha-glucosidase inhibitors. Oral
medications are usually prescribed when lifestyle modifications alone are not sufficient to
control blood sugar levels.

b. Injectable Medications:
For individuals who require additional blood sugar control, injectable medications may be
prescribed. Glucagon-like peptide-1 (GLP-1) receptor agonists and insulin are commonly
used. GLP-1 receptor agonists stimulate insulin secretion, suppress glucagon release, slow
stomach emptying, and promote satiety. Insulin therapy may be necessary when blood sugar

24
levels are not adequately controlled with oral medications or in specific situations, such as
during pregnancy.

c. Combination Therapy:
Sometimes, a combination of different medications may be prescribed to achieve optimal
blood sugar control. This approach may involve combining oral medications, injectable
medications, or both.

It is essential to follow the prescribed medication regimen, understand their effects and
potential side effects, and communicate any concerns or issues to the healthcare provider.

Blood Sugar Monitoring:

Regular monitoring of blood sugar levels is crucial in managing type 2 diabetes. It provides
valuable information about the effectiveness

of the management plan and helps make necessary adjustments. The frequency and method of
blood sugar monitoring may vary depending on individual needs and treatment plans. Some
common methods include:

a. Self-Monitoring of Blood Glucose (SMBG):

SMBG involves using a glucometer to measure blood sugar levels at home. It helps
individuals understand how their blood sugar levels respond to different foods, physical
activity, medications, and overall management strategies. Monitoring before and after meals,
as well as at specific times recommended by healthcare providers, allows for better
understanding and control of blood sugar levels.

b. Continuous Glucose Monitoring (CGM):

CGM systems provide real-time information about blood sugar levels throughout the day.
They involve wearing a sensor under the skin that continuously measures glucose levels and
transmits data to a receiver or smartphone app. CGM can help identify patterns and trends in
blood sugar levels, providing valuable insights for making adjustments in medication, diet,
and physical activity.

25
Regularly sharing blood sugar records with healthcare providers helps them assess the
effectiveness of the management plan and make necessary adjustments to achieve optimal
blood sugar control.

Self-Care Practices:
Self-care practices are integral to the successful management of type 2 diabetes. They involve
taking responsibility for one's health and making informed choices to promote well-being.
Some important self-care practices include:
a. Medication Adherence:
Consistently taking prescribed medications as directed by healthcare providers is essential for
effective management. Establishing a routine, setting reminders, and having a medication
management system can help ensure adherence.

b. Foot Care:
People with type 2 diabetes are at an increased risk of foot complications. Regularly
inspecting the feet for any cuts, blisters, or changes, wearing comfortable shoes, and
practicing good foot hygiene are crucial. Promptly seeking medical attention for any foot
problems is important to prevent complications.

c. Regular Check-ups:
Routine visits to healthcare providers, including primary care physicians, endocrinologists,
and diabetes educators, are essential. These visits allow for monitoring of blood sugar
control, assessment of complications, adjustment of medications, and receiving guidance on
self-care practices.

d. Diabetes Education:
Attending diabetes education programs or working with diabetes educators can provide
valuable knowledge and skills for managing type 2 diabetes effectively. These programs
cover topics such as nutrition, exercise, medication management, blood sugar monitoring,
and coping strategies.

26
2.8 Origin of Plant Based Diet

The literature review part has demonstrated the understanding and knowledge of the specific
topic with the support of authentic resources. This section will be going to focusing various
factors regarding the impact of a plant-based diet for T2D patients and health benefits with
the support of authentic sources. As medical professionals and the general public understand
more about the role of nutrition in maintaining health and avoiding chronic disease, new
healthy eating fads and diets are developing. There are a variety of modern diets that include
the Palaeolithic Diet, the ketogenic Diet, the gluten-free diet, the slow carb diet, the
macrobiotic diet, and the whole food diet. Eating a flexible, plant-based diet has evolved as a
way to guarantee the body receives the nutrients it needs while avoiding items associated to
health concerns and chronic illness.

Vegetarianism, from which the concept of just consuming plant foods arose, has been around
for a long time. Vedic Indians, who lived between 1500 BCE and 500 BCE, followed a
vegetarian diet because they thought that all living things belonged to the same family. They
were vegetarians. Leonardo da Vinci and his contemporaries, who lived in the 1500s and
1600s, are said to have catch neither cat or poultry. In 1847, one of the oldest and biggest
organisations encouraging vegetarianism was established in the United Kingdom.

Doctor T. Colin Campbell states that after studying the food business and examining
significant studies on dietary patterns and illness, he reached the conclusion that "Eat food"
was the best method to deal with the food problems. The Term "nearly entirely" is used as a
general guideline.

"The Plant-Based Foods Association was founded in 2016 to promote the use of whole,
unprocessed plant foods as a means of improving the well-being and preventing chronic
disease," (Bethesda et al., 2011). Plant-based foods will benefit from the organization's
efforts to remove roadblocks to a level playing field for animal-free ingredients and products.
Because of their efforts, plant-based diets and whole foods are becoming more popular.

27
2.9 Conceptual Framework

Donald Watson and Dorothy Morgan first used the term "vegan" in 1944. George A.
Henderson and his wife Fay, who produced the first vegan recipe book, utilised and promoted
the names 'Allvega' and 'Allvegan' as early as the 1970s. Before long, vegans started to
forego "eggs, honey," as well as "animals' milk; butter, and cheese," but only for a short
length of time. Animal-rights advocates have long referred to this movement as "the idea that
man should exist without exploiting animals" (Appleby P. et al., 2007).

Ancient India is attributed with the introduction of vegetarianism to the subcontinent between
3300 and 1300 BCE, particularly in northern and western ancient India. While his life is
obscure, Pythagorean sage Pythagoras may have promoted an early form of strict
vegetarianism, although his life may have been obscure enough to promote an early form of
strict vegetarianism, although his life may have been obscure enough to promote an early
form of strict vegetarianism, He admonished his followers to abstain from eating beans and
from donning woollen clothing." In spite of his reputation as a saintly man who abhorred
violence, Pythagoras even avoided the company of cooks and hunters "Archytas and Plato's
follower Eudoxus of Cnidus made this statement. " He was an Arab poet and a pioneering
vegetarian. According to Porphyry's De Abstinentia ab Esu Animalium (De Abstinentia for
Animals), animals need justice just as much as people deserve justice ("On Abstinence from
Animal Food"). Dr. William Lambe of London stated in his book A Vindication of Natural
Diet, published in 1813 by Percy Bysshe Shelley, that his "water and vegetable diet" could
treat everything from tuberculosis to acne in 1815. I find it annoying to feed my pets since it's
a necessary part of their lives, according to author Lambc. It's also a waste of time and money
(Nelson et al., 2019).

Plants comprised a significant portion of early human diets. Faiths like Hinduism and
Buddhism have long held vegetarianism as a core tenet. Vegetarianism was first documented
by Orphic mystics in the sixth century BC. The Greek philosopher and mathematician
Pythagoras is credited with popularising ethical vegetarianism. Many influential people
followed the Pythagorean lifestyle, which had an impact on vegetarianism up to the 19th
century. During the Middle Ages, vegetarian eating was almost extinct in Europe. Several
Renaissance and Enlightenment figures were vegetarians. (Nelson et al., 2016) The first
vegetarian association was founded by a group of English vegetarians in 1847. The

28
International Vegetarian Society was founded in 1908 and a vegan organisation was
established in 1944. Sylvester Graham, John Harvey Kellogg, and Maximilian Bircher-
Benner were three notable vegetarians of the early 1900s, At the beginning of the century, a
paradigm change happened. Contrary to conventional beliefs that vegetarianism increases the
risk of modem ailments, research reveals that it does not cause malnutrition. More and more
people throughout the world are embracing vegetarianism as a stylish lifestyle choice. Its
evolution is influenced by ethical, ecological, social, and health considerations.

Vegetarianism's nutritional prospects are bright because of the requirement for long-term
sustainability. As more people realise that animals and the environment are intertwined, they
want to do all they can to ensure that future generations may live in a sustainable world.

Figure 2.1: Conceptual framework

(Source: Self-created)

29
2.10 The importance of a plant-based diet for a healthy diet

T. Colin Campbell invented the term "plant-based diet" in 1980 to characterise the diet study
he was doing at the National Institutes of Health, Campbell claims. He described it as a
"vegetable-based low-fat, high-fibre diet that prioritised health over ethics"(Michelle Stark,
2015).

In an interview with the New York Times in 2011, vegan author Ellen Jaffe Jones explained
the term's origins: "During my time teaching culinary workshops for Physicians Committee
for Responsible Medicine, a national non-profit, the phrase "plant-based diet" became a
euphemism for veganism. The word "vegan" had a negative connotation since some people
believed it implied a strict adherence to vegetarianism only for the sake of protecting animals'
welfare at the expense of human health."

The American Institute for Cancer Research and the World Cancer Research Fund
recommend primarily plant-based diets that are rich in a wide variety of vegetables, fruits,
legumes, and minimally processed starchy foods, according to various sources. Others define
"plant-based diets" as those that "include generous amounts of plant foods and a few animal
products." Plant based and plant-only teens are used by different people. As part of a "plant-
based diet," which is also as "the practise of eating minimally processed plant foods,"
vegetables, grains, pulses. and other plant-based foods nay be regarded the staple. According
to Trautwein and McKay (2020), predominately the plant-based dietary pattern is vegetable
fat, dietary fibres and phytosterol or phytonutrients, and all these are macro and micro
components. Plant-based proteins have important antioxidants, minerals, and vitamins that
benefit human heal compared to animal proteins. As per the viewpoint of Pollakova et al.
(2021), vegan diets are important for the improvement of immunity levels for T2D patients
and helps them to suffer from serious conditions that occur because of irregular insulin
sensitivity.

30
 Figure 2.2: The value of the global plant-based food market from 2020 to 2026 by the
product types

(Source: Nils-Gerrit Wunsch 2022)

As per the above figure, it can be assumed that within 2026 the market of plant-based food
has been valued at 20 billion US dollars. Plant-based protein products have natural
ingredients that are less harmful, contain zero chemical products and are easy to digest. Plat
food habits ensure a lower risk of heart disease, help in better weight management, prevent
high blood pressure, and even prevent cancer.

2.11 The effectiveness of a plant-based diet for individuals of the 20-45 age
group who are suffering from Type 2 diabetes

A sustainable diet is one that uses natural and human resources sparingly, has low impact on
the environment, promotes food and nutrition security and a long and healthy life for the
present and future generations, and is accessible to everyone. Nutritional sufficiency,
environmental sustainability, cultural acceptability and cost all play a role in a sustainable
diet. (A. Casini; F. Sofi, 2017) Efficiency and environmental preservation are two possible

31
indicators of environmental sustainability. To generate a specific quantity of food, efficiency
measures the ratio of inputs to outputs that are necessary. When it comes to food production
and distribution, input energy is more important than the energy that is used by the human
body. As a result, environmental protection gauges the extent to which ecological systems are
safeguarded (Chavarro, Jorge E.).

Vegan and vegetarian diets are found to be better for the environment than those that include
a higher percentage of animal products, according to new research released in 2019.
Individuals who stick to the Palaeolithic and Ketogenic diets consume a lot of animal
products, which results in higher carbon emissions from their meals than those who follow
the standard omnivorous diet.

Switching from animal products like meat and dairy to plant-based alternatives may reduce
the C02 emissions of nine to sixteen years in four nations. Most of the food in plant-based
diets is grown without using as much land or emitting as much C02. An interactive map was
also made available, which showed potential places for further discoveries (Yokoyama,
2015).

According to a Chatham House study endorsed by the UN Environment Program, a shift to a

"predominantly plant-based diet" is necessary to minimise biodiversity loss and human
impact on the environment. 80% of the world's land is used to grow livestock for human
consumption, which has a major impact on the environment. We can help restore ecosystems
and support new species if we stop eating meat and dairy products.

Switching to a plant-based diet from animal agriculture might help return 100 billion metric
tonnes of carbon dioxide (C02) into the atmosphere by the end of the century, according to
researchers at the University of California, Davis. The cultivation of cattle for human
consumption takes up more than a third of the world's arable land (Grosso, G., June 2017).
According to Jardine et al. (2021), plant-based eating patterns and vegan diets improve
insulin sensitivity and improve the clinical outcome for Type 2 diabetes. Similarly, Zaki et
al. (2020), opined that a plant-based diet ensures a lower risk for Type 2 diabetes and
improves kidney function and reduces the mortality rate of patients with chronic kidney
disease. Research says that high-fat diets increase lipid accumulation in skeletal muscle and it
contributes to insulin resistance by reducing mitochondrial activities. Vegan diets have been

32
proven that it can improve glycaemic control. Meanwhile, a plant-based protein diet also
improves the functions of β-cells and plays a vital role in peripheral insulin resistance in Type
2 Diabetes patients. A low-fat vegan diet reduces hepatocellular lipid concentration by
approximately 34.3% as well as intramyocellular lipid concentration by almost 10.4%
(Jardine et al. 2021). However, these changes in intramyocellular and hepatocellular lid
concentration are correlated with changes in insulin resistance. Thus, plant-based protein
specifically a vegan diet is an effective treatment for Type 2 diabetes patients because of
insulin resistance and maintaining weight. As per the viewpoint of Banaszak et al. (2022),
non-pharmacological treatment for insulin resistance and effective intervention of plant-based
diets shows positive effects through the effects of vegetarian and vegan diets.

2.12 Benefits of a plant-based diet

A plant-based diet is generally considered to improve one's health, lower one's chance of
acquiring chronic illnesses like diabetes and heart disease, and also to help conserve the
environment. Unrefined and unprocessed plant-based meals may be a catalyst for other
healthy behaviours, such as cutting down on unhealthy food consumption and increasing
physical activity, in individuals (Orvosi Hetilap 2016). A plant-based diet can lower blood
pressure, keeps the heart healthy, helps to lose weight, improve kidney functions, reduce the
risk of cancer, and improve the cholesterol level, and minimizes the risk of stroke. Plant-
based diet or vegan diet advance in nutrition contains monosaturated fats and polyunsaturated
fats always beneficial for type 2 diabetes patients from the age group of 20 to 45 as these
items are easy to digest. Eating a more plant-based diet means taking more fibre
phytochemicals, vitamins, and minerals. According to Meyer (2023), plant-based diets and
vegan diets both can easily improve health and prevent chronic disease while there are
balanced nutritionally and planned appropriately.

33
 Figure 2.3: Managerial pathway that shows antidiabetic actions of different metallic
nanoparticles

(Source: Bhardwaj et al. 2020)

As per the above figure, it can be stated that the nanoparticles from plant resources have the
regulatory potential in controlling diseases like diabetes, Type 2 diabetes. According to
Johannesen et al. (2020), The antidiabetic actions of metallic nanoparticles have been an area
of research interest due to their potential therapeutic applications in diabetes management.
While the specific mechanisms of action may vary depending on the type of metallic
nanoparticle the effect of a plant-based diet on the outcomes related to glucose metabolism
and control of glycaemic levels is remarkable specifically for T2D patients. Conduct a
comprehensive literature review to identify metallic nanoparticles with potential antidiabetic
properties.

Evaluate the characteristics and properties of the metallic nanoparticles, such as size, shape,
surface charge, and biocompatibility. Design and perform in vitro experiments using relevant
cell lines or tissue samples. Assess the cytotoxicity and cellular uptake of metallic

34
nanoparticles. Investigate the effects of metallic nanoparticles on insulin secretion, glucose
uptake, and glucose metabolism in cells.

2.13 Main Plant Protein and its Effect on the Prevention of Type 2 Disease

Those who consume a vegan diet may strengthen their immune system. Plants are the only
source of critical nutrients that cannot be obtained from any other source. Plants include
several nutrients that may help keep your cells healthy and your body functioning properly.
Andrea Murray, an MD Anderson health education expert, explains that "plants give your
body with the resources it needs to fight illness" A plant-based diet has been shown to boost
the immune system, making it easier to fight off viruses and bacteria. The functioning of your
Immune system is vital to reducing your cancer risk. Eating more plant-based foods may help
lower inflammation. Many nutrients found in plants can reduce inflammation in the body.
Processed foods, bacteria, viruses, and other environmental contaminants all include
immune-stimulating phytochemicals and antioxidants. (Nataliya; Bivalacqua, Trinity, I May
2022)

As Murray points out, there are several antioxidants found in plants that may help combat
free radicals. Inflammation may be reduced by following a plant-based diet and paying
attention to your body's signals about how food affects you. Inflammatory diseases, such as
cancer, are connected to persistent inflammation. A plant-based diet may protect you from
some of the disease's causes. A plant-based diet has been shown to assist in weight reduction.
In order to lower your chance of developing cancer, it is critical that you keep your weight in
check. The most important thing you can do to reduce your risk of developing cancer is to
give up smoking. As a result of obesity, this is why. In addition to colorectal and
postmenopausal breast, oesophageal, and pancreatic cancers, obesity increases the risk of
uterine cancer.

Many of the variables that contribute to weight gain may be eliminated by eating solely
veggies.
When you include physical exercise into your weight-loss strategy, you'll see better results.
There are many fibre-rich plants in the world. All unprocessed plant foods include fibre.

35
Increasing your intake of this plant's structural component has several benefits. Plant-based
diets are better for absorbing immune-boosting and inflammation-reducing elements. Foods
high in fibre have anti-inflammatory, cholesterol-lowering, and blood sugar-regulating
properties. It is possible to minimise the risk of cancer by consuming a diet high in fibre. You
may find out more by reading Luke ONeil's blog article from July 23rd, 2019. As colorectal
cancer is the third most prevalent malignancy, this is especially true for those at high risk. In
addition, a plant-based diet lowers your chances of acquiring additional health issues. There
arc several health advantages to consuming a diet high in vegetables. Heart disease, stroke,
diabetes, and even certain mental illness may be prevented by eating a plant-based diet.
According to Martín-Peláez et al. (2020), unsaturated fats such as olive oil, avocado oil and
nuts are vegan foods and healthier for diabetes patients. Moreover, plant sources of omega-3
fatty acids such as chia seeds, and flaxseeds are fully nutritious and beneficial for the
treatment of diabetes and other diseases (Pivari et al. 2019). Veganism simply refers to
reducing animal products because of animal welfare and the planet which positively impacted
diabetes. For instance, 50 grams of beans, 25 grams of soya beans and 50 grams of lentils
intake a day helps to fulfil the demand for protein of any adult individual. Moreover, it can be
included that always look for low glycaemic index options while picking vegan foods which
are also high in fibre as GI helps to measure how quickly the carbohydrate has been absorbed
(Lifestylemedicine.org, 2023). The mechanism by which a plant-based diet act in order to
address T2D includes reducing lipid mass within hepatic and pancreatic cells. All these
benefits lead to the protection of the beta cell functions, decrease in inflammation, avoidance
of IR and improvement of insulin sensitivity.

Long-term manageability of the plant-based diet typically depends on behavioural factors and
a positive attitude with a positive mindset. The behavioural approach and long-term practice
make patients habituated to the plant-based diet and they forget the taste aspects of the
animal-based protein diet. According to Udayakumar et al. (2022), pant-baked foods and
beverages are easy to digest and preferable by health-conscious individuals as all these
constant low cholesterol levels and good fats. According to Laouali et al. (2021), plant-based
diets for Type2 diabetes reduce the risk factor of hypertension specifically for women
patients The immunity power of women patients is generally low and hypertension can be
reduced through plant-based diets and all these diets can improve sleep along with the quality
of food digestion process.

36
2.14 Different types of Plant-based diets in order to promote well-being

In nutrition, there are two approaches for identifying "special" diets. Diets tailored to address
specific health issues, such as dietary intolerances or allergies, are one option. We will not go
into detail regarding these diets in this research. A person's food habits account for the second
variation (a plant-based vegetarian diet and its specific forms) (Oliver 2017).
As part of a plant-based diet, you may eat a wide variety of plant-based foods. Dairy and
eggs, as well as meat and fish, may be included in vegetarian diets as a source of essential
nutrients. Vegans like to consume foods that have not been exposed to much industrialisation
and haven't undergone considerable processing. Since this is the case, phytonutrients are
better able to stay in the plants' cells (health-promoting compounds from plants). The
common vegetarian is of various kinds and it has beneficial aspects for health and disease
prevention. Adoption of whole-foods or plant-based diet is not only good for human well-
being but beneficial for the planet too. Numerous research study says that large
environmental benefits can be seen from a diet containing the minimum number of animal-
based foods such as vegetarian diets, vegan diets or pescatarian diets. The whole foods of a
plant-based diet include fruits, starchy vegetables, vegetables, whole grains, healthy fats,
legumes, seeds, nuts, unsweetened plant-based milk, herbs, spices, and seasonings. For
instance, fruits that are more beneficial for any type of disease treatment are citrus fruits,
bananas, pineapples, apples, berries, and any seasonal fruits.

Starchy vegetables such as sweet potatoes, potatoes, butternut squash and many others. While
gains such as brown rice, barley, rolled oats and so on Healthy fats such as olive oil, avocado
oil, unsweetened coconut oil and many others. Plant-based milk, specifically cashew milk,
coconut milk and almond are healthier for human health. Moreover, seeds and nuts like
almonds, cashew, pumpkin seeds, sunflower seeds, flax seeds, chia seeds, peanuts,
macadamia nuts and many others improve our immunity levels as much as possible.
According to Baden et al. (2019), the initial plant-based diet index score provides key
information regarding the benefits of plant-based foods diet rather than an animal-based food
diet.

37
 Figure 2.4: Types of common vegetarian diet

(Source: WHO, 2020)

As per the above figure, vegan, lacto vegetarian diets are included in the plant-based diet
which excludes any type of animal-based diet that offers protection against non-
communicable diseases.

As per the above figure, a rich animal protein diet leads to proteolytic bacteria that ferment
the dietary protein as well as generate uraemic toxins such as indole-3 acid, indoxyl sulphate,
trimethylamine N-oxide, and p-cresol sulphate. All these toxins change the colonic
environment and resulted in the disturbance in intestinal barriers and microbial dysbiosis. On
the other hand, the consumption of fibre promotes the growth of saccharolytic bacteria ad it
competes with proteolytic bacteria and as a result mitigates the harmful effects of the intake
of animal protein. Moreover, short-chain fatty acids easily can translocate into blood vessels
and are associated with improving insulin sensitivity and a more alkaline environment.

38
 Figure 2.5: The impact of plant-based intake on acid-based homeostasis in individuals
with low glomerular

(Source: Carrero et al. 2020)

As per the above figure, the plant-based diet has high proportion of basic amino acids and
fibre helps to improve insulin sensitivity, decrease bone reabsorption, reduce sarcopenia, and
preserve GFR. All these are essential for improving immunity power and fighting against
types of diseases. Specifically, the T2D patient suffering from kidney failure, lack of insulin-
sensitive digestion problems, weight gain and others. This plant-based diet helps them to

39
maintain their weight, fight august kidney function failure and improve insulin sensitivity.
Pant phosphorus and plant potassium helps in improving circadian phosphatase control and
lower the urinary phosphate excretion and the FGF-23 serum level and maintain acid-base
balance in the human body.

Nutrients Main plant source

Phytochemicals and antioxidants

N-acetyl Soy
cysteine

Flavonoids Apples, onions, citrus fruits, grapes, berries and others

Carotenoids Grape leaves, sweet potatoes, peppers, carrots, pumpkin, tomatoes and
others

Vitamins

Vitamin C Chives, guavas, orange juice, peppers, cherries,

Vitamin K Brussels sprouts, broccoli, Spinach raw, kale

B12 Spinach, mushrooms, kiwi fruit, pickled cucumber, sauerkraut, seaweed,

Bread, muesli and in many others

Folate Arrowroot, edamame, spinach, radishes, peppers and others

Minerals

Iron Beans, spinach, tomatoes, raisins, cashews, oatmeal, mushrooms,

peppers,

Magnesium Parsley, tomatoes, peppers, radishes, leeks

Zinc Whole-grain bread, oats, brown rice, nuts, seeds, legumes, fortified
cereals, tofu, soy and others

Table 1: The effect of protein beneficial through plant micronutrients

(Source Self-created)

40
As per the above table, the protein efficiency, vitamin, and mineral that can be intake through
the plant-based diet would be beneficial for T2D patients. Moreover, plant-based diet easy to
digest and the proper selection of food may contain all the essential elements that are required
for improving the health of the patients from the age group of 20-45.

According to Fehér et al. (2020), the enjoyment of eating meat as well as the immense
difficulties in giving up this habit have become the biggest berries for the patients of T2D and
others. Moreover, the preparation of the plant-based diet is too much complicated, excessive
commitments to eat meat, the risk regarding the intake of low protein food and many others.
A protein-based diet many times leads to an eating disorder and the preservative effect of the
family habits also makes it risky for the patients to avoid animal protein. Meanwhile, the
convenience and taste factors, difficulties in obtaining plant-based diet information, negative
discrimination, social constraints, and negative effect on mental health aces difficult to switch
to plant-based diets from animal-based protein diets. More specifically, financial constraints
are also another part of this factor as plant-baked protein products are the most cost and not
easily available. Plant-based nutrition helps patients to stay healthy and improve their
digestive system though people cannot sacrifice animal-based food products. Healthy eating
and light eating habits are a considerable way to help any disease though at a certain age,
people cannot sacrifice their favourite food item and forget about the care of their health.
According to Cheah et al. (2020),

Social Norms Perceived Benefits Environmental Concerns Perceived Barrier

Attitude Reducing Meat Consumption

Intension to Reduce Meat Consumption

Table 2: The Key Barriers and attitude toward avoiding animal-based diet

41
As per the above table, it can be stated that the attitude toward reducing meat consumption is
responsible negative due to some social norms, environmental concern, and many others.
Moreover, at present time, the use of preservatives in agricultural farms makes the plat-based
products lo harmful to human life. Thus, many people do not want to invest in their less
preferable food items which also may include harmful chemicals and preservatives. The
population rate makes it difficult to naturally grow fruit vegetables and other food items, thus
by the agriculture research many preservatives and chemicals have been used to increase the
production level. All these chemicals are harmful to the human body too and people do not
pay attention to adopting plant-based diets for their health purposes.

The plant-based diet helps in reducing the cholesterol level as much as possible. According to
Petroni et al. (2021), intensive lifestyle interventions and plant-based nutrition supplements
are required to improve metabolic control. The whole-body insulin resistance basically
reflects the muscle insulin resistance and reducing glucose along with amino acids needs to
be considered in the treatment of T2D. Weight is the key factor for Type 2 Diabetes patients
as it improves the digestive system, improves kidney function, and reduces the chances of a
heart attack. As a whale, maintaining weight is essential for overall health improvement and
middle-aged people need to focus on maintaining weight through a popper diet regular
exercise with a plant-based diet increases immunity power and noticeable changes in human
life. Apart from that, “monounsaturated fatty acids” (MUFAs) of vegetable origin whole
grain food items help to reduce the risk factors related to kidney failure, heart attack, and
obesity-related many difficulties.

2.15 Comparison of Selected Diets

PLANT EGG DAIRY POULTRY SEAFOODS OTHER

ANIMALS
VEGETARIAN Yes No No No No No
LACTOVEGETARIAN Yes No Yes No No No

LACTO-OVO Yes Yes Yes No No No

WGETARIAN
NON- VEGETARIAN Yes Yes Yes Yes Yes Yes

42
2.16 Vegetarian Etymology

Until around 1839, a "vegetarian diet" or "vegetable regimen" was referred to as a "vegetable
diet." Vegetables and "Arian" suffixes are what give it its name (in the sense of "supporter,
believer" as in humanitarian). Slavery was used in a written form for the first time ever when
it used by Fanny Kemble in her journal of her time living on a Georgian plantation in 1838-
1839.

2.17 Environmental and Diet

Animal agriculture, particularly industrial farming, is intrinsically unsustainable, according to

environmental vegetarians. This is the basis for their environmental vegetarianism. According
to a United Nations initiative from 2006, the cattle industry is one of the world's major
pollutants, contributing to air and water pollution, land degradation, climate change, and
biodiversity loss. This study's findings reveal that the cattle sector is one of the two or three
most major local and global sources of environmental problems. W. J. Craig, Jr., and A. R.
Mangels, when animals are slaughtered, they produce a significant amount of glasshouse
gases. Global glasshouse gas emissions from cattle (including enteric fermentation and
manure) account for 18 percent of global glasshouse gas emissions, assessed in carbon
dioxide equivalents, from 2006 research by the World Resources Institute (WRI). The IPCC
Second Assessment Report 100-year global warming potentials, approved by the UNFCCC
Conference of Parties, was used to quantify these GHG emissions in carbon dioxide
equivalents. In vitro meat (lab-created meat) may be healthier for the environment than
utilising conventional cattle, according to Singh and ptithi Pal (2006; Singh and Pal, 2006).
Vegetarians' reactions are not usually uniform. (Olsson, Anna,July 8, 2008) (Olsson) (Olsson)
Some livestock production is definitely good for the ecology, according to the Food Climate
Research Network at Surrey University. Only a few grazing animals may be seen here.

Ghent, Belgium, became "the first city in the world to become vegetarian at least once a
week" because of a "weekly meatless day" in May 2009. To honour the report, civil officials
would have one vegetarian meal a week. Government ads and "veggie city maps," produced
to showcase vegetarian establishments, urged people to participate in vegetarian days.

43
Students in Ghent public schools will take part in a weekly veggie day beginning in the
autumn of 2009. ("vegetarian day").

2.18 Ethical and Environment Benefits

Increasing the efficiency of resource extraction by following a plant-based diet may help to
lessen environmental effects of food production. Conserving the environment has become a
top priority for scientists due to the importance of reducing glasshouse gas emissions and
pollution. Industrial farm practises have been proved to inflict an unfair load on the
environment via the production and consumption of meat. In terms of environmental impact
metrics, plant-based diets surpassed Mediterranean diets in every category (meat-based
products and fish). There is three Brocks: Brock Bastian, Galina Bastian, and Brock Bastian.
For the purpose of assessing the environmental impact of vegetarian and vegan diets,
Denmark used life-cycle assessments (LCAs). It was not as excellent as the two plant-based
diets results (vegan and vegan). The two vegan diets did not very much, though. Individual
animals and whole species must be protected in order to secure the long-term existence of all
living things. To others, factory farm conditions that torture and eventually kill animals are
morally repugnant (the ahimsa principle). The attitudes of meat eaters, flexitarians, and
vegetarians on animal welfare were contrasted to their views on human welfare, as well as
their willingness to give, which were all investigated. In order to better understand how
individual give, we looked at their motivation to donate to organisations that seek to protect
animals and humans. Vegetarians were shown to be more inclined than non-vegetarians to
donate to animal Protection organisations. Janssen et al. suggest that vegetarians may be
prepared to tolerate the Processing of animal-derived items if animal welfare is considered.

2.19 Is The Vegan Gut Profile Unique

People who consume a diet rich in meat (the "mixed Western diet") have had their gut flora
completed to individuals who eat a diet low in meat since the 1970s. Reddy et al. did this
(1975). The anaerobic microflora Of meat eaters was shown to be more diverse in
Bacteroides, Bifidobacterium, Pepto-coccus and Lactobacillus than that of vegetarians and
vegans. As a distinct sort of vegetarian, vegan diets in the 1980s. While some research has
used subjects who have been vegan or vegetarian their entire lives, most studies have on
subjects who have been on a short-term Western, vegetarian, or vegan diet experiment to see
how their gut microbiota and microbial metabolism products were affected. Using a vegan

44
experimental diet as a medical intervention for a broad variety of illnesses was a first in this
study. This raises the prospect of using vegan or other therapeutic diets in medicine. Study
participants were divided into three groups: those who went vegan for 20 days. those who
went vegetarian for 20 days, and those who went lacto-ovo-vegetarian or mixed. Researchers
observed that the faeces of vegans had less Lactobacilli and Enterococci than those of non-
vegans. Vegan and vegetarian diets had significantly different results, indicating that the
previous research's wide distinction between meat and non-meat diets was insufficient and
that a focus only on vegan diets is necessary. (Reddy and co-workers, 1975) As an
experimental dietary regimen, veganism has recently gained more interest in the scientific
community. Gut flora profiles of vegans, vegetarians and omnivores have been examined in
new research. There was a link found between the kind of food ingested and the bacterial
community composition in the faeces of 20 vegans, I I lacto-vegetarians, and 29
nonvegetarians. The microbiota was quantified using PCR-based DNA profiling methods. In
both vegetarian and vegan patients, the Bacteroides-Privately group was more common than
in omnivores. However, this conclusion differs from that of the omnivores in that the ratio of
Clostridium cluster XIVa was lowered in both vegan and vegetarian individuals. The research
found that vegans were distinct from other vegetarians in two ways: Clostridia bacteria have
anti-inflammatory effects, A bacteria that produces butyrate and is known to protect
colonocytes, Faecal bacterium parasitize, was more common in vegans than in non-vegans.
C, Clostridium form was more common among vegans in the C. coccids subgroup.

They are surprising since they contradict earlier findings, despite the fact that direct
comparisons Impossible owing to the variety of approaches utilised. Neither vegan nor
vegetarian diets affected Bifidobacterial or Bacteroides bacterium levels, however the
Bacteroidetes-Prevotella bacterium ratio was greater in vegetarians. In the work of Van
Fasten and colleagues in 1987 veganism and vegetarianism seem to alter our microbiome
considerably, but these studies are the first to show that vegan and vegetarian microbiotas
may be separate. If the difference between veganism and vegetarianism is real, or if long-
term vegans can be compared to test participants who have only been vegan for a short
period, then large-scale research is necessary.

45
2.20 Advantages of Plants Based Diet

There are various benefits to a plant-based diet, and it's critical to recognise them and ensure
that they fulfil your personal and health demands. Animal-free diets can help with the
following:

• Vitamins, minerals, fibre, and antioxidants in abundance

• Cardiovascular health improvement
• Lower LDL and total cholesterol levels- plant-based diets are cholesterol-free and low
in saturated fats.
• Lower risk of type 2 diabetes and cardiovascular disease (a disadvantage of eating
meat)
• Glycaemic management has improved
• Weight management and BMI reduction (body mass index)
• Better brain function
• Lower risk of certain malignancies and protection from them
• Aids in Alzheimer's and dementia prevention and management

2.21 Benefits of Plant-Based Diet

According to a recent research, vegetarian diets have been linked to a range of health
benefits.
Vegetarian and vegan diets are becoming increasingly popular in the United States as a way
to Improve one's health, according to surveys conducted there. A total of 100 people in the
United States were interviewed by Dyett et al. for this research in order to discover how their
health beliefs affect their daily habits and food. Eating a Healthful Diet Intakes were used to
determine a person's dietary needs. The primary motivation for making a dietary change was
to improve one's health (47 percent). To enhance one's health and well-being is the second
most important reason to consume a plant-based diet. Animal welfare and environmental
stewardship received less consideration. Vcggicism has bccn found to improve health and
animal welfare. One-onone interviews were conducted with a total of 19 vegetarians.
Vegetarians were divided into two groups. Because of the health benefits of vegetarianism
and the avoidance of health concerns as a result, health-conscious vegetarians are drawn to it.
Animal welfare and human morality are the key concerns of ethical Vegetarians. To conduct

46
the "National Food consumption Survey," Hoek and his colleagues interviewed a
representative sample of Dutch citizens aged 18 and above. Vegetarians were shown to be
particularly interested in product information, speciality shops, novelty items, and
environmentally friendly goods.

Rather of recycling on supplements or the risk of nutritional insufficiency, a plant-based diet

helps ensure that the body receives the critical micronutrients it requires from whole plant
meals. The lipids, vitamins, minerals, fibre, and protein included in whole plant diets help to
keep your heart healthy. These nutrients may be found in a wide variety of whole plant foods,
such as nuts, seeds, fruits, vegetables, cereals, and legumes. For cooking, polyunsaturated
vegetable oils like olive and canola oil are used. Polyunsaturated fat is a mainstay of the
NIH's American Dietary Guidelines because of its heart-healthy characteristics. Animal
products including milk, eggs, and meat are the sole sources of vital vitamins and minerals
such vitamin B12, vitamin D3, and haemoglobin. A deficiency in certain nutrients may lead
to health issues among vegetarians and vegans. That's the opinion of Dr. Ambika Satija, a
nutritionist at Harvard's T.H. Chan School of Public Health, who says, "For heart health
protection, your diet must focus on the quality of plant foods." Reducing your use of animal
products without completely eliminating them may improve your diet." Vitamin D may be
received from sun exposure (15 minutes daily in suitable areas) and vitamin B12 can be taken
through supplements.
According to Trautwig and McKay (2020), predominately the plant-based dietary pattern is
vegetable fat, dietary fibres and phytosterol or phytonutrients, and all these are macro and
micro components. Plant-based proteins have important antioxidants, minerals, and vitamins
that benefit human heal compared to animal proteins. Vegan diets are important for the
improvement of immunity levels for T2D patients and helps them to suffer from serious
conditions that occur because of irregular insulin sensitivity. Plant-based eating patterns and
vegan diets improve insulin sensitivity and improve the clinical outcome for Type 2 diabetes.
It is reported that a plant-based diet ensures a lower risk for Type 2 diabetes and improves
kidney function and reduces the mortality rate of patients with chronic kidney disease.
Research says that high-fat diets increase lipid accumulation in skeletal muscle and it
contributes to insulin resistance by reducing mitochondrial activities. Vegan diets have been
proven that it can improve glycaemic control. Meanwhile, a plant-based protein diet also

47
improves the functions of β-cells and plays a vital role in peripheral insulin resistance in
Type 2 Diabetes patients.

2.22 Low Fat Diet

A low-fat vegan diet reduces hepatocellular lipid concentration by approximately 34.3% as

well as intramyocellular lipid concentration by almost 10.4%. However, these changes in
intramyocellular and hepatocellular lid concentration are correlated with changes in insulin
resistance. Thus, plant-based protein specifically a vegan diet is an effective treatment for
Type 2 diabetes patients because of insulin resistance and maintaining weight. Non-
pharmacological treatment for insulin resistance and effective intervention of plant-based
diets shows positive effects through the effects of vegetarian and vegan diets.

2.23 Plant Based Diet reduce the risk of diseases

A plant-based diet can lower blood pressure, keeps the heart healthy, helps to lose weight,
improve kidney functions, reduce the risk of cancer, and improve the cholesterol level, and
minimizes the risk of stroke. Plant-based diet or vegan diet advance in nutrition contains
monosaturated fats and polyunsaturated fats always beneficial for type 2 diabetes patients
from the age group of 20 to 45 as these items are easy to digest. Eating a more plant-based
diet means taking more fibre phytochemicals, vitamins, and minerals. Plant-based diets and
vegan diets both can easily improve health and prevent chronic disease while there are
balanced nutritionally and planned appropriately.
Unsaturated fats such as olive oil, avocado oil and nuts are vegan foods and healthier for
diabetes patients. Moreover, plant sources of omega-3 fatty acids such as chia seeds, and
flaxseeds are fully nutritious and beneficial for the treatment of diabetes and other diseases.
Veganism simply refers to reducing animal products because of animal welfare and the planet
which positively impacted diabetes. For instance, 50 grams of beans, 25 grams of soya beans
and 50 grams of lentils intake a day helps to fulfill the demand for protein of any adult
individual. Moreover, it can be included that always look for low glycaemic index options
while picking vegan foods which are also high in fiber as GI helps to measure how quickly
the carbohydrate has been absorbed. The mechanism by which a plant-based diet act in order
to address T2D includes reducing lipid mass within hepatic and pancreatic cells. All these
benefits lead to the protection of the beta cell functions, decrease in inflammation, avoidance
of IR and improvement of insulin sensitivity.

48
 CHAPTER :03
METHODOLOGY

49
 CHAPTER 03
METHODOLOGY

3.1 Methodology Article

A Methodology has been performed in order the identify relevant articles published in
various databases from 2019 to 2023. The databases that have been used were the
International Journal of Disease Reversal and Prevention, Circulation, Nutrients,
Biomedicine & Pharmacotherapy, Nature Reviews Nephrology, Sustainability, Diabetes,
metabolic syndrome, and Obesity: targets and Therapy, The Journal of Nutrition, Nature
Reviews Endocrinology, Applied Sciences, and many others.

Inclusion criteria Exclusion criteria

The search was reported in English in peer review Non-compliance with the key
journals information related to T2D

Studies published in between 2019 to 2023 Studies older than 2019

Annual reports from WHO, NCBI, BBC, PubMed Other sites

Data numeric representation Non-numeric representation

Diabetes defined as Type 2 Diabetes Other information that is not related

to T2D

Cite with for author affiliation Non-affiliation

Estimation based on the entire county with the T2D studies included patients below
population age group between 20 to 45 the age 20

50
 Studies that show the effectiveness of a plant-based Studies that support animal protein-
diet based diet

Full text available No full text is available

3.2 Collection

It is observed that there is heterogeneity across the literature collected. In this regard, the
study collects a total of 19 journal papers in order to address the review made in
consideration of the “implication of plant-based diet” among individuals with type 2 diabetes.
However, the homogeneous methods applied in the results takes a dig into a critical approach
to methodological approaches based on the relevance of the current study. It is observed that
Long-term manageability of the plant-based diet typically depends on behavioural factors and
a positive attitude with a positive mindset. The behavioural approach and long-term practice
make patients habituated to the plant-based diet and they forget the taste aspects of the
animal-based protein diet. pant-baked foods and beverages are easy to digest and preferable
by health-conscious individuals as all these constant low cholesterol levels and good fats.
Plant-based diets for Type2 diabetes reduce the risk factor of hypertension specifically for
women patients The immunity power of women patients is generally low and hypertension
can be reduced through plant-based diets and all these diets can improve sleep along with the
quality of food digestion process.

Identification Identification of records

through database
searching (removing
duplicates)
(n = 250)

Screened titles (n = 220) Excluded records (n= 20)

Screening
(

Abstracted screening
Excluded records (n=150)
(n=200)

Excluded full text articles

Assessing full text articles
(n= 31)
Eligibility for eligibility (n=50) 51
Conference abstracts = 16
Patients with other disorders
= 15
 Figure 1: PRISMA model

At first, 250 journals from different databases have been selected. After screening 20 have
been excluded. After the screening of the abstract 150 more journals has been excluded
because there was no relevant information regarding type 2 diabetes between the age group of
20 to 45. After that from the remaining 50 articles 31 has been eliminated due to information
regarding other disorders. The following keywords that have been selected for this article are
insulin sensitivity, the importance of a plant-based diet, the importance of behavioural
approaches to adopt a plant-based diet, and many others.
Example: The study based on review including systematic review are given 1-5 rating, 5-8
the study having randomized control trial with minimum involvement of population (like
below 500 people), 5-8 the study having randomized control trial with maximum
involvement of population (like more 500 people.

Numb Title Objectives Methods Variables Findings/ Ratings

er &Author Results
&
Referenc
es

1 Bade et Changes in Nurses’ Plant-Based Diet improving 6

al. 2019 Plant-Based Health Study Quality, Cause- plant-based
Diet Quality With the data Specific Mortality diet quality
and Risk of from US over a 12-
Total and female year period
Cause- registered was
Specific nurses ages 30 associated

52
 Mortality to 55 years with a
lower risk.
results
support
shifts
toward
diets that
emphasize
healthy
plant foods
for
improved
health
outcomes.

2 Banaszak The influence Systematic vegetarian diet, Vegetarian 8

et al. of a vegan literature vegan diet, insulin diets show
2022 diet on insulin review resistance, insulin beneficial
resistance sensitivity effects not
only on
insulin
resistance
but also on
other health
parameters,
including
body
weight,
body fat,
BMI and
lipid profile
parameters.
Meat-free

53
 diets are
suitable for
everyone,
regardless
of age or
health.

3 Bhardwaj ameliorative The secondary Diabetes These 5

et al. green metabolites of mellitus,blood secondary
2020 nanotechnolo source glucose level, metabolites
gical antidiabetic involved in
approaches in potential of the
diabetes different metallic reduction of
management various
metal ions
from their
metallic
precursors
and results
in the
synthesis of
the green
Metallic
Nanoparticl
es (MNPs).

4 Carrero et Plant-based A qualitative The effects of The current 6

al. 2020 diets to content animal proteins kidney
manage the analysis of the and fibre on the nutrition
risks and impact of gut microbiota and recommend
complications plant-based uraemic milieu, ations from
of chronic diet for Dietary the Kidney
kidney disease diabetes and Approaches to Disease
kidney disease Stop Outcomes

54
 patients Hypertension, a Quality
lower prevalence Initiative1
of CKD in patients
with type 2
diabetes mellitus2

5. Cheah et Drivers and A self- Social norms, it is 7

al. 2020 barriers administered environmental important
toward online survey concerns, the to
reducing meat completed attitude toward understand
consumption with 298 reducing meat what
females and consumption influences
male the type
participants and amount
living in of meat
Australia consumed
by meat-
eaters.
Other
emerging
dietary
forms such
as
“flexitariani
sm” and
“pescetaria
nsm” was
examined

6. Fehér et Benefits of questionnaire- benefits and The plant- 9

al. 2020 and the based survey barriers of plant- based
Barriers to the with a sample based diet, theory (vegetarian)
Switch to a of 506 New of planned diet—
Plant-Based Zealand behavior, Negative which

55
 Diet university Effect on Mental cannot be
students Health, regarded as
Convenience and being
Taste Factors uniform—
is an effort
to change
nutrition
habits,
during the
course of
which
foods of
animal
origin and
highly
processed
foods are
avoided and
replaced
with raw,
unprocesse
d or
minimally
processed
foods of
plant
origin.

7. Jardine et Potential A qualitative Weight Observatio 8

al. 2021 Mechanisms content management, nal studies
by Which analysis of the Plant-Based and
Plant-Based impact of Eating Pattern for randomized
Eating plant based Macrovascular and controlled

56
Patterns diet for Microvascular trials
Affect Insulin diabetes and Complications of support the
Resistance kidney disease Diabetes, Diabetic benefits of
and Weight patients retinopathy plant-based
Management nutrition for
diabetes.
The
consumptio
n of whole
grains,
legumes,
fruits, and
vegetables
in
conjunction
with the
elimination
of animal
products
reduces the
risk of
developing
type 2
diabetes. In
individuals
questionnai
re diabetes,
a low-fat,
plant-based
diet
improves
body
weight,

57
 glycemic
control,
plasma
lipid
concentrati
ons, and
blood
pressure,
while
reducing
the risk of
CVD and
microvascu
lar
complicatio
ns.

8. Johannese Effectivenssof Systematic glycemic control, Improveme 5

n et al. Plant-Based Reviews and plant-based diet, nt in
2020 Diets on Meta- vegan, vegetarian, glycemic
Outcomes Analyses glucose control can
Related to metabolism, presumably
Glucose dietary pattern be
Metabolism explained
by a
reduction in
excess body
weight as a
consequenc
e of the
reduced
content of
fat and

58
 energy in a
plant-based
diet
compared
to an
omnivorous
diet.

9. Laouali et plant-based A qualitative Plant-based, diet Healthier 6

al. 2021 diet indices content for type 2 diabetes, plant-based
and type 2 analysis of the hypertension, foods had
diabetes impact of BMI, mediation associations
(T2D) and plant-based analyis with lower
hypertension diet for T2D and
risks, as well diabetes and hypertensio
as the extent kidney disease n risks, and
to which the patients uPDI,
associations comprising
were modified unhealthy
and/or plant-based
mediated by foods, had
BMI. an
association
with higher
hypertensio
n risk.

10. Lourenco Psychological Qualitative Meat Intake This study 7

et al. Barriers to content Behaviour, used CLT
2022 Sustainable analysis sustainable diet, as a
Dietary through cross- psychological framework
Patterns sectional barriers to build
survey consumers’
collected decision-

59
 responses making
from 497 process
individuals toward
plant-based
dietary
adoption.
Specifically
, it focused
on the
relationship
between
predispositi
on and
behaviour
change by
incorporati
ng barriers
to
moderation.
W

11. Magkos Diet and A qualitative Long-term This study 7

et al. exercise in the content maintenance of might lead
2020 prevention analysis of the weight loss, to improved
and treatment impact of intensive lifestyle weight loss
of type 2 plant-based intervention, maintenanc
diabetes diet for physical activity e and
mellitus diabetes and glycaemic
kidney disease control.
patients Future
research
should
focus on

60
 better
understandi
ng the
individual
response to
dietary
treatment
and
translating
these
findings
into clinical
practice.

12. Martín- Mediterranean Systematic a quality diet, Mediterran 8

Peláez et Diet Effects reviews and primary ean diet
al. 2020 on Type 2 meta-analyses prevention, could be
Diabetes Mediterranean involved in
Prevention, processes
Disease related to
Progression, diabetes
and Related homeostasi
Mechanisms. s, many of
them
sharing
common
physio-
pathologica
l pathways.
The
Mediterran
ean diet
adherence

61
 could play
a role on
T2D-
related
mechanism
s, such as
anti-
inflammato
ry
antioxidant
actions,
glucagon-
like peptide
agonist
compounds,
and
changes in
gut
microbiota.

13. Pandey et Application online survey plant-based Overall, 8

al. 2021 of the Theory was conducted yogurt alternative, attitude,
of Planned among 265 theory of planned perceived
Behaviour to consumers behaviour behavioural
Predict control
Intention to (selfefficac
Consume y) and
Plant-Based perceived
Yogurt sensory
Alternatives attributes
were
significant
predictors

62
 for the
intention to
consume
plant-based
yogurt
alternatives
among
plant-based
yogurt
consumers
in
Denmark.

14. Petroni et To analyze A qualitative nutrition T2D is the 7

al. 2021 Nutrition in content supplements; paradigm of
Patients with analysis of the sarcopenia, conditions
Type 2 impact of a Medical Nutrition where
Diabetes plant-based Therapy for Type genetic,
diet for 2 Diabetes, behavioural
diabetes and and
kidney disease individual
patients and factors
Present drive
Knowledge disease
and occurrence
Remaining and severity
Challenges

15. Pivari et Diabetes A qualitative type 2 diabetes The 6

al. 2019 Mellitus and content mellitus, functional
Its analysis of the inflammation, mechanism
Complications impact of antioxidant by which
, plant-based activity, curcumin
Curcuminoids diet for molecular and exerts its

63
 supplementati diabetes cellular effect
on in pre- mechanisms appears to
diabetes and discovered, be the
T2DM Molecular modulation
patients Mechanisms of of many
clinical trials Curcumin in signaling
T2DM molecules.
However,
this
mechanism
is not
completely
clear, due
to the
complexity
of the
disease.

16. Pollakova Impact of Systematic molecular and Clinical 7

et al. Vegan Diet in Reviews and cellular trials with
2021 the Prevention Meta– mechanisms vegan diet
and Treatment Analyses discovered, in pre-
of Type 2 Molecular diabetes
Diabetes Mechanisms of and T2D
Curcumin in people, in
T2DM which the
quantity of
simple and
complex
carbohydrat
es and the
quality of
the

64
 nutrients
taken will
be
evaluated,
should be
conducted.

17. Trautwein Role of A qualitative dietary pattern, The 8

, and Specific content behavioral risk protective
McKay, Components analysis of the factors, The Role effect of
2020 of a Plant- impact of of Saturated, predominat
Based Diet in plant based Monounsaturated, ely plant-
Management diet for and based
of diabete Polyunsaturated dietary
Dyslipidemia Fatty Acids on patterns
and the Blood Lipids and such as the
Impact on CVD Risk MED and
Cardiovascula Nordic diet
r Risk or the
DASH and
Portfolio
diet on
CVD risk
and related
risk factors,
e.g., LDL-
C, is
associated
with
specific
plant-based
foods
which are

65
 known for
their CV
health
benefits

18. Udayaku fostering the A qualitative Maintaining the Noticeable 9

mar et al. quality, content overall quality and improveme
2022 originality analysis of the shelf life of plant- nts in the
and impact of based food and shelf life of
naturalness of plant based beverages plant-based
food. The diet for foods and
application of diabete beverages
probiotic were
microorganis observed
ms to foods due to the
and beverages antimicrobi
provides al effects
various health exerted by
benefits probiotics
and
potential
probiotic
strains
which make
them useful
alternatives
to
artificially
synthesized
chemical
preservativ
es.

19 Zaki et al. Treatment of A qualitative sarcopenia, Improveme 7

66
 2020 type 2 content Medical Nutrition nts in
diabetes analysis of the Therapy for Type weight,
mellitus with impact of a 2 Diabetes, blood
a whole-food, plant-based nutrition pressure,
diet for supplements, and lipid
diabetes and values were
kidney disease noted as
well.

Table 3: Characteristics of the Included Data

(Source: self-created)
According to Trautwig and McKay (2020), predominately the plant-based dietary pattern is
vegetable fat, dietary fibres and phytosterol or phytonutrients, and all these are macro and
micro components. Plant-based proteins have important antioxidants, minerals, and vitamins
that benefit human heal compared to animal proteins. Vegan diets are important for the
improvement of immunity levels for T2D patients and helps them to suffer from serious
conditions that occur because of irregular insulin sensitivity. Plant-based eating patterns and
vegan diets improve insulin sensitivity and improve the clinical outcome for Type 2 diabetes.
It is reported that a plant-based diet ensures a lower risk for Type 2 diabetes and improves
kidney function and reduces the mortality rate of patients with chronic kidney disease.
Research says that high-fat diets increase lipid accumulation in skeletal muscle and it
contributes to insulin resistance by reducing mitochondrial activities. Vegan diets have been
proven that it can improve glycaemic control. Meanwhile, a plant-based protein diet also
improves the functions of β-cells and plays a vital role in peripheral insulin resistance in Type
2 Diabetes patients.

Validity and reliability:

There were 40 questions were prepared to assess the effect of plant based diet and diabetes
type 2 among vegeteranian people. The questionnaire were send for the validity to 2-3
experts of Amity medical school (including professors). After the validity, I have checked the
reliability of the validated 40 questionnaire. The validity checked by cronbach’s alpha. The
cronbach’s alfa values was XXXX. That indicate the questionnaire was reliable.

67
CHAPTER :04
RESULTS

68
 CHAPTER 04

RESULTS

The plant-based diet helps in reducing the cholesterol level as much as possible. Intensive
lifestyle interventions and plant-based nutrition supplements are required to improve
metabolic control. The whole-body insulin resistance basically reflects the muscle insulin
resistance and reducing glucose along with amino acids needs to be considered in the
treatment of T2D. Weight is the key factor for Type 2 Diabetes patients as it improves the
digestive system, improves kidney function, and reduces the chances of a heart attack. As a
whale, maintaining weight is essential for overall health improvement and middle-aged
people need to focus on maintaining weight through a popper diet regular exercise with a
plant-based diet increases immunity power and noticeable changes in human life. Apart from
that, “monounsaturated fatty acids” (MUFAs) of vegetable origin whole grain food items
help to reduce the risk factors related to kidney failure, heart attack, and obesity-related many
difficulties.

The theory of planned behaviour for the adoption of the plant-based diet will be effective to
predict human actions and a variety of processes to govern those actions. Development of the

69
theory of planned behaviour perceived the behavioural control regarding the diet practices of
T2D patients. The theory of planned behaviour on self-care refers to self-care behaviour and
various positive changes in the lifestyle of T2D patients controlling the level of diabetes and
reducing the risk factors. Self-care behaviour helps to adopt good knowledge about the diet
specifically for the younger patients.

70
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84
85
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As per different research studies it can be assumed that, within 2026 the market of plant-
based food has been valued at 20 billion US dollars. Plant-based protein products have
natural ingredients that are less harmful, contain zero chemical products and are easy to
digest. Plat food habits ensure a lower risk of heart disease, help in better weight
management, prevent high blood pressure, and even prevent cancer.

The enjoyment of eating meat as well as the immense difficulties in giving up this
habit have become the biggest berries for the patients of T2D and others. Moreover, the
preparation of the plant-based diet is too much complicated, excessive commitments to eat
meat, the risk regarding the intake of low protein food and many others [6]. A protein-based
diet many times leads to an eating disorder and the preservative effect of the family habits
also makes it risky for the patients to avoid animal protein. Healthy eating and light eating
habits are a considerable way to help any disease though at a certain age, people cannot
sacrifice their favourite food item and forget about the care of their health.

It can be stated that the attitude toward reducing meat consumption is responsible negative
due to some social norms, environmental concern, and many others. Moreover, at present
time, the use of preservatives in agricultural farms makes the plant-based products lo harmful
to human life. Thus, many people do not want to invest in their less preferable food items
which also may include harmful chemicals and preservatives. The population rate makes it

90
difficult to naturally grow fruit vegetables and other food items, thus by the agriculture
research many preservatives and chemicals have been used to increase the production level.
All these chemicals are harmful to the human body too and people do not pay attention to
adopting plant-based diets for their health purposes.

Ques No Question Options

1 Gender 1. Male
2. Female
2 What is your age? 1. 20-25 Years
2. 25-30 Years
3. 30-35 Years
4. 35 – 40 Years
3 Are you following a Vegetarian Diet? 1. Yes
2. No
4 Are you Suffering from diabetes? 1. Yes
2. No
5 which diabetes are you suffering from 1. Type 1 Diabetes
2. Type 2 diabetes
3. Gestational Diabetes
4. Prediabetes
6 How would you rate your overall knowledge of 1. Very High
diabetes? 2. High
3. Average
4. Low
5. No knowledge
7 Are you familiar with the concept of a plant- 1. Yes
based diet? 2. No

8 Do you believe a plant-based diet can be 1. Yes

2. No
beneficial for diabetes management
9 Which of the following benefits do you 1. Improved blood sugar
control
associate with a plant-based diet for diabetes
2. Weight Management
management 3. Reduced Risk of
cardiovascular complications
4. Increased Nutrient intake
10 Have you or someone you know tried a plant- 1. Yes
2. No
based diet for diabetes management
11 If you have tried a plant-based diet for diabetes 1. 1
2. 2
management, please rate its effectiveness:
3. 3
4. 4
5. 5
12 What are your main concerns or barriers when 1. Nutritional Adequacy
2. Practicality and Convenience
considering a plant-based diet for diabetes

91
 management 3. Social and Cultural Factors
4. Taste and Food Preferences
13 What additional information or support would 1. Recipe Ideas and Meal
Plans
you like to see available regarding a plant-
2. Nutritional Guidance and
based diet for diabetes management in our Education
3. Tips for Dining Out and
community
Social Events
4. Support Groups and
Community Engagement
14 How would you rate the availability of plant- 1. Excellent
2. Good
based food options in your local community
3. Fair
4. Poor
15 Are you aware of any local restaurants or food 1. Yes
2. No
establishments that offer plant-based options
suitable for diabetes management
16 Do you believe that healthcare professionals 1. Yes
2. No
provide sufficient information and guidance on
3. Maybe
adopting a plant-based diet for diabetes
management
17 Have you discussed or received 1. Yes
2. No
recommendations from a healthcare
3. Maybe
professional about incorporating a plant-based
diet into your diabetes management plan
18 What types of resources or support would you 1. Educational Materials
2. Cooking Classes and
find most helpful in adopting and maintaining a
Demonstration
plant-based diet for diabetes management? 3. Individual counselling or
coaching
4. Online support communities
19 How likely are you to recommend a plant-based 1. Very Likely
2. Likely
diet to someone with diabetes
3. Neutral
4. Unlikely
20 Are there any specific cultural or dietary 1. Traditional food preferences
2. Religious or cultural
considerations in your community that should
practices
be addressed when promoting a plant-based 3. Availability of ingredients
4. Food preparation techniques
diet for diabetes management
21 Do you believe that government policies and 1. Yes
2. No
initiatives should support and promote the
3. Maybe
adoption of plant-based diets for diabetes
management
22 Have you attended any educational sessions or 1. Yes
2. No

92
 workshops on plant-based diets and diabetes 3. Maybe
management
23 How would you rate the level of awareness and 1. 1
2. 2
promotion of plant-based diets as a diabetes
3. 3
management strategy in your community 4. 4
5. 5
24 Are there any cultural or societal factors in your 1. Traditional food culture
2. Social expectations and
community that make it challenging to adopt a
pressure
plant-based diet for diabetes management 3. Limited awareness and
education
4. Access to plant based option
5. other
25 Do you believe that health insurance plans 1. Yes
2. No
should cover nutritional counselling and support
3. Maybe
for individuals following a plant-based diet for
diabetes management
26 How important is the taste and enjoyment of 1. Very Important
2. Somewhat important
food when considering a plant-based diet for
3. Not important
diabetes management
27 Are you familiar with any plant-based 1. Yes
2. No
substitutes or alternatives for commonly
3. Maybe
consumed animal-based foods
28 What sources of information do you trust when 1. Healthcare professionals
2. Research studies and
seeking guidance on adopting a plant-based
scientific journals
diet for diabetes management 3. Registered dietician
nutritionist
4. Diabetes organizations or
associations
29 Would you be interested in participating in a 1. Yes
2. No
community-based program that promotes plant-
3. Maybe
based diets for diabetes management, such as
cooking classes or support groups
30 Do you believe that adopting a plant-based diet 1. Yes
2. No
can have a positive impact on the overall health
3. Maybe
and well-being of individuals with diabetes
31 Are you currently following a plant-based diet 1. Yes
2. No
for diabetes management

93
32 If you are currently following a plant-based diet 1. Less than 3 months
2. 3-6 months
for diabetes management, how long have you
3. More than 1 year
been on this diet
33 How has a plant-based diet impacted your 1. Positive impact
2. No significant impact
diabetes management
3. Mixed impact
4. Negative impact
34 Are there any concerns or misconceptions 1. Yes
2. No
about plant-based diets that you would like to
address
35 How likely are you to seek professional 1. Very likely
2. Likely
guidance from a registered dietitian or
3. Neutral
nutritionist regarding a plant-based diet for 4. unlikely
diabetes management
36 Are there any specific challenges you face in 1. Yes
2. No
maintaining a plant-based diet for diabetes
3. Maybe
management
37 Have you noticed any changes in your overall 1. Yes
2. No
health or other health parameters since
3. Maybe
adopting a plant-based diet for diabetes
management
38 If you have noticed changes in your overall 1. Improved blood sugar
control
health, please describe the nature of these
2. Weight loss or weight
changes management
3. Increased energy and vitality
4. other
39 Are you interested in participating in research 1. Yes
2. No
studies or clinical trials exploring the benefits of
plant-based diets for diabetes management
40 Do you feel this study has helped you in 1. Yes
2. No
understanding the concept of plant-based diet? 3. Maybe

94
 CHAPTER :05
CONCLUSION
95
 CHAPTER 05

CONCLUSION

In the concluding section, it can be stated that the entire study manifested the impact
of a plant-based diet, the benefits of a plant-based diet and the effectiveness of it on T2D
patients has been illustrated thoroughly. Moreover, the theoretical application of behavioural
approaches to adopting a plant-based diet has been also discussed in this section. Meanwhile,
the convenience and taste factors, difficulties in obtaining plant-based diet information,
negative discrimination, social constraints, and negative effect on mental health makes
difficult to switch to plant-based diets from animal-based protein diets. More specifically,
financial constraints are also another part of this factor as plant-baked protein products are the
most cost and not easily available. Plant-based nutrition helps patients to stay healthy and
improve their digestive system though people cannot sacrifice animal-based food products.
Based on the available information up until September 2021, the plant-based diet has shown
promise and received positive appraisal among vegetarian individuals with type 2 diabetes.
Here is a summary of the key points supporting this conclusion:

96
Improved Glycaemic Control: Plant-based diets, particularly those that emphasize whole,
unprocessed foods such as fruits, vegetables, whole grains, legumes, and nuts, have been
associated with improved glycaemic control among individuals with type 2 diabetes. These
diets are typically low in added sugars, refined carbohydrates, and saturated fats, which can
help stabilize blood sugar levels and reduce insulin resistance.

Weight Management: Plant-based diets are often effective for weight management, as they
tend to be lower in calorie density and higher in fiber compared to omnivorous diets. By
promoting satiety and reducing calorie intake, a plant-based diet can assist individuals with
type 2 diabetes in achieving and maintaining a healthy body weight, which is crucial for
diabetes management.

Cardiovascular Health Benefits: Plant-based diets have been linked to various

cardiovascular health benefits, including reduced risk factors such as high blood pressure,
high cholesterol levels, and inflammation. These benefits are particularly relevant to
individuals with type 2 diabetes, who are at a higher risk of developing cardiovascular
complications.

Nutrient Density: A well-planned plant-based diet can provide all the necessary nutrients,
including protein, vitamins, minerals, and essential fatty acids. While careful attention must
be paid to meeting nutrient requirements, a varied plant-based diet can be nutritionally
adequate for individuals with type 2 diabetes.

Sustainability and Environmental Impact: Plant-based diets have also gained popularity
due to their positive environmental impact. The production of plant-based foods generally
requires fewer natural resources and produces fewer greenhouse gas emissions compared to
animal-based food production. This aspect aligns with the ethical and environmental concerns
often associated with vegetarian individuals.

It is important to note that individual needs may vary, and the effectiveness of a plant-based
diet for managing type 2 diabetes can depend on factors such as overall dietary quality,
individual adherence, and personal preferences. It is recommended that individuals with type
2 diabetes consult with a healthcare professional or registered dietitian before making any
significant dietary changes to ensure personalized and appropriate recommendations.

97
Multiple studies have suggested that adopting a plant-based diet may have various health
benefits for people with type 2 diabetes, including improved blood glucose control, reduced
cardiovascular risk, and potential weight loss. Some studies have also found that a plant-
based diet may be more effective than a conventional diabetes diet.

Moreover, several research studies have shown that vegetarian and vegan diets can help
improve glycaemic control and reduce the risk of diabetes complications. Therefore, the
plant-based diet may be an excellent option for people with type 2 diabetes who wish to
manage their condition through dietary interventions. However, it is essential to consider that
any diet change must be tailored to an individual's preferences, medical history, and lifestyle.
Consulting a healthcare professional or a registered dietitian is always recommended before
making significant dietary changes.

In conclusion, the plant-based diet has shown promising results in managing type 2 diabetes
among vegetarian individuals. Still, further research is needed to determine its long-term
effects and efficacy.

98
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