Metabolic Syndrome & Plant-Based Diets

Metabolic Syndrome & Plant-Based Diets
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Plant-based diets appear to protect against metabolic syndrome, also known as syndrome X, which is characterized by the so-called “deadly quartet”—abdominal obesity, high fasting sugars, high triglycerides, and high blood pressure.


Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Metabolic syndrome, also known as syndrome X, is a medical disorder characterized by the so-called “deadly quartet”—abdominal obesity, high fasting sugars, high triglycerides, and high blood pressure. And, it sets people up for nonalcoholic fatty liver disease, stroke, diabetes, cancer, and heart disease. It’s been estimated to afflict about a quarter of the American population.

How do we stop it? How do we prevent it? Well, if it’s all about obesity, the level of fat in our blood, and high blood pressure, then that seems like a job for plant-based nutrition. We didn’t know for sure, though, until recently.

Even after adjusting for lifestyle factors, such as smoking and exercise, risk was highest in those eating non-vegetarian; intermediate risk for those eating semi-vegetarian; and lowest in those eating vegetarian—cutting the odds of having metabolic syndrome by more than half.

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Images thanks to James Heilman, MD via Wikimedia Commons.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Metabolic syndrome, also known as syndrome X, is a medical disorder characterized by the so-called “deadly quartet”—abdominal obesity, high fasting sugars, high triglycerides, and high blood pressure. And, it sets people up for nonalcoholic fatty liver disease, stroke, diabetes, cancer, and heart disease. It’s been estimated to afflict about a quarter of the American population.

How do we stop it? How do we prevent it? Well, if it’s all about obesity, the level of fat in our blood, and high blood pressure, then that seems like a job for plant-based nutrition. We didn’t know for sure, though, until recently.

Even after adjusting for lifestyle factors, such as smoking and exercise, risk was highest in those eating non-vegetarian; intermediate risk for those eating semi-vegetarian; and lowest in those eating vegetarian—cutting the odds of having metabolic syndrome by more than half.

Please consider volunteering to help out on the site.


Images thanks to James Heilman, MD via Wikimedia Commons.

Doctor's Note

We see this same stepwise progression towards lower disease risk the more plant-based one’s diet gets, with high blood pressure and diabetes (see Uprooting the Leading Causes of Death); cataracts (see Preventing Cataracts with Diet); and obesity (see Thousands of Vegans Studied). So, it’s not all or nothing. Just adding more healthy plant foods to crowd out some of the animal and junk foods in the diet can offer significant protection. It does appear, though, that to maximize one’s benefits, one has to move towards maximizing the proportion of plants in the diet.

For more context, please check out my associated blog posts:  Plant-Based Diets for Metabolic SyndromePlant-Based Diets for Fibromyalgia; and The Science of Açaí Berries.

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36 responses to “Metabolic Syndrome & Plant-Based Diets

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  1. Hi Michael – hope you are well.

    I wondered – since I have Prostate Cancer, am I best avoiding the Erythritol?

    Have a great Xmas!

  2. All vegetables are not equal.

    Livers of rats on a high fructose diet look much like the livers of alcoholics suggesting that fructose (fruit sugar) can overwhelm the normal metabolic machinery of this organ. It has been suggested that it is the lack of control (by insulin) of the movement of fructose into the liver cells that is a major factor in the development of the medical condition called Metabolic Syndrome. For an athlete, using fructose to supply energy during exercise (which will avoid its accumulation in the liver) is a positive, but the use of fructose as an alternative sugar in everyday living (it is fructose corn syrup that sweetens colas, for example) appears to have some health risks.

      1. Well stated.
        I feel that, simply stated, the absence of fiber is a general indicator of a worse food compared to another, because it represents processing. People are willing to point to fruit, but overlook the”similar blood raising effect of animal proteins because it seems cheaper, is more satisfying and fits into the norm of society.

      2. Of course it isn’t. But then you have people who drink Big Gulps all day suddenly trying to be healthy. So they eat several pounds of sweet fruit instead. That’s not gonna be good for them, is it? Ergo: understanding the effects of sugar is essential, regardless of source. So it’s not helpful to state what the average problem is in terms of actual food items.

        1. The body processes the fructose in fruit in a healthy manner when eaten with the whole fruit. It is well known that drinking fruit juice from the fruit, it not as healthy as eating the fruit itself. That is why smoothies are far better than juiced fruit, all the fibers and phytonutrients that are tied to the pulp are lost if not accompanied with the juice.

    1. Sweetie, the healthy fructose found in whole fruit or fruit juice is NOT the same as high fructose corn syrup or HFCS, it is not made by simply juicing ‘corn’, lol, it is not even a ‘natural’ fructose, natural fructose comes from fruit.

      High fructose corn syrup is man-made from corn starch, using a few enzymes in the large factory test-tube they create an ‘unnatural’ fructose that is cheaper than real sugar.
      Taken from Diabetes Health: “…
      To make corn syrup:

      Step #1 -you mix the corn starch with water and then add an enzyme, produced by a bacterium, that breaks the starch down into shorter chains of glucose.

      Step #2 – Then you add another enzyme, produced by a
      fungus, that breaks the short chains down into glucose molecules. At
      that point, you have regular corn syrup.
      Step #3 – To make the corn syrup into high fructose corn syrup, you turn some
      of its glucose molecules into fructose molecules by exposing the syrup
      to yet another enzyme, again produced by bacteria. This enzyme converts
      the glucose to a mixture of about 42 percent fructose and 53 percent
      glucose, with some other sugars as well. This syrup, called HFCS 42, is
      about as sweet as natural sugar (sucrose) and is used in foods and
      bakery items. HFCS 55, which contains approximately 55 percent fructose
      and 42 percent glucose, is sweeter than sucrose and is used mostly in
      soft drinks.”

      It is not comparable to the sugar from fruit, in fact it is quite unhealthy to the human body, stick with fruit baby

  3. One thing good about plant based diets is that they are low glycemic, anti-inflammatory and high in antioxidants. On a typical western diet,
    weight gain and accumulation of fat results in obesity and obese individuals
    tend to have low grade chronic inflammation. A diet high in saturated fat increases inflammation in the body whereas consumption of monounsaturated and omega-3 fatty acids improves the inflammatory profile in obese individuals.
    For obese and diabetic individuals, Barry Sears, PhD proposes an anti-inflammatory diet consisting of 150 grams of low glycemic carbohydrates daily achieved through a Mediterranean Diet, 100 grams protein daily from low fat chicken, fish or vegetarian diet(soybeans), and 50 grams of fats from monounsaturated and omega-3 sources. This diet provides 1450 calories daily which may be difficult for most to achieve without getting hungry therefore the higher protein content in the diet is necessary to stimulate the release of the satiety hormone from the gut.
    It’s important to choose foods according to the glycemic index even on a vegetarian diet as even fruits and vegetables can increase glycemic load which in turn increases production of inflammatory

    1.Ros ´arioMonteiro and Isabel Azevedo, Chronic Inflammation in Obesity and the Metabolic Syndrome, Mediators of Inflammation 2010
    2. Barry Sears, PhD, Anti-Inflammatory Diets for Obesity and Diabetes, J Am Coll Nutr August 2009 vol. 28 no. 4 Supplement 1 482S-491S
    3. Christian K. Roberts, Ph.D.,1,2,3 and Simin Liu, M.D., Sc.D, Effects of Glycemic Load on Metabolic Health and Type 2 Diabetes Mellitus, Journal of Diabetes Science and Technology Volume 3, Issue 4, July 2009

  4. The elephant in the room is that 100 million people in the US already have diabetes or pre-diabetes and are already insulin resistant which means that a high carb, plant based diet will spike their blood sugar and exacerbate their conditions.

    Dr. Christopher Gardner (a committed vegetarian) conducted the Stanford A to Z diet comparison study and found that the best diet for insulin resistant people was an Atkins type, low carb, higher protein diet and that people who were insulin resistant could not stick with the Ornish vegetarian diet.

    I don’t doubt that a vegetarian diet will reduce the chances of developing insulin resistance but how about not advocating a high carb plant based diet that will harm the people who are already insulin resistant?

    1,500+ videos on this site and while I have not seen them all, it does seem this is and issue that should be addressed.

    PS: A vegan diet that eliminates all grains and legumes might work for someone who is insulin resistant but it is almost impossible to stick with it given the extremely limited options that are left.

    1. Patients with prediabetes and diabetes respond best to a low fat whole food plant based diet. The issue is to make sure the carbs are complex and not simple and to avoid fructose. Fructose although low glycemic is metabolized by the liver to fats among other metabolites which makes diabetes worse.. it is the fat in the diet that causes the insulin resistance and turns off the cellular genes that drive the mitochondria to burn the glucose. So diabetes is a “glucose” processing problem caused by “fats.. both animal and plant” in the diet. An example from my clinical experience… last spring I was caring for 6 pre-diabetic patients at the McDougall Whole Foods Program. At the end of the 7 day program 5 had normalized their fasting blood sugar the sixth was well on her way to normal. Of course if type two diabetics have had their disease for a long period of time they may need to use some long acting insulin. Dr. McDougall has written excellent newsletter articles on these subjects… available for free via his website. The science keeps coming but only reinforcing this paradigm. For example Dr. Kempner the founder of the “Rice Diet” was able to treat severe hypertension and type two diabetes with a diet centered around rice. You can follow a plant based diet and be fat and/or sick. The data at this point shows the “Atkins” type diet to be harmful and I can’t think of one type of patient I would recommend it for. When consuming grains and legumes it must be done properly as many products containing them are processed with lots of added ingredients.

      1. I’ve read several scientific publications that state it is “well known” that high carb / low fat diets raise trigylcerides. This was my personal experience too (dramatic rise to above normal levels), lowering the carbs and increasing (good) fats normalized them. I am wondering why this issue is not discussed or even it seems, mentioned by proponents of high carb diets along with an explanation of how to avoid that, if one can. I ‘d appreciate any insight into this issue.

      2. Actually this is true, science does not support the Atkins diet, unless you are looking at the science paid for BY Atkins. If you are trying to find ways to support your meat eating it will not be found in legitimate scientific studies. And I know this personally, I was prediabetic, becoming insulin resistant when my now ex-doctor told me the same BS on high protein low carb. After I fired her, I went on a raw vegan diet, I ate 8-10 fruit a day and raw veggies, and low fat, no MEAT. In 4 months my A1C was down to a healthy 5.3, my total chol 131, my triglycerides are now normal, and I lost 40 pounds, I wanted to prove that fruit and veggies as whole foods will cure DM and insulin resistance, a lifestyle disease, and I did.

        1. What idiot told you that Atkins is high protein?
          Lots of research support HFLC (high FAT, get it?), just not research supported by the grain industry. And in the U.S., this would of course include your own lobby driven and rather awful FDA.

          1. What idiot? Have you even read his book? I guess than, to you, Dr Atkins is the ‘idiot’, as high protein and low carb is the basis for his diet. I have found that when people use name calling or curse words they usually don’t know what they are talking about, you are a perfect example. Your attempts at dominating everyone with loose aggressiveness and empty attempts at degrading people, fails, as all it does is show your true colors, a person with a lack of substance and education (and perhaps age).
            Try just knowing what you are talking about before entering the conversation, talk with everyone, learn. Trying to ‘yell’ your thoughts to ‘convert’ our thoughts doesn’t work with adults on the internet. Try bringing a calm tone, an open mind, with actual real information. Perhaps, then you will not need to resort to name calling when you don’t have anything or any science to back up your personal views. Most everyone will listen and give back their view, its a community with a wide diversity of people, I am one of that community with 5 yrs of graduate school studying medicine with a NP degree and a certified Family Nurse Practitioner. I know a bit about nutrition and human pathology. So, please, shouting incorrect facts does nothing in this crowd but show you up

            1. Ok, what uninformed person made the claim?
              I realise now that the newest editions of Atkins book has been changed after his death. Perhaps this is why his message has been so severely corrupted. Typically, to achieve ketosis, one has to take 80% of the calories in the form of fat. That doesn’t leave room for any protein dominance, does it? (The modern Atkins advice seem to have been severely corrupted by commercial interests. That’s a great shame.)

    2. Before going Vegan almost 6 years ago I was pre-diabetic, my first blood test after Veganism showed ALL required levels were normal or as the doctor put it to me last year “the gold standard for a healthy human being”

  5. Years ago when I had high cholesterol (on a fish&dairy vegetarian diet), my doctor advised me to cut the cheese (lowered my cholesterol 15%), use only low fat dairy and eat a high carb diet. However my triglycerides shot way up above normal on the high carb diet (and my HDL was still very low). Once I increased the fat (from nuts, olive oil, fish) and the protein (from low fat dairy including whey supplement), my trigylcerides went back to a mid normal range and my cholesterol profile overall improved (total was normal, HDL went up). I have read it is common for high carb diets to raise trigylcerides. I am wondering if this is typically because of some imbalance in the carbs e.g. too many grains (or not whole grains), not enough legumes, etc. This has kept me from adopting a high carb, low fat diet. Anyone have experience with this?

    1. You can’t have your feet on both sides of the fence and expect health. When you eat bad carbs or partial foods, such as breads, white rice, etc. you are asking for high triglycerides. It wouldn’t have mattered what you ate afterwards as long as you didn’t eat that. It is much different that when you eat high carb as in WHOLE fruits, then it will have the opposite affect. You can eat a very unhealthy vegetarian / vegan diet, or you can be at the peak of health on them if you choose the right whole foods. If you want to see how you do on a healthy vegan diet, try it for 2 weeks, eat only whole foods, no processed foods, nothing in a box, no breads or anything white, no dairy, no meats, and that also means no oils unless you can show me an ‘oil tree’ it was not meant for you to eat. Expect to bring alot home from the store, but you will spend less. After 2 weeks tell how you feel. Watch your calories, make sure you eat enough, remember 10 oranges only comes to about 900 calories. Eat lots of greens. Keep fruit in your desk at work, pack a big lunch, 2-3 bananas, a mango or two, sliced red sweet potato, a small handful of walnuts only, 4-5 oranges, some kale chips, or raw sliced turnips, then save and eat two apples on the drive home from work. When you get home, fix a one – two pound greens salad, use fresh raw drsg, like raw tahini with chipoli spices and lemon juice, or blend a couple tomatoes with spices and pour over it. Very quick and easy. Make sure every thing you eat is ‘whole’, not fruit juice, not pasta, only whole complete foods, then let us know how you did after 2 weeks, I know what you will say if you followed the instructions :)

    1. Here’s an idea: Make your own website. Put up the literature that supports your position. Instead of “2 minute videos with no real analysis” you could do eight minute videos with your genius commentary and really save the world. Show us how it’s done.

      1. I suggest reading a book about the Ketogenic diet instead.
        No need for me to do what others have done well already (I.e write that book).
        It will take a bit longer than 1 minute 20 seconds, but it will be informative.

  6. What are your views on fructose malabsorption and SIBO? As I take it, it seems very difficult to eat a healthy plant-based diet while having these conditions.

  7. Eating organic whole foods is key to stopping and preventing metabolic syndrome. We’ve seen this in numerous parts on the world where people eating organic fruits and vegetables, and even clean sea foods.

  8. So i have a complex situation. On one hand, all research point toward a plant based diet helping us humans. However i get so sick that i sometimes think i will die when i eat lots of fiber or just a little bit of brown rice, grains, the list goes on forever (I follow FODMAP diet which helps me survive). Any suggestion what i can do, what i can read, what tests i can do, what hospitals i can go to? If there’s a serious possibility getting out of this money is not an issue. Id travel to any clinic in the world. My wild non professional guess is that i have SIBO since i apparently cant break down food, causing massive bloating, burping for hours (or days, this part is the worst). I get super sick from all legumes especially. Just going to random common doctors is not an option, they suck big time. I just want to understand how to fix the issue now that i already have it. I understand that a very healthy diet is good to prevent it in the first place but im eating healthy and its not doing much for me. Just FODMAP and ultra restrictive diet helps like a patch on the wound. Im also a vegan. The more healthy nutrient dense food i eat the worse i get, white rice is the safest choise.

    1. PlsGiveMeAHealthyGut: Your situation sounds just horrible and as you know, obviously not one we can fix in a post on a forum. (In other words, I understand how serious this is and I won’t be giving you a flip answer to try tweaking your diet by doing X.) I do have some suggestions for you though. Dr. McDougall runs a 10 day live-in clinic and during that time, I believe you become a patient of record. If you are not familiar with Dr. McDougall, he is a famous plant based doctor who has helped many people overcome various problems. I don’t know how much experience he has with your kind of problem, but it seems like you could look into it and find out.

      Another recommendation is to look into the True North Health Center. They typically heal people through a live-in, medically supervised fasting program, and they fully understand the benefit of WFPB diets after the fasting. It seems to me that you could talk to that center and find out if they think their program would be of benefit to you.

      If you are generally interesting in the True North idea or if you want to start with a less intensive/expensive option, you might start with Dr. Michael Klaper, who I believe is associate with True North. And either way, he is another one of those famous whole plant food diet doctors, extremely knowledgeable, and who gives lectures on topics like our digestive system and leaky gut. So, I know he is familiar with general gut health issues. Dr. Klaper gives phone consultations. So, you could start with a phone consultation and he could tell you whether he thinks that True North would be of help to you or not. Or he might be able to recommend some specific tests.

      I hope this gives you some leads that lead to a great turn around for you. Best of luck!

  9. Hi,

    I have been on WPFB diet for now almost 9 months and got my blood report back.

    Total Cholesterol
    202 to 181

    145 to 122

    214 to 147

    The only thing that went up was my SGPT (liver) to 51

    Is this normal?

    1. Hi Smatan Harihar, I’m not sure if you are asking if the drop in cholesterol numbers is normal or if the elevated liver enzyme is normal so I’ll just give you my opinion about your numbers in general. My opinion is limited by the fact that I don’t have any more information about you or the state of your health other than what you have told us in your post. The cholesterol numbers coming down are certainly consistent with what I would expect after switching to a WFPBD. After 9 months I might expect to see an even bigger drop but again you may have other factors that I’m not aware of but the improvement you’ve gotten is certainly worthy of you continuing on the WFPBD road.
      As for the elevated liver enzyme. That can be caused by any number of things and without having more information I couldn’t speculate the cause in your particular case. In general a WFPBD does not make liver enzymes increase so I would think there is some other contributing factor which may be transient or more chronic. I would suggest you ask you doctor for an opinion. Hope that helps.

        1. I took a look at your full lab profile. My first question is are you taking any prescription medications on a regular basis? If so that can sometimes make your liver transaminases slightly elevated. Second, is this a new elevation? if not what was the level the last time and when was that lab done? The reason I ask is because the other liver transaminase (SGOT), although within the normal range is at the high end of the normal range. This is often and early indication of a fatty liver. If the SGPT was elevated or at the high end of the range on your last labs I might lean toward this explanation. Especially if you are not taking any medications on a regular basis. This could also be just a transient elevation that may resolve spontaneously and would warrant having them checked again in 3-6 months to see where they are. These are obviously points you should discuss with your doctor. When I have a patient with liver transaminases that stay at the upper limit of normal even though they are still “in range” I often do an ultrasound to check for fatty liver. Its an inexpensive and easy non-invasive test. The good news is that if you do have a fatty liver, a WFPBD would be the best thing you could do!
          As an aside, I notice that your B12 was at the lower end of normal so I would make sure you are supplementing with a good b12 supplement as well especially since you are now WFPB.
          Hope this helps.

          1. Thanks again for the reply.

            I am not taking any medication. I only take B12 supplement. I started off in April 2016 with 1000mcg every week and have recently (a month back) switched to taking 5000 mcg per week. My doctor also pointed out the lower level of B12. He told me to take 1000mcg every day.

            Regarding the elevated level of SGOT & SGPT. I tested it last year and it was 21 (SGOT) and 31 (SGPT). My doctor has scheduled a ultrasound for fatty liver. Hopefully this is transient elevation since I do not drink and have been on WFPB low diet. Past 9 months have been almost no intake of fat, other than oil (which was also occasionally when we went out to eat). This is probably the lowest fat intake I have had in my life, thanks to the diet.

            This is my 2016 Jan blood work

            Is it possible that due to my LDL reducing my liver is processing this fat? What happens when LDL starts reducing? Doesn’t that excess fat get into the blood stream and into the liver?

  10. I have a Metabolic Myopathy it is under in the undiagnosed clinic but would a plant based diet help my pain and fatigue by change in food.

  11. I recommend to look the youtube videos from Paul Mason. A lot will become clear as to where Metabolic syndrome comes from and what we can do about it.

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