In 2021, it was estimated that more than 4m South African adults had diabetes. In lifestyle diseases, type 2 diabetes mellitus (T2DM) is arguably a leading scourge of our modern consumption habits, underscoring the seemingly inevitable detriments of society’s high intake of calories, refined sugars and animal products.
The number of South Africans with T2DM is staggering and contributes to equally high healthcare costs. One review of medical schemes in South Africa estimates that the average direct costs for patients in 2016 were R2 486 per patient, alongside R18 711 indirect costs on average.
If left untreated, long-term complications may include heart disease, blindness, kidney failure, and the need for amputations – further exacerbating the costs of treatment and its debilitating effects.
With approximately 537m adults afflicted with T2DM worldwide as of 2021, this represents a significant economic strain that can both be prevented and remedied.
Could plant-based diets play a role in preventing and managing the burden of T2DM in South Africa? A recent study suggests that a plant-based prescription may offer various health benefits.
A diagnosis of T2DM is not always a life sentence. Improving lifestyle factors can prevent, manage and potentially reverse T2DM. South African health systems recommend three months of lifestyle changes for all persons diagnosed with T2DM, with or without pharmaceutical interventions.
A high-quality diet, regular exercise, improved sleep and stress management can be powerful lifestyle changes to enable health and wellbeing. Someone with T2DM who consults a registered dietician for medical nutrition therapy can improve blood sugar control and reduce healthcare costs.
Plant-based eating
Dietary approaches increasing plant-based food consumption are gaining popularity worldwide, including in South Africa.
In 2021, UBUNTU Wellness centre in Cape Town developed the UBUNTU 21-day whole food plant-based eating challenge for T2DM.
Around the country, and in their own homes, participants of the challenge are provided with medical care and guided by a recipe book, Healing Diabetes and Other Lifestyle Disease: Cooking Africa’s Plant-Based Whole Foods, with 80 affordable recipes and a sample seven-day meal plan from the programme.
Healthy plant-based eating in South Africa
To understand what unfolded during the challenge, the Physicians Association for Nutrition (PAN) South Africa and North-West University conducted a multiple-case study including 10 of its participants.
Through interviews with participants and their physicians, the research unpacks unique perspectives on how the challenge affected their health and fitted into their daily lives.
Dr Nanine Wyma, MD of PAN South Africa, said: “There is not enough scientific evidence on how healthy plant-based eating may benefit South Africans. The research represents a significant step forward in exploring plant-based dietary approaches for diabetes and other chronic diseases in South Africa.”
Dr Christi Niesing, senior lecturer at North-West University, supported the research as an explorative foundation for future investigations.
“Understanding the multi-layered contextual factors which influence the behaviour change of individuals greatly supports the development of subsequent health promotion interventions.”
Participants said they found it difficult to adapt to the plant-based diet during the first week.
Thereafter, they experienced remarkable health benefits: it improved their blood sugar control, and some were able to reduce medications or come off of them entirely.
They also lost weight and abdominal circumference and gained psychological benefits.
Professor Andrew Robinson, public health physician and principal investigator of the study, said, “I was so impressed by how this simple intervention empowered patients to take control of their own health.
“The importance of this study is that it suggests that it may be possible to reverse T2DM with nutritional interventions. Health promotion interventions that mitigate the economic impact of the non-communicable disease pandemic will be an integral component of the success of the NHI. More local research must be done to properly inform the steps our health services must take to implement necessary effective health promotion interventions at every level.”
The physicians were positive about the approach, and described it as “very powerful” in its potential to manage chronic disease. The positive health outcomes also sparked genuine interest among local healthcare clinics and staff.
Reality of plant-based diets in SA
Health may be a powerful motivator for dietary change, but food choices are influenced by a number of contextual factors – personal, interpersonal, organisational, cultural and healthcare systems.
South African food environments still largely promote animal-based diets, making it difficult to access a diversity of fruits, vegetables and healthy plant-based meals.
PAN South Africa hopes that the research improves health promotion and promotes the understanding of plant-based nutrition among local healthcare professionals.
“It was interesting to see how little health professionals knew about the healing potential and power of a plant-based diet. It will be difficult to shift towards lifestyle interventions that challenge the current curative approach to chronic non-communicable diseases, as there are huge financial interests in the pharmaceuticalisation of healthcare,” observed Robinson.
There are several socio-economic challenges to normalising the dietary programme in this country, among them, the lifestyle precepts of a society in which the everyday use of animal products is still entrenched.
Meat consumption patterns have increased in South Africa, as recently as within one generation. The consumption of animal products is firmly rooted in local culture and across ethnic groups.
Eating a plant-based diet contrasts starkly with this standard and may provoke disagreement and acrimony when challenged.
Furthermore, future doctors and dieticians are not adequately trained in plant-based nutrition on a university level.
A survey of local health science students found that 74% felt they don’t learn enough about nutrition and disease, and 67% required more information on plant-based diets.
This represents a significant gap in the competencies of South African physicians to address lifestyle-related illnesses like diabetes.
Issued by the Physicians Association for Nutrition (PAN) South Africa