 Diabetes isn't just about the amount of body fat but the distribution of body fat. Check out these cross sections of two different thighs from two different patients. This is an MRI, so the fat shows up as white and the black is the thigh muscle. At first glance it looks like the one at the bottom has more fat. That's the subcutaneous fat under the skin. But if you look at the top one, see how their muscle is more marbled in the middle with fat? Those white streaks? That's not gristle, that's fat. Like one of those really fatty Japanese beef steaks? That's the fat infiltrating into the muscle, colored in red there. The green is the fat between your muscles and then the yellow is the fat outside of the muscles under the skin. And if you add up all three types, both of those thighs actually have the same amount of fat, just distributed differently. And that seems to be the critical factor in terms of determining insulin resistance, the cause of type 2 diabetes. The subcutaneous adipose tissue, the fat right under the skin, was not associated with insulin resistance. So it's healthier to have this thigh. Is it possible a more plant-based diet also affects a more healthier distribution of fat? We didn't know until now. The effect of a vegetarian vs. confessional diabetic diet on thigh fat distribution and subjects with type 2 diabetes. Researchers decided to put it to the test. 74 diabetics were randomly assigned to either follow a vegetarian diet or conventional diabetic diet. Both diets were calorie restricted down to the same number of calories. The vegetarian diet was also egg-free and dairy limited to a max of 1 serving of low fat yogurt a day. And the reduction in the more benign subcutaneous fat was comparable, about the same in both groups. But the more dangerous fat, the fat lodged inside the muscle itself, was reduced only in response to the more plant-based diet. So even on the same number of calories, there can be a healthier weight loss on the more plant-based diet. Those eating strictly plant-based also have lower levels of fat stuck inside the individual muscle fibers themselves, what's called intramyrocellular lipid, which may help explain why vegans in particular often found to have the lowest odds of diabetes. And it's not just because they're slimmer. Even if you match subjects pound for pound, there's significantly less fat inside the muscle cells of vegans compared to omnivores, as measured in one of their calf muscles, which is a good thing, since storing fat in muscle cells may be one of the primary causes of insulin resistance, which is what's behind both pre-diabetes and type 2 diabetes. Whereas if you put some on a high fat diet in just a single week, the fat in their muscle cells shoots up 54% and go on a high protein diet, and you may undermine one of the principal benefits of weight loss, eliminating the weight loss- induced improvement in insulin action, the improvement in insulin resistance. These individuals were put on a calorie-restricted diet, less than 1,400 calories a day, until they lost 10% of their body weight. Half were getting more of a regular protein intake, 73 grams a day, and the other half a higher protein diet. Now normally you lose 10% of your body weight and your insulin resistance improves. That's why it's so critical for obese type 2 diabetics to lose weight. But the beneficial effect of 10% weight loss was eliminated by the high protein intake. Those extra 32 grams of protein a day abolished the weight loss benefit. The failure to improve insulin sensitivity in the high protein weight loss group is clinically important because it reflects a failure to improve a major cause-and-effect mechanism involved in the development of type 2 diabetes. In summary, they concluded, they demonstrated that the protein content of a weight loss diet can have profound effects on metabolic function. All protein? Any kind of protein? If you split it up between animal versus plant protein, following people over time animal protein intake is associated with an increased risk of diabetes in most societies, whereas plant protein intake appears to have either a neutral or protective association with diabetes. Yeah, but those were just observational studies. People who eat lots of animal protein might have lots of unhealthy behaviors. But you see the same thing in randomized controlled interventional trials where you can improve blood sugar control just by replacing sources of animal protein with plant protein. We think it may be the branched chain amino acids concentrated in animal protein. Higher levels in the bloodstream are associated with obesity and development of insulin resistance. We may be able to drop our levels by sticking to plant proteins, but you don't know if that has metabolic effects until you put it to the test. I hate it when titles ruin the suspense, but indeed decreased consumption of branched chain amino acids improves metabolic health. They demonstrated that a moderate reduction in protein intake rapidly improves metabolic health, improving blood sugar control, while also decreasing BMI and body fat. Check this out. The protein-restricted group was eating literally hundreds more calories per day, significantly more calories than the control group, so they should have gained weight, right? But no, they lost weight after about a month and a half. They were eating more calories, but lost more weight, about 5 pounds more than the control group, eating fewer calories. And this protein restriction? They were just having people eat the recommended amount of protein a day. It's about 56 grams a day. So they should have just called that the normal protein group, or the recommended protein group, and the group that was eating more typical American protein levels, and suffering because of it, the excess protein group. And as a bonus, just sticking to the recommended protein intake, double the levels of a pro-longivity hormone called FGF21, but that's for another video.