Rethinking Diabetes

November 13, 2023
Current medical guidance for treating diabetes may be fundamentally flawed, according to this provocative study. Medical journalist Taubes (The Case for Keto) notes that diabetes treatment consisted of following high-fat diets until the 1921 discovery of insulin. In 1971, the American Diabetes Association began advising diabetes patients to adopt the American Heart Association’s general dietary guidelines for “carbohydrate-rich/low-fat diets,” despite the fact that carbohydrates were “the one macronutrient that bodies could not safely metabolize.” The advice, Taubes explains, was based on the paternalistic assumption that patients wouldn’t follow a more restricted diet and so it would be easier to instead rely on insulin therapy. Worse, the high-carb diet had little evidence to support it, and when clinical trials were finally conducted on its effects in the 1980s, they found the diet exacerbated “defects in fat and carbohydrate metabolism” for diabetes patients. Taubes warns that the “medicalization of modern life” has led to a reliance on pharmaceuticals with harmful long-term side effects (long-term use of insulin therapy has been linked to severe hypoglycemia and weight gain) and makes “medical associations become ever more likely to consider... diseases beyond the control of patients.” He argues for the need for more research on how diets, such as a low-carb/high-fat regimen, could benefit diabetes patients. Exhaustively researched and providing cautionary insight into the fallibilities of medical advice, this intrigues. Agent: Kristine Dahl, Curtis Brown.

Starred review from November 1, 2023
The author of The Case Against Sugar and Why We Get Fat returns with an investigation of diabetes. Taubes, a three-time winner of the Science in Society Journalism Award, explains that insulin allows cells to use sugars (i.e., carbohydrates) for energy. Diabetes results when insulin loses this ability. In Type 1 diabetes, usually beginning in childhood, the body produces little or no insulin. Type 2, which occurs later in life, is associated with obesity, and weight control is the best treatment. Until the discovery of insulin in 1921, a low-carbohydrate, low-calorie diet prolonged lives. The use of insulin seemed to work miracles; patients rose from significant illness and resumed normal lives. Doctors continued to prescribe the same "diabetic" diet, but they quickly learned that patients rarely followed it. Doctors fumed but accepted reality and decided to "cover" the increased carbohydrates and calories with insulin and other drugs. That remains the standard treatment today. However, by the 1930s, even well-controlled diabetics were developing heart disease, kidney failure, strokes, blindness, blocked arteries, and other maladies. Decades later, we are experiencing an obesity epidemic, a 600% increase in diabetes (between the early 1960s and 2015), an outpouring of drugs meant to normalize blood sugar, and numerous studies to determine if this could prevent these complications. The author also examines "the demonization of fat." Faced with skyrocketing heart attacks in the general population, experts condemned America's typical high-cholesterol, high-fat diet. In 1971, the American Diabetic Association "began prescribing carbohydrate-rich/low-fat diets for diabetic patients largely because this is what the American Heart Association was suggesting for effectively all Americans." Taubes is blunt: "They were wrong." Although the ADA has softened its condemnation of fats, which diabetics can metabolize, it continues to encourage carbohydrates, which they can't without pharmaceutical help. A must-read book for diabetics, but doctors will also learn a lot.

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December 22, 2023

Multi-award-winning science writer Taubes argues for a different approach to diabetes care, centering on diet (particularly, fewer carbohydrates and more fat) over a reliance on insulin in Rethinking Diabetes. Prepub Alert.

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Starred review from January 1, 2024
Given the prevalence of type 2 diabetes, health and science journalist Taubes (The Case against Sugar, 2016) offers a crucial reassessment of the proper diet for controlling the disease. This is, at times, a demanding read, bulging with the history of managing diabetes mellitus (types 1 and 2) since the discovery of insulin in 1921, descriptions of research, and the contentious debate over the healthiest diet. When it comes to the connection between diet and chronic illness, Taubes has consistently proven himself to be a superb investigator. He warns that ""[g]etting things wrong in science may be at least as common as getting them right"" and bemoans how ""belief systems in medicine can be so intractable."" He convincingly makes the case that the optimal diet for controlling diabetes is a very low carbohydrate diet with replacement of calories from carbohydrates chiefly by calories from dietary fat (through what we call a keto diet). There's plenty of information here, especially about insulin and human metabolism. Based on Taubes' analysis, dramatically limiting carbohydrate calories should be the featured bill of fare for most diabetic individuals. Like a Michelin-star chef, Taubes has prepared a tantalizing offering spiced with sound science and heavy on fat calories.

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