Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments
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An eye-opening investigation into the history of diabetes research and treatment by the award-winning journalist and best-selling author of Why We Get Fat “[Gary] Taubes’s meticulous, science-based work makes him the Bryan Stevenson of nutrition, an early voice in the wilderness for an unorthodox view that is increasingly becoming accepted.”—Neil Barsky, The Guardian
Before the discovery of insulin, diabetes was treated almost exclusively through diet, from subsistence on meat, to reliance on fats, to repeated fasting and near-starvation regimens. After two centuries of conflicting medical advice, most authorities today believe that those with diabetes can have the same dietary freedom enjoyed by the rest of us, leaving the job of controlling their disease to insulin therapy and other blood-sugar-lowering medications. Rather than embark on “futile” efforts to restrict sugar or carbohydrate intake, people with diabetes can lead a normal life, complete with the occasional ice-cream cake, side of fries, or soda.
These guiding principles, however, have been accompanied by an explosive rise in diabetes over the last fifty years, particularly among underserved populations. And the health of those with diabetes is expected to continue to deteriorate inexorably over time, with ever-increasing financial, physical, and psychological burdens. In Rethinking Diabetes, Gary Taubes explores the history underpinning the treatment of diabetes, types 1 and 2, elucidating how decades-old research that is rife with misconceptions has continued to influence the guidance physicians offer—at the expense of their patients’ long-term well-being.
The result of Taubes’s work is a reimagining of diabetes care that argues for a recentering of diet—particularly, fewer carbohydrates and more fat—over a reliance on insulin. Taubes argues critically and passionately that doctors and medical researchers should question the established wisdom that may have enabled the current epidemic of diabetes and obesity, and renew their focus on clinical trials to resolve controversies that are now a century in the making.
9 reviews for Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments
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Dan Sherman –
Excellent book though sometimes too detailed – Really important information, though!
The book really covers two topics – The first is the specific question of how diabetes has been treated over time and the second is a more general but incredibly important question of how we develop and disseminate information about (any) disease and its treatment.Much of the book covers how the (once rare) disease of diabetes was treated. In the pre-insulin era (i.e., before the early 1920s), it was treated mostly with diet, and then with insulin (and other pharmaceuticals) in combination with diet, though the crucial question is what type of diet. In terms of this history, the book is fascinating. However, it is very, very detailed with lots of cross-references to various researchers/physicians and their writings over time. As interesting as this is (and it is), it made it somewhat hard to read (and the book has a huge number of references).A central theme of the book is diet was the key approach to treating diabetes before insulin and other drugs and that successful treatment – even in the late 1700s – often meant restricting carbohydrates, which meant boosting protein and especially fat – pretty much the approach used in “keto” diets today.The approach changed though when insulin became available in the 1920s, and common practice was to allow large amounts of carbohydrates in the diet and “cover” them with insulin. This would lower blood sugar by pushing it into cells, which often led to individuals gaining weight and potentially developing other illnesses related to the intake of large amounts of insulin, including heart disease.What is fascinating about the book is that notions of how to treat diabetes have changed very slowly, even if evidence that medical as opposed to dietary approach to treatments have not been effective. Although type 2 diabetes was once seen as a disease resulting from low levels of insulin, researchers found that diabetics with high levels of blood sugars had high levels of insulin their bodies produced – basically, they had become resistant to insulin and needed more and more insulin to deal with the sugars in their blood.Ultimately the book show that the evidence that treatment guidelines have been based on often is pretty flimsy and is oversold. Taubes has found much research that shows that a low-carbohydrate diet is indeed the best way to prevent/treat diabetes ,in that lower sugar intake leads to lower (with fewer spikes) blood sugar and requires less (if any) insulin to treat. To my mind (my training is not in medicine…..), this seems plausible and even obvious. It does seem as if major medical associations (e.g., American Diabetes Association) are slowly coming around to this perspective, being less dogmatic in their recommendations.The research (and experience of patients) shows that allowing that a lower-carbohydrate/sugar diet can work in treating diabetes and not be bad in terms of cardiovascular health (one concern that led to people pushing for low-fat/higher carb diets).I really enjoyed this book in terms of content and writing and found that it fits in well with author’s other book on sugar and the desirability of a keto (or at least much lower sugar) diet. I think the book would have been improved if provided an initial chapter (or perhaps an appendix) on what diabetes was and basic anatomy/physiology behind it. This would have given material in the book more context.I do think the historical discussion of diabetes treatments could have been greatly shortened, with more focus being on how guidelines for treatment changed in recent years – less say pre-1970 and more afterward as more information became available (largely as a result of technology) of how blood sugar/insulin/cholesterol interacted in the body. This last third of the book was most interesting, with much of the earlier discussion pretty slow-going.Taubes has again done an amazing job pulling together all of this information, though ultimately I would liked to have had a shorter book more focused on the debate on how best to treat diabetes – something more like his famous “case against sugar” article and less on the very detailed history of research studies and their interpretation.The book is very highly recommended, both for coverage of diabetes treatment and also the general question of how we develop scientific evidence and perhaps hold onto “conventional wisdom” longer than we should. I’m going to reread this book again, along with Gary’s other related books.PS For someone specifically interested in diabetes and its treatment, I’d suggest books by Dr. David Perlmutter and Mark Hyman – They review the evidence and explain science pretty clearly.
Thomas Gregorios –
Outstanding history of science, enabling diabetics to decide what is “normal” for them
A compelling authoritative history of the medical science and the development of public policy on one of the most important disease epidemics of our times. Being a science journalist, Taubes kept me engaged through all 404 pages, of the many twists and turns of research and treatment, without the narrative ever dragging.Without doubt, Taubes has a greater knowledge of the scientific literature on diabetes than any other person, seemingly having combed through every journal, conference proceedings, and textbook on the topic from the nineteenth century through the present. This is one of a series of acclaimed books and articles which he has published in his long career devoted to pursuing this topic.This study illuminates more than the topic of research, treatment, and public policy development on diabetes. It applies to the larger process of medical science and how it is translated in to medical treatments and recommendations for the broader public.The book reveals two tragedies beyond the horrific impact which the disease has on those afflicted. One is how early insights on the disease, that could have greatly reduced the impact and suffering, were forgotten, over-ridden, or submerged. In this, historians of science will find this book an excellent work, extensively researched and footnoted, a compelling and pleasurable read.The second tragedy is that in formulating public policy and the recommendations of organizations such as those of the American Diabetes Association, critical tradeoffs were never explained to those affected. As is clear from Taubes’ work, by eating consistently a specialized low carbohydrate diet the majority of diabetics can reverse or prevent the manifestation of the disease and thus enjoy “normal health” and a “normal lifespan.” Or they can “eat normally,” a “normal American diet,” or slight modification of it, as recommended by the American Diabetic Association, and mitigate the resulting adverse effects with medication and insulin while accelerating the progression of the disease.For diabetics and those working with them this book will provide an understanding of how these public health recommendations were developed, through the history of the study and treatment of the disease, and allow them to choose for themselves which “normal” they wish to pursue. The right to make a knowledgeable decision is their right as human beings. It is one that they were always entitled to, and should have been given long ago, with great clarity, without being so obfuscated by those who claim to be aiding them.This book will not disappoint either of these groups.
P Vilefort –
The Science Behind Proper Treatment of Diabetes & the Keys to Reversal
This is a wonderfully researched book. I have a Master of Science in Dietetics but much of what I was taught is not based upon scientific fact. For instance the idea that saturated fat is the cause of heart disease is not based upon any true science. Not one study that attempted to show a link between saturated fat in your diet and the development of heart disease has ever shown a positive link. Other things in your diet that replaced saturated fat has increased the incidence of heart disease, not decreased it.With the development of insulin there have been a whole host of problems that surfaced that didn’t exist prior to the discovery of insulin. Get the book for yourself or for a friend that has diabetes. There are some additional book references that the author provides for you that could change your life if you have either form of diabetes. That is the book by Richard K. Bernstein, MD.Thank you Gary Taubes for a book that has been sorely needed for a very long time.
Art Jones –
Fascinating, thought provoking and LONG
An extraordinarily well researched review of the history of diabetes—physiology, diagnosis, treatment—in the context of professional debates and disagreements about all of those. Also a great review of how “scientific “ and “medical “ decisions are made. Not always easy reading but well worth it for anyone—physician, patient, parents—with an interest in the area.
Mitch of the East –
Gary Taubes always gives historical background to his subject matter that draws the reader in so they may see a clear picture of where we are and how we got there. This book is no exception and if you are interested in the issues surrounding the development and treatment of diabetes written from a historical and scientific perspective this is it. This is a well researched, annotated and written treatise on how we got to the wrong place with regard to diabetes care. Politics, strong personalities, blinding focus on unproven theories, it’s all here and more. Diabetes does not have to be a progressive debilitating disease, it is because we focus on the symptom of higher and higher glucose that damages everything over time. What if we focused on prevention of higher and higher insulin levels leading to insulin resistance within the body and did that by dietary interventions, primarily the reduction of carbohydrates. Taubes doesn’t use a sledge hammer but conveys the message in an interesting and entertaining manner.
Sam –
Adopting a diet that aligns with our ancestral and biological makeup, rather than relying on contemporary cultural food-like substances, can significantly enhance both physical and mental well-being.The carnivorous nature of our physiology provides a compelling explanation for the observed reduction or elimination of mental health concerns when individuals adopt a meat-only carnivore diet.Thank You Dr Georgia Ede.
Ita –
Don’t buy this book if you are looking for authoritative directions for how best to deal with type1 or type 2 diabetes. Conclusive advice is simply not possible to give in 2024. We still await the trials that might make this possible. What Gary Taubes offers is invaluable – an extensive account of the merits of the approaches that have been taken to prolong life with diabetes. Equipped with this information, you will be in a better position to make decisions for yourself.Before the discovery of insulin in 1921, diet was the only method through which diabetes could be controlled. However, doctors were by no means unanimous about an ideal diabetic diet. Gary Taubes deals with their varied recommendations in the first part of this book.The discovery of insulin promised liberation from a restrictive diet. Diabetes was seen mainly as a disease where patients had lost their ability to regulate their blood sugar (glucose) level. If good glycemic control could be achieved, all would be well. This turned out to be less simple than anticipated. The appropriate dose depended on diet, and the appropriate diet depended on the insulin dose. The administration of insulin carried with it a lethal danger – the risk of hypoglycemia.During the 1950s, stunning discoveries in biochemistry were announced. It had become possible to determine the sequence in which amino acids were linked to form proteins, and the first protein whose sequence was revealed was the relatively small insulin. In parallel with the work on proteins was that on DNA. The 1950s was the decade when Watson and Crick astonished the world with their model of the double helix. The future looked very bright, not just for diabetics. On the horizon lay the possibility of synthesising human insulin and perhaps even treating the disease at gene level.Studies made possible through the use of radioisotopes and the ultracentrifuge in the 1960s allowed for the first time the measurement of circulating insulin and the separation of lipoproteins in blood according to their density. We learned that, although it is glucose derived from sugar and starch that stimulates a healthy pancreas to produce insulin, the tissue most sensitive to the hormone is fat. Fat tissue is metabolically very active. Mobilisation and deposition of fat goes on continuously. Fat tissue responds to insulin by synthesising and storing fat. Low levels of insulin stimulate the release of fat and its use as fuel. Our brains are not dependent on glucose, as once believed. They can also use ketones synthesised by the liver from fat.Heart disease, a risk with diabetes, is elevated by the transport of fat in blood, not as cholesterol, but as triglycerides in very low density lipoproteins. The more insulin secreted, the greater the conversion of carbohydrate (sugar and starch) to triglycerides by liver cells. But isn’t diabetes associated with impaired insulin secretion, you ask? Not necessarily. High levels of insulin in blood can be found especially in type2. The patients have developed insulin resistance.The 1970s ushered in an era of self monitoring, led by Richard Bernstein. By 1971 it had also been demonstrated that patients with diabetes (both types) manifest a relative or absolute excess of glucagon, the pancreatic hormone that raises blood sugar levels. Insulin, glucagon and other hormones act as an orchestra to achieve homeostatic harmony in a non-diabetic person. Because the insulin that is injected or infused in insulin therapy is not secreted by the pancreas, homeostatic responses are absent. As Gary Taubes puts it, ‘The body has lost its ability to protect itself in essence FROM insulin.’1988 saw the introduction of Syndrome X, now known as metabolic syndrome, which is common to type2 diabetes, obesity and heart disease.This book isn’t just for diabetics. It’s for all of us. Since he published ‘Good Calories, Bad Calories’, many people are profoundly grateful to Gary Taubes.
Bela Butalia, Ms –
Acquired this book after listening to the writer, Gary Taubes on a podcast. It was an impulsive buy as I am not a medical student, just a diabetic. But was I glad I bought it. Taube writes about the history of the cure for diabetes from the early 1920s onwards, navigating with great skill through the omissions and commissions of the American Diabetes Association (ADA), and how or why certain choices about diet for patients were taken, which were not giving the right results. If it were not so obviously about the US, anyone could mistake it for the reality of India. A thick book, but eminently readable.
davefly –
If you have type 2 diabetes you must read this book, it is a challenging read but I promise it puts you in the driving seat towards an improved management of the disease.