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Summary
Summary
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."--Niel 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.
Author Notes
GARY TAUBES is the author of six books, including the best sellers Good Calories, Bad Calories and Why We Get Fat . He is a former staff writer for Discover and correspondent for Science , and his writing has appeared on the cover of The New York Times Magazine and in The Atlantic , Esquire , and numerous "best of" anthologies, including The Best of the Best American Science Writing. He has received three Science in Society awards from the National Association of Science Writers and the Robert Wood Johnson Foundation Investigator Award in Health Policy Research. He lives in Oakland, California.
Reviews (3)
Publisher's Weekly Review
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. (Jan.)
Kirkus Review
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. Copyright (c) Kirkus Reviews, used with permission.
Booklist Review
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.
Table of Contents
| Introduction | 3 |
| 1 The Nature of Medical Knowledge | 26 |
| 2 The Early History | 33 |
| 3 Diabetes in Retrospect | 44 |
| 4 The Fear of Fat | 61 |
| 5 Insulin | 92 |
| 6 Rise of the Carbohydrate-Rich Diet | 104 |
| 7 Good Science/Bad Science, Part I | 127 |
| 8 Good Science/Bad Science, Part II | 165 |
| 9 Good Science/Bad Science, Part III | 205 |
| 10 The End of Carbohydrate Restriction | 236 |
| 11 Diabetes and Heart Disease | 248 |
| 12 What You See Is All There Is | 280 |
| 13 Low Blood Sugar | 314 |
| 14 High-Fat Diets | 331 |
| 15 Very-Low-Carbohydrate Diets | 352 |
| Epilogue The Conflicts of Evidence-Based Medicine | 388 |
| Acknowledgments | 405 |
| Notes | 407 |
| Bibliography | 435 |
| Index | 471 |
