RETHINKING DIABETES

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.