Rethinking Diabetes: What Science Reveals About Weight-reduction plan, Insulin, and Profitable Remedies

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.

Detailed and accessible history of diabetes research and treatment
This is a great book. It explores the history of the science and personalities behind our current understanding and treatment of diabetes, and the unfortunate divergence between the two.I want to highlight one aspect, in response to a one-star review claiming the book conflates type I and type II diabetes. This is actually the book for you if you want to understand:1. The medical difference between type I and type II diabetes.2. The research and clinical history of how we gained this understanding.3. The way in which the earlier understanding of type I diabetes influenced the treatment, and as Taubes persuasively argues, continued mistreatment of type II.This book tackles some complex material, but is written in Taubes’s usual lucid and accessible style. I believe it is suitable for the lay reader, and I would expect it to be informative to medical professionals as well (which I cannot say with certainty since a am a layman myself.)

An exhaustive history of the medical establishment’s struggle to understand and treat diabetes
When I was a child in the 1950’s, my father—who barely finished grammar school—warned me “If you eat too much sugar, you could get diabetes.”That was the conventional wisdom then, but it was soon abandoned when researchers fixated on dietary fat as the assumed cause of a worrisome rise in heart disease. Low fat, high carb diets became the standard, and to a large degree they still are.If only the researchers had listened to my dad! Mounting evidence implicates excessive carbohydrate consumption as the culprit in the current epidemic of obesity, Metabolic Syndrome, and diabetes.I’ve read all of Taubes’ books on diet, obesity, and diabetes. They’re all excellent. This one is different in that it makes the case for low carb somewhat indirectly, by documenting in great detail the many failures—and few successes—of physicians, researchers, and “health institutions” to confront the evidence that was staring them in the face.Not everyone will be interested in this level of historical detail, but Rethinking Diabetes is a monumental work that gives perhaps the first clear look at how we got to where we are in grappling with the insidious disease that’s disabling and killing so many of us, and where we might go from here.

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.

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.