HEOn a gray Sunday, in the middle of Covid lockdown, I received an unwelcome phone call from my family doctor. Until then, I had managed to avoid the doctor’s office except for routine checkups for almost my entire life. I got lucky.
“I’m sorry to bother you on the weekend,” he said. “But your tests just came back and your blood sugar level is concerning. I’m sure you have diabetes.”
During quarantine, I experienced symptoms that I realized were warning signs for type 2 diabetes, along with prediabetes, which affects nearly half of all adult Americans, according to the U.S. Centers for Disease Control and Prevention. . I was thirsty all the time and started drinking jugs of sweet cider. I was urinating more than usual and my urine was orange in color. When my doctor gave me a blood test, he found that my A1C, a measurement of blood sugar over a three-month period, was 11.8%, a level usually considered “totally high.” Anything above 5.7% is considered pre-diabetic. More than 6.4% have diabetes.
I did my homework. I learned that type 2 diabetes is a high blood sugar condition that leaves me vulnerable to blindness, amputation, and kidney and heart disease. I’m not an anxious person by nature, but I suddenly had a terrible feeling that my life was going to be shortened. In reality, my education about the dysfunctional state of the American diet and nutrition was just beginning.
This was a new world for me, but also eerily familiar. For the past several years, I have focused on criminal justice reform as the founder of a nonprofit criminal justice organization called the Marshall Project. As polarizing as criminal justice and racial equality are in this country, I learned that nutrition is even more controversial. If mass incarceration is a national scandal hiding in plain sight, then our twin epidemics of diabetes and obesity, which disproportionately affect the poor and people of color, are similarly sources of deep human suffering to which we have become accustomed.
The Upper East Side diabetes specialist my doctor sent me to tried to reassure me. “This is not a death sentence,” he said. “It tends to get worse over time, but can be managed with the right medication and lifestyle changes.” He wrote prescriptions for insulin and metformin and gave meticulous instructions on how to prick my fingertip to measure my blood twice a day, how to record the numbers, and how to poke a needle into my abdomen to inject insulin.
I asked him what changes I should make in my diet. Twenty years ago, I was struck by author Gary Taubes’ controversial and groundbreaking article published in the New York Times Magazine in 2002, describing the growing movement in diet and diabetes circles to reduce diabetes: “What If It’s All a Big Lie?” Carbohydrates to lose weight and lower blood sugar.
Taubes’s upcoming book, Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments, examines a century of research on diabetes and tries to show why so many experts got things so wrong for so long. This is Taubes’ fifth book on nutritional science, and I’d argue that his rigorous, science-based work (he’s a three-time winner of the National Science Writers Association Society Journalism award) makes him the Bryan Stevenson of nutrition. the first voice in the wild of an unorthodox view that is becoming increasingly accepted.
While low-carb diets are more accepted today than when Taubes first wrote about them in 2002, largely due to his journalism and advocacy, these diets are still far from the standard of care for patients, even diabetics. In fact, my doctor’s facial expression showed that he was considering for the first time the question of how diet might affect diabetes management.
“Of course you should cut back on sugar if possible,” he said meekly. “Basically, if you’re at a birthday party, eat half a slice instead of one piece of cake.” Was this the equivalent of a doctor telling a smoker with lung cancer to smoke less instead of quitting? The pharmaceutical intervention would clearly be the prescribed medication. Dietary change was implied but not emphasized.
On my way out, the doctor gave me a pamphlet called Living with Diabetes, published by the American College of Physicians. On its cover was a photo of a cheerful, overweight couple holding hands. “You can still eat carbs,” it said. “Just reduce portion sizes.” Inside were photos of delicious carbohydrate-rich foods like muffins, orange juice, bagels, and pasta, followed by pages of instructions for preparing, injecting, storing, and traveling with insulin supplements.
“I didn’t want to take pictures at first, but I didn’t realize how much better I could feel,” said one happy customer in the brochure. “It made a big difference for me.”
On page 57 there was a striking inscription in small print: Development of the book “Living with Diabetes: The Daily Guide for You and Your Family” was funded by a donation from Novo Nordisk, the Danish pharmaceutical giant that sells insulin to diabetics. Since 1924.
Fear can be a powerful motivator, and I am disgusted by both throwing substances into my body and premature death, so I decided to read the literature on what type 2 diabetes is. I discovered a huge community of scientists, doctors, and patients who already understood that type 2 diabetes is, in fact, reversible and that the solution is simple: stop eating carbohydrates, the only macronutrient that diabetics like me cannot safely metabolize without help. from drug treatments.
I stopped eating the breads, pasta, sweets and starchy foods I was used to. It wasn’t easy; I still miss my pizza, bagels, and sushi (white rice is a no-no for me). I used to consume them all with pleasure.
I was actually living in parallel universes. At the same time, I was in close consultation with my doctor, who prescribed the laborious, painful, and expensive drug treatments sanctioned by the American Diabetes Association. Independently, I was following a cheap, common-sense route that worked better than any drug ever could. Thank goodness my blood sugar dropped. My A1C dropped to 5.4%, which is a healthy level. Within three months of the first insulin injection into my abdomen, my diabetes seemed to be in remission. I lost 20 kilos. One way to think about this is that if I eat carbohydrates my diabetes manifests itself. I would actually be fine if I didn’t.
Fortunately, my doctor stopped all medications when he saw my blood sugar levels. “You don’t need me anymore,” he said. But he also showed a shocking lack of curiosity about what I had done to lower my A1C so dramatically. I now understand that my doctor made an honest attempt to follow the guidelines published by the American Diabetes Association. I didn’t ask him if he was aware that the ADA’s five largest funders are pharmaceutical companies Abbott, AstraZeneca, Eli Lilly and Co, Novo Nordisk and Regeneron.
Nutrition in America is undoubtedly difficult. Consider the debates that medical professionals still have: low fat, low carb, carnivore, vegetarian, vegan, energy balance model (calories in, calories out) vs carbohydrate insulin model (carbohydrates!). Given the billions spent on research, there is a shocking lack of consensus about why we get fat and get diabetes, and what we should and shouldn’t eat to avoid or prevent it.
There’s more to this than just one patient’s anecdotal story. Diabetes and obesity are costly killers. Diabetes alone will be the sixth-highest cause of death for Americans this year, but since it’s also closely linked to heart and kidney disease, Alzheimer’s, and stroke, it’s hard to know exactly how many Americans are dying prematurely from it.
Diabetes is also big business; In 2017, Americans spent $237 billion to treat the disease, or about $100 billion More than ten years ago. Obesity, a symptom or cause of diabetes depending on which medical professional you consult, accounts for more than billions of dollars. According to a 2022 article in the Lancet, nearly half a million American deaths each year can be attributed to excess weight.
I recently asked Gary Taubes how we can create the same sense of national urgency around diet and diabetes that the Marshall Project and other organizations are trying to bring to criminal justice policy. His answer was both measured and responsible. He did not call for an immediate ban or taxation of sugary substances he thought were toxic, as I did, nor did he demonize the pharmaceutical or food industries or the medical profession, as I did.
“There is significant evidence that replacing carbohydrates mostly with fats is beneficial in treating both obesity and diabetes,” he said. “There have been nearly 200 clinical studies done to test the health outcomes of these diets.” However, he added, none of these studies were of the scale or duration to provide the type of evidence needed to mobilize medical consensus.
What’s needed, he said, are large government-funded nutrition studies that pinpoint why we’re getting fat and how we should treat people with diabetes. “I believe the scientific consensus is wrong, but we need more studies to prove this,” he concluded.
It wasn’t the answer I was looking for, but I respected Taubes’ respect for dietary guidelines. Taubes is a journalist who thinks like a scientist; This is what makes his work so interesting.
I don’t think like a scientist; I am a patient. It makes me angry that we allow companies to market sugary cereals to kids and sugary drinks to everyone, or that the American Diabetes Association is also funded by the pharmaceutical industry and is so focused on pharmaceutical solutions for my disease. Or that more than 100,000 people will die this year from diabetes, a disease that is often reversible.
It amazes me how much resistance there is to funding nutrition research that digs deep into whether sugar is addictive or toxic, or pinpoints why 42% of all Americans are obese, according to a recent CDC study. Finally, it pains me that overweight people are demonized despite mountains of evidence showing that obesity is a result of metabolism, poverty, poor nutrition, and bad medical advice.
The obesity and diabetes epidemics are a collective national failure; The sooner we accept this, the sooner we can start working to fix them.