by ohOn a gray Sunday in the middle of the Covid lockdown, I received an unwanted call from my GP. Until then, for virtually my entire life, I had managed to stay out of the doctor’s office except for routine checkups. My luck had run out.
“Sorry to bother you for a weekend,” he said. “But your tests just came back and your blood sugar levels are alarming. “I’m pretty sure you have diabetes.”
During lockdown, I experienced symptoms that I now understand as warning signs of type 2 diabetes, the disease (along with its precursor, prediabetes) that, according to the U.S. Centers for Disease Control and Prevention, affects nearly half of all American adults. . I was always thirsty and had been given jugs of sweet apple cider to drink. I was urinating more than usual and my urine had an orange tint. 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 commonly known as “sky high.” Any value greater than 5.7% is considered prediabetic. Above, 6.4%, are diabetic.
I did my homework. I learned that type 2 diabetes is a condition of high blood sugar that makes me vulnerable to blindness, amputation, and kidney and heart disease. I’m not a worrier by nature, but I suddenly had the dreaded feeling that my life was about to get shorter. In reality, my education on the dysfunctional state of the American diet and nutrition was just beginning.
This was a new world to me, but also eerily familiar. For the past several years, as the founder of a nonprofit criminal justice organization called the Marshall Project, I have focused on the issue of criminal justice reform. I learned that as polarizing as criminal justice and racial equity are in this country, 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 afflict the poor and people of color—are equally sources of profound human suffering to which we have simply 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 with the right medication and lifestyle changes, it can be controlled.” He prescribed me insulin and metformin and offered me meticulous instructions on how to prick my fingertip to measure my blood twice a day, how to record my numbers, and how to stick a needle into my abdomen to inject insulin.
I asked him what changes, if any, I should make to my diet. Two decades earlier, I had been affected by writer Gary Taubes’ controversial and groundbreaking 2002 New York Times Magazine article, “What If It Had All Been a Big Lie?”, which chronicled the growing movement in diabetes and diet circles. to reduce carbohydrates to lose weight and reduce blood sugar.
Taubes’ upcoming book, Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments, explores a century of diabetes research and attempts to show why so many experts got it so wrong for so long. This is Taubes’ fifth book on nutritional science, and I would argue that his meticulous, science-based work (he is a three-time winner of the National Association of Science Writers’ Science in Society Journalism award) makes him the Bryan Stevenson of nutrition. , one of the first voices in the desert in favor of an unorthodox vision that is increasingly accepted.
While low-carb diets might be more accepted today than when Taubes first wrote about them in 2002, largely due to his journalism and advocacy, they are still far from the standard of care for patients, even diabetics. In fact, my doctor’s facial expression suggested that this might be the first time he had considered the question of how diet might influence diabetes treatment.
“Sure, you should cut back on sugar if you can,” he said meekly. “Basically, if you’re at a birthday party, instead of eating a piece of cake, just eat half a piece.” Was this the equivalent of a doctor telling a smoker with lung cancer to smoke fewer cigarettes instead of quitting? The pharmaceutical intervention was clearly going to be the prescribed medication. A change in diet was hinted at, but not highlighted.
On my way out, the doctor handed me a pamphlet, Living with Diabetes, published by the American College of Physicians. On its cover was a photo of a happy, very overweight couple holding hands. “You can still eat carbs,” he said. “Just reduce the portion sizes.” Inside were photographs of delicious carbohydrate-rich foods, such as pastries, orange juice, bagels, and pasta, followed by pages of instructions on how to prepare, inject, store, and travel with a supply of insulin.
“At first I didn’t want to take injections, but I didn’t realize how much better I could feel,” whispered one satisfied customer in the brochure. “He made a big difference to me.”
On page 57, in small print, came the surprise message: “The development of Living with Diabetes: A Daily Guide for You and Your Family was funded by a grant from Novo Nordisk,” the Danish pharmaceutical giant that has been selling insulin to diabetics. since 1924.
Fear can be a powerful motivator and I happen to have an aversion to both injecting substances into my body and premature death, so I decided to read the literature about what type 2 diabetes is. I discovered a huge community of scientists, doctors and patients who already They had understood that type 2 diabetes is, in fact, reversible and that the remedy is simple: stop eating carbohydrates, the only macronutrient that diabetics like me cannot safely metabolize without help. of drug therapies.
I stopped eating the breads, pastas, sweets and starches that I had become accustomed to. It was not easy; I still miss my pizza, my bagels, and my sushi (white rice is a no-no for me). He had consumed it all with relish in the old days.
In fact, he lived in parallel universes. For one thing, I was in close consultation with my doctor, who prescribed cumbersome, painful, and expensive drug therapies that were enshrined by the American Diabetes Association. Regardless, I was following a cheap, common sense path that worked better than any medication. Fortunately, my blood sugar levels plummeted. My A1C dropped to 5.4%, a healthy level. Three months after injecting insulin into my abdomen for the first time, my diabetes seemed to be in remission. I lost 20 pounds. One way to think about it is that my diabetes manifested itself if I ate carbohydrates. If he didn’t, he was basically fine.
Admittedly, when my doctor saw my blood sugar levels, he took me off all my medications. “You don’t need me anymore,” he said. But he also showed a surprising lack of curiosity about what I did to lower my A1C so dramatically. I now realize that my doctor was making an honest attempt to follow the guidelines issued by the American Diabetes Association. I didn’t ask him if he knew that the top five funders of the ADA are the pharmaceutical companies Abbott, AstraZeneca, Eli Lilly and Co, Novo Nordisk, and Regeneron.
Nutrition in the United States is, without a doubt, complicated. Consider the debates that medical professionals still engage in: low-fat versus low-carb, carnivores versus vegetarians and vegans, the energy balance model (calories in, calories out) versus the carbohydrate-insulin model (they are Carbohydrates!). Given the billions spent on research, there is a surprising lack of consensus about why we become fat and diabetic, and what we should eat and what not to eat to avoid or prevent it.
There is more to this than a patient’s anecdotal story. Diabetes and obesity are costly deaths. Diabetes alone will likely be the sixth leading cause of death among Americans this year, but because it is also closely linked to coronary heart disease, kidney disease, Alzheimer’s, and stroke, it is difficult to know precisely how many Americans die prematurely from diabetes. she.
Diabetes is also big business: In 2017, Americans spent $237 billion treating the disease, roughly $100 billion. further than a decade before. Obesity, which is either a symptom or a cause of diabetes depending on which medical professional you ask, accounts for billions of dollars more. According to a 2022 article published in The Lancet, nearly half a million American deaths annually can be attributed to excess weight.
I recently asked Gary Taubes how we could create the same sense of national urgency about diet and diabetes that the Marshall Project and other organizations are trying to bring to criminal justice policy. His response was measured and responsible. He did not call for immediately banning or taxing sugary substances, no matter how toxic he might think they are, as I would do, nor did he demonize the pharmaceutical or food industries or the medical profession, as I would do.
“There is significant evidence that replacing carbohydrates primarily with fat is beneficial in the treatment of both obesity and diabetes,” he said. “Nearly 200 clinical trials have been conducted to test the health outcomes of these diets.” But, she added, none of those trials were of a scale or duration that would provide the kind of evidence needed to drive medical consensus.
What is needed, he said, are massive government-funded nutritional studies that establish once and for all why we gain weight and how we should treat people with diabetes. “I think the scientific consensus is wrong, but we need more studies to prove it,” she concluded.
This wasn’t the answer he was looking for, but he respected Taubes’ respect for dietary due process. Taubes is a journalist who thinks like a scientist: that’s what makes his work so compelling.
I don’t think like a scientist; I am a patient. I’m outraged that we allow companies to market sugary cereals to kids and sugary drinks to everyone else, or that the American Diabetes Association is simultaneously funded by the pharmaceutical industry and leans so heavily toward pharmaceutical solutions for my disease. Or that more than 100,000 people will die this year from diabetes, a disease that is usually reversible.
It surprises me that there is still so much resistance to funding nutritional studies that get to the bottom of whether sugar is addictive or toxic or determine once and for all why 42% of all Americans, according to a recent CDC study, are obese . Finally, it pains me that overweight people are demonized, despite mountains of evidence suggesting that obesity is a function of metabolism, poverty, poor diet, and poor medical advice.
The obesity and diabetes epidemics are a collective national failure; The sooner we recognize this, the sooner we can start working to fix them.
