Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments

by Gary Taubes

Overview

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.

Product Details

ISBN-13:	9780525520085
Publisher:	Knopf Doubleday Publishing Group
Publication date:	01/02/2024
Pages:	512
Sales rank:	50,323
Product dimensions:	6.30(w) x 9.20(h) x 1.50(d)

About the Author

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.

Editorial Reviews

11/13/2023

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.)

Publishers Weekly

12/22/2023

Science writer Taubes's (The Case for Keto) current, accurate, jargon-laced, science-heavy work examines diabetes history and treatments from 1770s Scotland through 21st-century prescription drugs. Proclaiming medical care is as much art as science, and evidence-based medicine is not applicable to every patient, he explores ways medical misconceptions influence patients' long-term well-being. Delving into reasons modern medicine frequently conflicts with the greater goal of establishing reliable knowledge about and cures for diabetes, how diets fail to manage diabetes, and why insulin may or may not help patients in the long-term, this book's densely written chapters (sometimes eight pages, sometimes 41) review numerous diabetic diagnosis and treatment methods, detailed case studies (1915–2000s), diabetes history, multiple diet choices (meat, carbohydrates, high fat, keto, and more), and reliance on insulin to counteract food with or without dietary changes. Footnotes provide additional comments and explanations. End notes refer to works listed in the current, up-to-date bibliography. VERDICT This is thought-provoking and will interest healthcare professionals and students, dieticians, nutritionists, and diabetic/prediabetic patients looking for disease and treatment history and potential future treatment possibilities. What's different about this exceptional book is that it doesn't limit its angles to only diets, recipes, diagnosis, or managing blood sugar.—Laurie Selwyn

Library Journal

★ 2023-10-04
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.

Kirkus Reviews

"One of the crucial responsibilities of scientists and science journalists is to question established beliefs and common assumptions. Gary Taubes accomplished precisely this in this thought-provoking book. Through his extensive research, Taubes offers significant insights, shedding light on the evolution of our understanding of diabetes, for good or bad. Additionally, Taubes delves into the potential of promising and efficacious treatments, offering a glimpse into the future of diabetes management."—Siddhartha Mukherjee, author of The Emperor of All Maladies

“Decades of research have brought us shifting and even contradictory recommendations on managing diabetes. In lucid prose, Taubes sifts through and critically reviews what is known. Rethinking Diabetes convincingly makes the case for a new paradigm for the prevention and treatment of this common disorder.”—Abraham Verghese, M.D., author of The Covenant of Water

"Given the prevalence of type 2 diabetes, health and science journalist [Gary] Taubes...offers a crucial reassessment of the proper diet for controlling the disease...When it comes to the connection between diet and chronic illness, Taubes has consistently proven himself to be a superb investigator... [Here] He convincingly makes the case... Like a Michelin-star chef, Taubes has prepared a tantalizing offering spiced with sound science and heavy on fat calories."—Tony Miksanek, Booklist, starred review*

"The author of The Case Against Sugar and Why We Get Fat returns with an investigation of diabetes... A must-read book for diabetics... doctors will also learn a lot."—Kirkus Reviews, starred review*

"[A] provocative study...Exhaustively researched and providing cautionary insight into the fallibilities of medical advice, this intrigues."—Publishers Weekly

"If there is one book that can help us understand where diabetes treatment has gone wrong and how to fix it, it is Gary Taubes’s Rethinking Diabetes. Taubes’s new book is both an objective, methodical history of type I and II diabetes—among the deadliest and costliest conditions of our time—and a blueprint for how to move forward. Taubes’s proposed approach leverages decades of evidence of efficacy of low-carbohydrate, high-fat nutritional strategies that can reverse diabetes in most people. This book should be required reading for our nation’s leaders and citizens alike, especially those failed by a standard of care dictated by misguided scientific dogma."—Jan Ellison Baszucki, author of A Small Indiscretion and founder of Metabolic Mind

“Rethinking Diabetes is more than a definitive account of the greatest health epidemic of our time. It is also a roadmap powerful enough to change and save lives, all laid out by a master researcher who builds his case on unshakeable foundations until a simple and stunning truth emerges. In this groundbreaking, hopeful, and beautifully written work, Gary Taubes will change the way one thinks about diabetes, science, and the world itself. The most important book I’ve read in a decade.” —Robert Kurson, author of Rocket Men

"If any disease needs to be rethought, it is surely diabetes, and that is the premise of Gary Taubes’s latest book...[This] message is important and should be heard...“Rethinking Diabetes” builds on arguments that Mr. Taubes has made in his other books...and he seems to have read every study ever conducted on the relationship between food and diabetes." — James S. Hirsch, The Washington Post

"This is [Gary] Taubes’s fifth book about nutrition 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, an early voice in the wilderness for an unorthodox view that is increasingly becoming accepted."—Neil Barsky, The Guardian

"Gary Taubes has a well-earned reputation as a brilliant and fearless scientific thinker. He also happens to be a remarkable historian and writer. I'm going to recommend Rethinking Diabetes to everyone I know at risk who wants to be healthy. I'm also going to recommend it to my science writing students as a model of how it's done."
—Sam Apple, author of Ravenous

“A monumental work of journalism that reads like a detective story. Taubes’s reporting offers a riveting account of the history of diabetes treatment and suggests a more hopeful pathway ahead." 
—David Bornstein, co-founder of the Solutions Journalism Network

"Gary Taubes gives us an unsurpassed context and commentary on twists and turns in our understanding of diet and diabetes. A consummate science writer, Taubes challenges the conventional wisdom regarding our reliance on traditional therapeutics and, instead, elevates food and nutrition as our North Star for good health. A must-read for anyone who cares about health care, health equity or health."
—Kelly Close, founder, The diaTribe Foundation/Close Concerns

“Gary Taubes has once again done a masterful job exposing the bias of those who promoted and entrenched high-carbohydrate, low-fat diets as part of the management of people with type 1 and type 2 diabetes, and the lack of evidence supporting this dietary approach. Rethinking Diabetes is an outstanding book, a must read for all people with diabetes and those who treat them.”—Martin Abrahamson, M.D., former chief medical officer, Joslin Diabetes Center, co-author of Conquer Your Diabetes

“Nobody can read Rethinking Diabetes and walk away with their faith in the scientific establishment unshaken. The good news is that there is a path forward for the nearly one out of ten Americans who will suffer from diabetes, a largely preventable disease. With this book, Gary Taubes cements his status as one of America’s greatest living science journalists."
— Michael Shellenberger, author of Apocalypse Never

“With the rigor and clarity that mark all his work, Gary Taubes tackles the history of the science of diabetes, and he reveals why and how much of the conventional wisdom is misguided—and, even more important, how a better approach is possible. This book is indispensable reading for anyone who wants to understand this disease.” – Gretchen Rubin, author of The Happiness Project

“A blockbuster historical explanation of the science and the sociology of why diabetes is running rampant internationally.  As Taubes frames the story, it’s easy to understand how and why Americans lost and diabetes won." — George Lundberg, editor-at-large, Medscape

"In this meticulously researched, wonderfully well-written book, Gary Taubes tells the story of how the medical community over time repudiated the wisdom of earlier generations of doctors, who knew that high-carbohydrate diets were exactly the wrong thing to recommend to people with diabetes. It's a cautionary tale of politics and power in academic medicine that distorted medical practice and public health for the prevention and treatment of diabetes, even as science produced startling breakthroughs that, in a better world, should have led to better outcomes for patients. An absolute must-read for anyone who cares about science, medicine, and health."
—Jay Bhattacharya, Professor of Health Policy at Stanford and co-author of Health Economics

“ Kudos to Gary Taubes for writing a remarkable tour de force that should be of considerable interest to all persons with diabetes and clinicians and researchers in the field. The historical narrative is both erudite and gripping.  A must read.” — Sanjiv Chopra, M.D., Professor of Medicine, Harvard Medical School, Co-author, Conquer Your Diabetes

“In Rethinking Diabetes, one of our finest science writers tackles one of our most persistent and perplexing health issues. In re-examining how we came to believe what we do about diabetes, he suggests where we have gone astray and where successful treatment lies. This is an essential, vital contribution to the ongoing debate about an ongoing scourge.”—Marty Makary, author of The Price We Pay

“A fascinating deep dive into the history of diabetes and how new treatment paradigms may be game- changing.”— Jason Fung, M.D., author of The Obesity Code

“Gary Taubes embeds the story of diabetes in human context, illuminating the role of researchers, doctors, and establishment organizations in coming up with hypotheses and guidelines and then holding on to them long past their sell-by date. Rethinking Diabetes is a riveting tale of how the human impulse to confirm one’s beliefs rather than reexamine them, let alone change them, has impeded our understanding of diabetes—as well as a celebration of the brave souls, doctors and patients alike, who defied tradition and convention to come up with more effective treatments.”—Carol Tavris, coauthor of Mistakes Were Made (But Not by Me)

From the Publisher