We all want the pill

Wednesday, January 24th, 2024

Rethinking Diabetes by Gary TaubesThe Guardian reviews Gary Taubes‘ Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments

Gary Taubes is probably the most single-minded person I have ever met. In 2002, when he was a little-known science journalist and author of two books on scientific controversies, an article of his was published in the New York Times, headlined: What If It’s All Been a Big Fat Lie? In it, he argued that the low-fat dietary advice of the previous couple of decades wasn’t only incorrect, but actively dangerous and the reason for, as he put it, the “rampaging epidemic of obesity in America”. For Taubes, dietary fat wasn’t a problem at all. Instead, the real danger was carbohydrate, he asserted, sparking a backlash, and fuelling the ongoing conversation about what constitutes a “healthy diet”. He wasn’t the first to assert that carbs were bad (Robert Atkins got there before him), but perhaps because of his serious and scientific background — he has a physics degree from Harvard and studied aerospace engineering at Stanford — he has been a polarising figure, with as many ardent followers as detractors.


Before the discovery of insulin in the 1920s, diet was the only way to manage diabetes and although various options were tried by early practitioners, low-carb was, says Taubes, among the most popular (with medics, at least). Insulin was a gamechanger. Not only did it almost magically save the lives of children with type 1 diabetes, who would often arrive at hospital comatose and die swiftly afterwards, but it also meant that people with diabetes of both types could eat a more or less normal diet.


What Taubes would like to see is low-carb diets being offered alongside or instead of diabetes medications. “When insulin therapy started in the 1920s, they had no idea what the long-term side-effects were or what the long-term consequences of living with diabetes were [because most people with type 1 died],” he says. “Then doctors find out that it’s just easier to let patients eat whatever they want and give them drugs to cover them. Then it’s another five, 10 or 20 years before they start seeing the long-term complications, which they think of as long-term complications of the disease.” What he wishes scientists at the time had concluded was: “The reason we’re keeping them alive is insulin therapy. So what we’re seeing is the long-term complications of the disease as controlled by insulin therapy, and the insulin therapy might be causing the complications as much as the disease is.

“By the late 1930s, you have this tidal wave of diabetic complications: the heart disease, the atherosclerosis, the neuropathy, the kidney failure, the blindness, amputations. And nobody ties it back.” By then, the low-carb diet had fallen far from favour. “Nobody wants to eat a diet. So nobody’s being told: ‘Look, if I give you insulin, I’m going to keep you alive until you’re 30, especially if I give you a lot of insulin and you do eat your carbs. But if I tell you not to eat the carbs and we minimise the insulin use — which for type 2 could be no insulin — I might keep you alive as long as anyone else in your family.’”

In the book, which is laden with references, studies and dense historical detail, Taubes mentions case records from the 1700s in which patients on low-sugar diets beg for a medical solution, suggesting that the preference for medication over a highly prescriptive diet has been with us for a long time. “If you’re told, a pill or a diet, we all want the pill. But if you’re told a pill or a diet and the diet will keep you healthy and the pill will give you a chronic degenerative disorder where you’re still going to have these horrible complications, they are just going to be 20 to 30 years later… the pill is going to be easier, because it always is. But if you change the diet, it’s not a hypothetical change: you can put your diabetes into remission, you can stop taking these medications.”


  1. Cae says:

    I actually watched this scenario played out in my brother’s life…

    When my brother was in his mid-30′s, he was diagnosed with Type 1 diabetes, which is unusual, as he’d never had any symptoms of it in his childhood or youth, and it does not run anywhere in our family…
    …But, by the time he was diagnosed, my brother had a 15 year history of daily consumption of large amounts of corn syrup sweetened soft drinks!

    Once diagnosed, he was prescribed insulin and used it regularly, as directed…
    And at that time, he totally eliminated soft drinks, and other sugar sweetened beverages from his diet. And since he’d never had much of a taste for eating sweets, he ended up (without really trying) on a primarily low carb regimen.
    His weight quickly came down and by his mid-40′s my brother was fairly healthy, though still being prescribed and using insulin accordingly with blood sugar testing…
    Unfortunately, damage had already been done, so at 47, he survived a major heart attack, and was left in a frail, fragile state of ill-health, from which he died about a year and a half later.

    The intriguing thing, is that while he was in hospital, undergoing treatment for the heart attack, doctors determined that my brother no longer had diabetes at all!
    They had no explanation, nor any interest in determining one, but I did some research and discovered that it is possible, though very rare, for type 1 diabetes to go into remission.

    My supposition is that my brother was perfectly healthy in childhood, and managed to all but ‘kill’ his pancreas with his sweetened soft drink compulsion, and then, after so many years without imbibing excess sugar/corn syrup, his pancreas ‘recovered’ and he was no longer diabetic.

    So, there’s a case history confirming Gary Taubes’ work…just thought you might find it interesting.

  2. BHS says:

    You have no idea how hard the doctors tried to keep me from a low carb diet. And these were doctors working largely with Indian patients.

    So I finally said, ‘to the heck with them,’ and went low carb anyway. No more fry bread, or pancakes, not even high sugar fruits or vegetables. Within three months I was off all medication with normal blood sugar.

    Why tell people whose grandparents were hunter gatherers to eat a high carb low fat diet anyway?

  3. Faze says:

    As one prominent cardiologist told me over dinner, “Treatment guidelines say that we are supposed to have the patient try lifestyle modification [diet and exercise] before we prescribe the [statin] drugs. But I prescribe the drug first thing. Why? Because after treating thousands of patients I know that none of them will actually attempt the diet and exercise. NONE OF THEM …”

  4. Jim says:

    No one has ever been amerifat on a diet of steak and rice.

  5. TRX says:

    I came across an article excoriating Gary Taubes and his book “Good Calories, Bad Calories”. Taubes was a charlatan and a fool and probably tortured kittens, and should be prevented from spreading his pseudo-science claptrap at once.

    Guided by the ringing endorsement, I purchased a copy of the book and read it. It’s not a “diet book.” It’s more of a book-length college thesis on diet and health; tediously detailed and exhaustively annotated and referenced.

    Hey, worth a shot. I lost 99 pounds the first year I was on it. (missed an even hundred by *that* much…) Taubes only briefly covered the anti-inflammatory aspects of a low-carb diet. I had childhood-onset arthritis; enough that I had to retire early because of mobility problems, and had progressed from using a cane all the time to using crutches on bad days. Not to mention the fearsome group of allergies – I was allergic to *everything*, which impressed the hell out of the allergy doc.

    The allergy symptoms went away after a few weeks, and I dispensed with the meds I had been on for decades. It took about six months before the arthritis symptoms mostly went away, and about a year before they went completely away. I dispensed with those meds too.

    Even if I didn’t lose any weight, the low carb diet would be worth it. The weight loss was just a bonus.

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