The 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.
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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.
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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.”