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

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

Author: Gary Taubes

Publication Details: Alfred A. Knopf, 2024, 512 pps., $35.00 hardcover

Gary Taubes is a science journalist and historian, and his books on nutrition are deep and thorough. He became well-known in 2002 when he published “What If It’s All Been a Big Fat Lie?” in The New York Times Magazine, exposing that saturated fats from natural sources are healthy and that eating sugar and processed carbohydrates is the main driver of metabolic dysfunction, insulin resistance, and excess body fat.¹ Rethinking Diabetes is Taubes’ fifth book since then and is a history of diabetes, much like The Case Against Sugar is a history of sugar and the sugar industry. ²

Rethinking Diabetes takes us back to the very beginning of recognizing the disease in the late 19th century. Remarkably, diabetes was regarded as one disease up until the 1970s, and urine testing was the standard measurement. One weakness of the book is that the distinction between type 1 and type 2 diabetes is not made often enough, and I was frequently confused as to which disease he was referring to.

Taubes dedicates the book to the late Dr Sarah Hallberg, who championed low carbohydrate nutrition to manage and even reverse type 2 diabetes. Her 2015 TEDx Talks presentation, “Reversing Type 2 Diabetes Starts With Ignoring the Guidelines,” has been viewed by millions, and I use it with patients and for presentations. ³ Her memorable line from that video is, “I can reverse type 2 diabetes in anyone if they stop eating foods they do not need.” Hallberg became the medical director of Virta Health, an online program for reversing type 2 diabetes through low carbohydrate nutrition.⁴ Dr Hallberg had an untimely death from cancer in 2022.

A recurrent theme in Rethinking Diabetes is the continued use of dietary carbohydrates in managing a disease of excess blood sugar. This approach started with Elliott Joslin, the first recognized expert in the disease and has been continued in diabetic education to this day. Current diabetic education recommends a 40% to 60% diet of complex carbohydrates and avoidance of simple and processed sugars.⁵ The tide may be turning toward a ketogenic diet for the avoidance and treatment of type 2 diabetes as the carbohydrate-insulin model is now scientifically well established. ⁶

Because medical knowledge and guidelines about diabetes were wrong for most of a century and still are, argues Taubes, he focuses on the truths revealed by solid science. He opens the book with a chapter on “The Nature of Medical Knowledge” and the forces that direct it in the context of history. He devotes three chapters to “Good Science/Bad Science.” After his final chapter on “Very-Low-Carbohydrate Diets” as the key to managing diabetes, he has an epilogue titled “The Conflicts of Evidence-Based Medicine.” The epilogue may be tough reading for some advocates of evidence-based medicine, but I think it is right on target.

Gary Taubes is not a clinician, and that is apparent throughout the book. The principal value of Rethinking Diabetes is the deep history of diabetes that makes this book well worth reading and using as a reference.