Are you one of the 29.7 million Americans diagnosed with diabetes? Perhaps you are one of the 8.7 million Americans with undiagnosed diabetes? These statistics are probably underestimates since they were obtained in 2021 by the American Diabetes Association.
The truth is America is getting fatter and obesity often leads to diabetes. Recent estimates place 42% of Americans in the obese category. You may have noticed that advertisers for diabetes drugs now use obese actors and actresses to peddle their drugs. It seems they want to get the attention of the obese population since that’s the reality of many, though not all, diabetics.
Not surprisingly then, the prevalence of diabetes is increasing. The prevalence of diabetes in America grew from 6.3% in 2004 to 8.3% in 2021 according to the CDC. While obesity is a major risk factor for developing diabetes, family history, age, and race are also important risk factors. These statistics make it likely that one in 10 Americans has diabetes. The World Health Organization lists diabetes as the ninth leading cause of death worldwide.
What is the state of diabetes treatment today?
It has been more than 100 years since the miraculous discovery of insulin to treat diabetes. A lot of progress has been made since then, but there is still much more progress to be made. If you’re a diabetic, or know someone in your family who is, you’ll probably be interested in a new book called Rethinking Diabetes by Gary Taubes. I have not read the book, but I have read a review of the book published in The Wall Street Journal by James S. Hirsch.
Mr. Hirsch, a diabetic himself who has also written books about diabetes, has a unique perspective for reviewing this new book. He says if any disease needs to be rethought, it is surely diabetes, and that is the premise of Gary Taubes’s latest book. A veteran science journalist who has now written five books on the relationship between diet and chronic disease, Mr. Taubes is not interested in the many other factors that undermine diabetic health, including access to care and the affordability of therapies. Instead, he offers a unified theory on why patient outcomes are lagging. The key is food, specifically our overreliance on carbohydrates.
Mr. Hirsch says, “Mr. Taubes believes that diabetes is a cautionary tale for “the medicalization of modern life,” which unduly emphasizes pharmacology over diet and nutrition. We’d be much healthier, he argues, if we ate better and took fewer drugs. Whatever the practical limits of that goal—and I have my doubts—Mr. Taubes’s message is important and should be heard.”
Hirsch goes on to tell us Taubes makes a convincing case that dietary fat has been given a bad rap since even before the insulin era began in 1921. Dr. Elliott Joslin, America’s leading diabetologist in the first half of the 20th century, was among those who believe that dietary fat either caused diabetes or made its complications worse. He believed that once insulin was discovered, its goal was to allow patients to increase their consumption of carbohydrates – which include such staples as bread, potatoes, and fruit – without sugar appearing in the urine.
The “demonization” of fat, Mr. Taubes writes, would only intensify in the decades to come as it was linked to heart disease, leading the ADA and other health organizations to prescribe diabetic diets high in carbohydrates and low in fat. But this approach has been discredited recently with respect to heart disease. The American Heart Association no longer recommends the low-fat diet as a solution to heart disease.
The problem is that carbohydrates increase your blood sugar, and elevated blood sugar—hyperglycemia—is exactly what people with diabetes are trying to avoid. The latest tactic now takes the opposite approach – low carbohydrates. This approach is advocated by Dr. Richard Bernstein, an engineer-turned-doctor who also has Type I diabetes. In the 1970s, he became the first person to use a home glucose meter; looking at his data, he realized that a low-carb diet minimized his glycemic swings. For the past 40 years, in his books, academic papers and other advocacy, he has been the leading low-carb evangelist for people with diabetes.
Mr. Taubes’s larger point is that we have allowed pharmacological miracles in the treatment of diabetes, insulin being one of them, to supplant food and nutrition as the foundation of good health. He concurs with Dr. Arnoldo Cantani, a 19th-century Italian physician, who said that the remedy for diabetes “is not in the drugstore but in the kitchen.”
Though I am not a diabetic, I certainly concur with those who advocate diet, exercise, and weight control over a pharmaceutical panacea that seems to gloss over these fundamentally important tenants of good health. America needs to lose more weight, not take more drugs.
