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On a dreary Sunday during the midst of the Covid lockdown, I received an unpleasant phone call from my family physician. Up until that point, I had been fortunate enough to avoid frequent visits to the doctor’s office, only going in for routine appointments. However, my good fortune had come to an end.

“I apologize for contacting you on a weekend,” she said. “However, the results of your tests have come in and your blood sugar levels are concerning. I suspect that you may have diabetes.”

During the period of confinement, I experienced indications that I now understand to be cautionary signals for type 2 diabetes, the condition – along with its preliminary stage pre-diabetes – that, according to the US Centers for Disease Control and Prevention, affects almost half of all adult Americans. I constantly felt thirsty and had developed a habit of consuming large amounts of sweet apple cider. I noticed that I was urinating more frequently than usual and that my urine had a distinct orange color. When my doctor conducted a blood test, she discovered that my A1C level, which measures blood sugar over a three-month period, was at 11.8%, a level commonly referred to as “extremely high”. Anything above 5.7% is considered pre-diabetic, while a level above 6.4% indicates diabetes.

I completed my assignment and discovered that type 2 diabetes is a health problem caused by high levels of sugar in the blood, which puts me at risk for blindness, amputation, and kidney and heart diseases. Although I am not normally a worrier, I suddenly felt a sense of dread that my life may be cut short. However, this was just the beginning of my learning about the unhealthy eating habits and lack of nutrition in America.

This was a completely new experience for me, but it also felt strangely familiar. In my role as the founder of a non-profit organization called the Marshall Project, I have spent the last few years dedicated to addressing criminal justice reform. Through this work, I have come to understand just how divisive topics like criminal justice and racial equality can be in our country. However, I have also learned that the topic of nutrition is even more contentious. While mass incarceration is a glaring issue that often goes unnoticed, our simultaneous epidemics of diabetes and obesity, which disproportionately affect those living in poverty and people of color, are similarly causing immense suffering that has sadly become normalized.

My doctor referred me to a diabetes specialist in the Upper East Side who reassured me that my diagnosis was not a death sentence. He explained that while the condition may worsen over time, it can be effectively managed with proper medication and lifestyle adjustments. He prescribed insulin and metformin and provided detailed guidance on how to monitor my blood sugar levels twice a day, track my readings, and administer insulin injections using a needle in my abdomen.

I inquired about any suggested adjustments to my eating habits. Twenty years prior, I had been influenced by Gary Taubes’s provocative and revolutionary article from 2002, “What If It’s All Been a Big Fat Lie?”, published in the New York Times Magazine. It discussed the increasing trend in dietary and diabetes communities to decrease carbohydrate consumption for weight loss and improved blood sugar levels.

Taubes’s upcoming publication, Rethinking Diabetes: The Truth About Diet, Insulin, and Effective Treatments, delves into a hundred years of diabetes research and aims to explain why numerous experts have been mistaken for such a long time. This is Taubes’s fifth work on nutrition science, and I believe his thorough and evidence-based approach (he has received the Science in Society Journalism award from the National Association of Science Writers three times) makes him the equivalent of Bryan Stevenson in the field of nutrition – a pioneering voice advocating for an unconventional perspective that is gaining more recognition.

Although low-carbohydrate diets are more widely accepted now than when Taubes initially wrote about them in 2002, they are still not the standard of care for patients, including those with diabetes. My doctor’s facial expression indicated that he may not have previously thought about the role of diet in treating diabetes.

He timidly suggested, “It would be beneficial to reduce your sugar intake, if possible. For example, at a birthday party, opt for half a piece of cake instead of a full one.” Could this be compared to a doctor advising a lung cancer patient to simply smoke less instead of quitting altogether? It was evident that medical intervention would be the preferred course of treatment. Making changes to one’s diet was mentioned briefly, but not emphasized.

As I was leaving, the doctor gave me a pamphlet called “Living with Diabetes” from the American College of Physicians. The cover featured a picture of a happy couple, both of whom were overweight, holding hands. The words on the cover reassured me that I could still consume carbohydrates, I just needed to be mindful of portion sizes. Inside, there were images of appetizing foods high in carbs such as cake, orange juice, bagels, and pasta, along with detailed instructions on how to prepare, inject, store, and transport insulin.

Initially, I was hesitant to receive injections, but I didn’t realize the extent to which it could improve my well-being,” expressed a satisfied customer in the pamphlet. “It had a significant impact on my life.”

On page 57, in small font, there was a crucial detail: “The creation of the Living with Diabetes: An Everyday Guide for You and Your Family was supported by a grant from Novo Nordisk,” the large Danish pharmaceutical company that has been providing insulin to individuals with diabetes since 1924.

I have a strong aversion to injecting substances into my body and the fear of premature death, which motivated me to research what type 2 diabetes entails. To my surprise, I found a large community of professionals and individuals who have discovered that type 2 diabetes is reversible. This means that blood sugar levels can be lowered to a non-diabetic range, although this does not guarantee a permanent cure. The remedy is simple: eliminate carbohydrates from the diet, as diabetics, like myself, cannot properly metabolize them without the aid of medication.

I have discontinued my consumption of bread, pasta, sweets, and starchy foods that I had become used to. It was a difficult adjustment, as I still crave pizza, bagels, and sushi (although white rice is now off-limits). In the past, I used to indulge in these foods with enthusiasm.

I was essentially living in two different realities. On one side, I regularly consulted with my doctor who prescribed me with complex, painful and costly medication endorsed by the American Diabetes Association. On the other hand, I decided to take a more affordable, common sense approach which proved to be more effective than any medication. To my delight, my blood sugar levels significantly decreased and my A1C reached a healthy level of 5.4%. Within three months of starting insulin injections, my diabetes seemed to be in remission and I also lost 20 pounds. In simpler terms, my diabetes only showed symptoms when I consumed carbohydrates and was otherwise under control.

My doctor deserves recognition for discontinuing my medication when he saw my blood sugar readings. He stated that I no longer required his services. However, he did not show much interest in learning about the methods I used to significantly decrease my A1C levels. It has now come to my attention that my doctor was simply adhering to the guidelines set by the American Diabetes Association. I did not inquire if he was aware that the top five contributors to the ADA are the pharmaceutical giants Abbott, AstraZeneca, Eli Lilly and Co, Novo Nordisk, and Regeneron.

The topic of nutrition in the United States is undoubtedly complex. There are ongoing debates among medical professionals regarding low fat versus low carb diets, the differences between carnivores and vegetarians/vegans, and the two main models of energy balance and carbohydrate insulin. Despite the large amount of money invested in research, there is a concerning lack of agreement on the causes of obesity and diabetes, as well as recommendations for dietary choices to prevent or manage these conditions.

There is more to this than one patient’s anecdotal story. Diabetes and obesity are costly killers. Diabetes alone is likely to be the sixth-highest cause of death for Americans this year, but since it is also closely linked to coronary and kidney diseases, Alzheimer’s and stroke, it is difficult to know precisely how many Americans die prematurely because of it.

Reworded: The treatment of diabetes is a lucrative industry, with Americans spending $237 billion in 2017, which is $100 billion more than ten years prior. The issue of obesity, which is considered either a symptom or a contributing factor to diabetes, also incurs billions of dollars in costs. A 2022 article in the Lancet states that almost half a million deaths in the US each year are linked to being overweight.

I recently inquired with Gary Taubes about how we could generate a similar level of national urgency regarding diet and diabetes, as the Marshall Project and other groups are aiming to do with criminal justice policies. His response was thoughtful and sensible. He did not propose an immediate prohibition or tax on sugary products, despite his belief in their harmful effects, nor did he vilify the pharmaceutical or food industries or the medical field, as I might have.

According to the speaker, there is substantial proof that replacing carbohydrates with primarily fats can effectively treat both obesity and diabetes. He also mentioned that nearly 200 clinical trials have been conducted to assess the impact of these diets on health outcomes. However, he noted that none of these trials were large enough or long enough to provide sufficient evidence for a shift in the medical consensus.

He stated that what was necessary were extensive nutrition studies funded by the government to definitively determine the causes of obesity and how to properly treat individuals with diabetes. He expressed his belief that the current scientific consensus is incorrect, but more research is needed to prove it.

Although it wasn’t the response I had hoped for, I admired Taubes’s adherence to the principles of proper dietary investigation. Taubes approaches his writing with a scientific mindset, which adds to the appeal of his work.

I do not have a scientific mindset; I am a patient. It angers me that corporations are allowed to advertise sugary cereal to kids and sugary drinks to everyone else. It also bothers me that the American Diabetes Association receives funding from the pharmaceutical industry and heavily promotes pharmaceutical treatments for my condition. It is also concerning that over 100,000 people will lose their lives to diabetes this year, despite the fact that it can often be reversed.

I am amazed by the continued reluctance to support research on the effects of sugar on our health, whether it is addictive or toxic. It is also concerning that 42% of Americans are obese, according to a recent CDC study, yet overweight individuals are often unfairly criticized. Despite numerous studies suggesting that obesity is linked to factors such as metabolism, poverty, diet, and medical advice, it is disheartening to see the stigma placed on those who struggle with their weight.

The widespread issues of obesity and diabetes are a result of our nation’s failure as a whole. It is imperative that we recognize this and take steps towards addressing and resolving these problems.

This article was updated on December 6, 2023 to clarify that although type 2 diabetes can be reversed or put into remission through lifestyle modifications, there is no guarantee that this will be a permanent solution.

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  Neil Barsky, a former journalist for the Wall Street Journal, is the creator of the Marshall Project, a non-profit organization that provides news coverage on the American criminal justice system.

Source: theguardian.com