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Summary
On episode 628 of 40+ Fitness, Coach Allan sits down with Gary Taubes, an investigative science and health journalist and co-founder of the nonprofit Nutrition Science Initiative. He is the author of Why We Get Fat and What to Do About It and Good Calories, Bad Calories, and a recipient of the Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
Gary's new book, Rethinking Diabetes, traces a century of diabetes treatment decisions, from carbohydrate-restricted diets before insulin existed to the insulin era that followed, and argues that many of the field's core assumptions were locked in before they were ever rigorously tested.
The conversation covers how insulin's discovery in 1921 saved lives immediately but also reshaped diabetic diets toward carbohydrates, how insulin and glucagon are supposed to work as a pair, and why Gary is cautious about the long-term unknowns of today's GLP-1 drugs.
Links
- https://garytaubes.com
- https://unsettledscience.substack.com
- https://twitter.com/garytaubes
- Episode 224 – The worst part of a western diet – Gary Taubes
- Episode 469 – The Case for Keto with Gary Taubes
Key Takeaways
- Diabetes treatment decisions were locked in decades before the underlying science was tested. Gary argues doctors are trained to practice medicine, not to rigorously test hypotheses, so early assumptions about diet and insulin dosing hardened into dogma rather than being revisited as new evidence emerged.
- Before insulin, diabetes was treated almost entirely through diet. From 1797 doctor John Rollo's near carnivore diet through the starvation therapy used between 1914 and 1921, physicians kept patients alive longer by restricting carbohydrates, decades before anyone understood why it worked.
- Insulin's discovery in 1921 saved lives immediately but created a new problem. Once patients were given insulin, doctors had to feed them carbohydrates at every meal to prevent fatal low blood sugar, reversing decades of near carb-free treatment almost overnight.
- Liberalizing diets to cover with more insulin produced a wave of complications a decade later. Heart disease, kidney failure, blindness, and amputations showed up in patients in their 20s and 30s, roughly the diseases people otherwise get in their 50s through 80s, and doctors blamed poor blood sugar control rather than the insulin doses themselves.
- Insulin and glucagon are meant to work as a matched pair, but medicine focused almost entirely on insulin. Glucagon, secreted by neighboring pancreatic cells, raises blood sugar through the liver, and Gary argues newer GLP-1 drugs may work partly through glucagon-related effects that current thinking largely ignores.
- Two competing philosophies of diabetes care emerged, and only one was ever really tested. One approach restricts carbohydrates so blood sugar and drug needs stay low; the other lets patients eat freely and covers it with escalating doses of insulin. Gary says the trials that exist favor the low-carbohydrate approach, but conventional guidelines never adopted it.
- Obesity, diabetes, gout, heart disease, cancer, and dementia cluster together in the same populations. Gary sees this cluster as evidence the common driver is refined sugar and processed grains rather than simple overeating, which is why he treats dietary restriction as therapy rather than willpower.
- New GLP-1 drugs worry him because of how little is known about their long-term effects. He points to unresolved questions like what happens to a fetus if a woman stays on the drug during pregnancy, or what happens to her weight if she stops, as territory medicine has not yet reckoned with.
- Gary's three strategies to get and stay well: eat whatever diet makes your symptoms, like excess weight, high blood sugar, or high blood pressure, go away in the short term; get enough sleep; and stay physically active, since both tend to make people happier and more emotionally balanced even if their effect on longevity is less certain.
“Obesity is not an overeating problem. It's, in effect, a carbohydrate intolerance problem.”
Gary Taubes
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Episode Notes
Podcast: 40+ Fitness
Episode: 628
Published: 2024-02-06
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Gary Taubes, an investigative science and health journalist and co-founder of the nonprofit Nutrition Science Initiative, Rethinking Diabetes
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