The book really covers two topics - The first is the specific question of how diabetes has been treated over time and the second is a more general but incredibly important question of how we develop and disseminate information about (any) disease and its treatment.
Much of the book covers how the (once rare) disease of diabetes was treated. In the pre-insulin era (i.e., before the early 1920s), it was treated mostly with diet, and then with insulin (and other pharmaceuticals) in combination with diet, though the crucial question is what type of diet. In terms of this history, the book is fascinating. However, it is very, very detailed with lots of cross-references to various researchers/physicians and their writings over time. As interesting as this is (and it is), it made it somewhat hard to read (and the book has a huge number of references).
A central theme of the book is diet was the key approach to treating diabetes before insulin and other drugs and that successful treatment - even in the late 1700s - often meant restricting carbohydrates, which meant boosting protein and especially fat - pretty much the approach used in "keto" diets today.
The approach changed though when insulin became available in the 1920s, and common practice was to allow large amounts of carbohydrates in the diet and "cover" them with insulin. This would lower blood sugar by pushing it into cells, which often led to individuals gaining weight and potentially developing other illnesses related to the intake of large amounts of insulin, including heart disease.
What is fascinating about the book is that notions of how to treat diabetes have changed very slowly, even if evidence that medical as opposed to dietary approach to treatments have not been effective. Although type 2 diabetes was once seen as a disease resulting from low levels of insulin, researchers found that diabetics with high levels of blood sugars had high levels of insulin their bodies produced - basically, they had become resistant to insulin and needed more and more insulin to deal with the sugars in their blood.
Ultimately the book show that the evidence that treatment guidelines have been based on often is pretty flimsy and is oversold. Taubes has found much research that shows that a low-carbohydrate diet is indeed the best way to prevent/treat diabetes ,in that lower sugar intake leads to lower (with fewer spikes) blood sugar and requires less (if any) insulin to treat. To my mind (my training is not in medicine.....), this seems plausible and even obvious. It does seem as if major medical associations (e.g., American Diabetes Association) are slowly coming around to this perspective, being less dogmatic in their recommendations.
The research (and experience of patients) shows that allowing that a lower-carbohydrate/sugar diet can work in treating diabetes and not be bad in terms of cardiovascular health (one concern that led to people pushing for low-fat/higher carb diets).
I really enjoyed this book in terms of content and writing and found that it fits in well with author's other book on sugar and the desirability of a keto (or at least much lower sugar) diet. I think the book would have been improved if provided an initial chapter (or perhaps an appendix) on what diabetes was and basic anatomy/physiology behind it. This would have given material in the book more context.
I do think the historical discussion of diabetes treatments could have been greatly shortened, with more focus being on how guidelines for treatment changed in recent years - less say pre-1970 and more afterward as more information became available (largely as a result of technology) of how blood sugar/insulin/cholesterol interacted in the body. This last third of the book was most interesting, with much of the earlier discussion pretty slow-going.
Taubes has again done an amazing job pulling together all of this information, though ultimately I would liked to have had a shorter book more focused on the debate on how best to treat diabetes - something more like his famous "case against sugar" article and less on the very detailed history of research studies and their interpretation.
The book is very highly recommended, both for coverage of diabetes treatment and also the general question of how we develop scientific evidence and perhaps hold onto "conventional wisdom" longer than we should. I'm going to reread this book again, along with Gary's other related books.
PS For someone specifically interested in diabetes and its treatment, I'd suggest books by Dr. David Perlmutter and Mark Hyman - They review the evidence and explain science pretty clearly.
Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments
4.5 | 249 ratings
Price: 19.69
Last update: 01-04-2025
About this item
Top reviews from the United States
Dan Sherman
Excellent book though sometimes too detailed - Really important information, though!
Reviewed in the United States on January 11, 2024
Mark M
Taubes is a great writer
Reviewed in the United States on August 16, 2024
Kindle Customer
Always fantastic
Reviewed in the United States on April 17, 2024Art Jones
Fascinating, thought provoking and LONG
Reviewed in the United States on February 15, 2024P Vilefort
The Science Behind Proper Treatment of Diabetes & the Keys to Reversal
Reviewed in the United States on August 4, 2024John of Earth
Diabetics should be aware
Reviewed in the United States on September 10, 2024Amazon Customer
Poor Quality Hardback
Reviewed in the United States on January 28, 2024Eric M. Kahn
This is a book describing the facts if life!
Reviewed in the United States on September 4, 2024