21 ms·

Rethinking Diabetes – interview with Gary Taubes

135 points by prmph 3y ago

epgui 3y ago
[flagged]
- alphazard 3y ago
  Some fields attract higher levels of intellect and employ more rigorous methodologies than others. This is mostly a consequence of the economic value to be gained from working in a field, rather than anything deep about the nature of the problems in that field. There is plenty of low hanging fruit for smart people to pick by jumping over to a field that has less talent, and less sophisticated methodologies. For example many of the social sciences struggle to reproduce findings, and properly deploy the scientific method. There is no such crisis in experimental physics.
  - epgui 3y ago
    There is not much low hanging fruit in biochem / medicine in 2024. It’s a gargantuan mountain of knowledge you have to get through before you have any hope of seeing the big picture.
  - n2d4 3y ago
    > There is no such crisis in experimental physics. Then why do I keep hearing about superconductors on here? This sort of thinking comes from ignorance and arrogance. When you do research at the frontier of any subject, you won't compete with the average university graduate in that subject, you'll compete with people with the highest "intellect" who also studied this subject for their entire lives, and you're incredibly unlikely to find a breakthrough without doing that too. The amount of Nobel Prize winners who went on to support compete bogus theories in other fields is endless.
    - epgui 3y ago
      The comment... > There is no such crisis in experimental physics. ... also seems to completely miss that there is a spectrum from "hard" science to "soft" science (contrary to what many might expect, "soft" sciences are arguably much more difficult to work with), and that physics is the "hardest" (ie.: in many ways "most straightforward", although by this I do not mean to trivialize it at all) natural science there is. You need much more sophisticated statistical techniques & experimental design when you're dealing with complex systems (eg.: society, ecology, psychology, etc) than when you are dealing with simple systems (cue the joke about physicists assuming spherical cows).
- emmanuel_1234 3y ago
  He's not exactly new to the domain, now. One thing I appreciate with Taubes (having read his early books, not the more recent ones -- I really liked The case against sugar), is that he has an epistemologically correct approach to the problem. He looks at it through the eyes of a rigorous scientist, unlike most people in nutrition science. For the most part, he was very cautious in his claim and spent most of his time discussing why claims accepted as correct are completely full of shit. It's likely that, through time, he built a corpus of knowledge and understanding that allow him to be a bit more assertive today (again, I've not read his recent work), but really, his early books are, in my opinion, remarkable for their thoroughness and intellectual honesty.
  - epgui 3y ago
    > He looks at it through the eyes of a rigorous scientist, unlike most people in nutrition science I don’t know where you get your nutrition science, but that’s a very bizarre perspective.
    - emmanuel_1234 3y ago
      See for example https://en.wikipedia.org/wiki/Seven_Countries_Study https://en.wikipedia.org/wiki/Seven_Countries_Study
      - deleted 3y ago
        [deleted]
      - epgui 3y ago
        There is no shortage of studies whose conclusions were later found out to be false or overly-simplistic. Nutrition science isn't bad because nutrition scientists are bad. The truth is that nutrition is a very very young science, and it also happens to be one of the most difficult health sciences. It will take a very long time for the body of knowledge in that field to take form.
- dang 3y ago
  "Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something." "Don't be snarky." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
kshahkshah 3y ago
Is this basically a book review? Anyway, keto is great. I wasn’t terribly overweight and lost 19lbs in 9 weeks with it with a cheat day included. It’s great because it’s a very simple set of very few rules. It’s easy to adhere to because it removes moment decision making around whether or not you “should” or “deserve” to have X food. It’s nearly impossible for you to eat enough calories to maintain your current weight on keto when you’re already overweight. Therefore a deficit is nearly guaranteed therefore weightless is guaranteed. On top of all that you do get better at burning fat and don’t get as hungry. The counterpoint is the tough piece - how do you come off that diet and reenter the real world where people eat carbs. How can you get pizza with friends, etc. I understand their are some who view keto as a lifestyle, good for them but most people aren’t going to do that. Beyond the simple reality of calories are calories, none of this other stuff around fat vs protein vs carbs is really very hard to understand. Simple carbs are rocket fuel, they provide a lot of energy over a very short period of time. If you’re not going to use it, once the sugar saturates your blood, the excess will be taken out and stored. Then you’ll get hungry again. Fats are slower burning, so it’s harder for you to saturate your blood quickly. This is an over simplification obviously but this is just not so hard to understand that it needs to be an endless debate over or be positioned as controversial in order to sell books. 1. Losing weight can and often will fix your diabetes. 2. Be conscious of the method you choose for weight loss, when you obtain your goal weight - what will you do long term?
- drjasonharrison 3y ago
  The problem with your simple model of carbs, fats, proteins is that in people with type 2 diabetes their dietary fats have clogged up their muscle cells ability to store blood sugars as glycogen. So while removing the "rocket fuel" from the diet its not clear that the underlying problem has been solved. At least not until the fats have been removed from the muscle cells. And yes, transitioning off of a keto diet may lead to the reversal of the positive gains (insulin sensitivity, body composition, average blood sugar level measured using red blood cell oxidation or A1C). And agreed, controversy gains attention which may lead to book sales.
- pixl97 3y ago
  Don't forget to add fiber on this... Modern foods are horrifically fiber deficient, as in it's removed and fed back to animals. One of the key things you said around this is... >once the sugar saturates your blood, This is the glycemic index. Our modern diet is filled with foods that are pretty much instantly available to the bloodstream. If like me you have a continuous blood sugar monitor you can see this in effect. Drink a soda and minutes later your sugar levels go up. Eat simple carbs and 15-20 minutes and it starts climbing. Move to more complex carbohydrates and items high in fiber that take a long time to break down and the ramp is slower and less steep. The problem for just about everyone is how do we get away from our simple carbohydrate based lifestyles.
coldcode 3y ago
As a newly diagnosed Type 2, but not overweight, I take metformin and have a carefully altered my diet to slow down my digestion and have few easily digestible carbs (i.e. such as the whites, flour, sugar, potatoes and rice). But it takes 3 months to see if my A1C goes down (a measure of the past 3 months of blood sugar), so I won't know for a couple more months. Going keto to me seems like using a shotgun to kill a fly on your foot, it is too hard to keep up with, and causes other issues, while simply understanding how carbs affect your blood sugar is much easier to do. Part of the problem is that all the tables of carbs assume you are only eating the one thing (which is how they make the tables), but the actual affect on blood sugar spikes is the sum of what you ate. For example, eating a boiled potato by itself will spike a Type 2 steeply, but eating it with lots of butter will not. I prefer to understand my health issues by reading a wide variety of information from people who specialize in them, not just read one guy's opinion.
- chimeracoder 3y ago
  > ). But it takes 3 months to see if my A1C goes down (a measure of the past 3 months of blood sugar), so I won't know for a couple more months. Yes, though depending on what your diagnosis is, you may be able to get a monitor which allows you to track your blood sugar in near-realtime. The technology has advanced a lot in the last 20 years.
  - didgeoridoo 3y ago
    A1C represents the long-term glycation of hemoglobin due to blood sugar exposure. Even if you could measure it at home, it wouldn’t change fast enough for rapid tracking to be meaningful. You need to wait for red blood cells to be replaced (hence the 3 month cadence) before expecting any change in A1C.
    - chimeracoder 3y ago
      > A1C represents the long-term glycation of hemoglobin due to blood sugar exposure. You're not measuring HbA1C in real-time; you're measuring the blood sugar in real-time. HbA1C is a lagging indicator, used because it's a convenient and non-invasive diagnostic and a summary statistic. It's not the way you measure the short-term or medium-term effectiveness of interventions.
drjasonharrison 3y ago
Taub, a science writer, has a theory and book to sell. His theory that drugs instead of diet leads to later problems is pretty well established. I don't know if he also discusses how insulin resistance in type 2 diabetes starts, or how the ability of the pancreas to make insulin in adulthood can be damaged by fat soluble poisons leaking into and out of fat cells. As an alternative to his book, I suggest looking at the research on plant based diets fat toxity. https://nutritionfacts.org/topics/diabetes/ https://nutritionfacts.org/topics/diabetes/
- ramraj07 3y ago
  If nothing he says is fundamentally wrong, why not let this narrative be around. More people than not have a distaste in science nowadays and it’s beneficial to have multiple perspectives as long as they’re not scientifically inaccurate.
sgt101 3y ago
Great to see him (and this article) conflating Type 1 with Type 2. The kind of conflation that could kill someone. Good job, theguardian.
- Orangeair 3y ago
  [flagged]
  - peterfirefly 3y ago
    Didn't mean to be a copycat. Hadn't seen your response when I wrote mine.
  - dang 3y ago
    Please edit out swipes like "What are you talking about?" from your HN comments. They're never needed, and tend to degrade discussion. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
    - peterfirefly 3y ago
      Disagree in this case. It made the comment easier to read than my sibling comment that happened to use the exact same quote.
- peterfirefly 3y ago
  From the article: Another example, for Taubes, of how early researchers were mistaken, concerns the differences between type 1 and type 2 diabetes, which are so different they almost shouldn’t share a name.
  - sgt101 3y ago
    From the article: >Taubes has published five books on sugar, fat and carbohydrate, including his latest, Rethinking Diabetes, in which he posits that low-carb diets have been under-used as a way to manage blood glucose in type 1 and type 2 diabetes, in favour of drug-heavy treatment regimes which, he suspects, may do more harm than good. So, it conflates and then says "we shouldn't conflate". It's not good enough. I currently live with a type-1 teenager who is not at all happy about her condition and my family simply does not need cross talk that can be selectively quoted back at us over the dinner table. This sort of wording and "questioning" is harmful and dangerous. Before my daughter was diagnosed she got scary thin, we were seriously frightened by the process and I have no doubt that without insulin she would have died before her 10th birthday. Taking insulin or not taking insulin is a life and death issue for us, this sort of article is not the right place for a debate of this sort - that debate should happen in the scientific community. This isn't a popularity contest.
sombragris 3y ago
Type 2 here. The article text sounds strange to me, maybe because I live elsewhere than the US/UK. From Day 1 of my diagnosis (in 2009) I was prescribed a low-carb diet alongside with medication and, eventually, insulin. I was never told I could just manage my blood sugar with insulin and medication without a low-carb diet. So this guy comes across to me as preaching to the choir.
- emmanuel_1234 3y ago
  From all the diabetic I know, in France, Asia or North America, you're the only one I ever heard of with such recommendation. A friend of mine in France was actively advised _against_ a low-carb diet to control her diabetes. She did it anyway and saw incredible results. Nevertheless, and despite improvement on all indicators in her blood test, her doctor advised her to return to a normal diet and control it with insulin and "complex" carbs. That was in 2019.
  - ramraj07 3y ago
    My mother’s doctors do similar things - partly because they have internalized the “cultural impossibility” of old Asians to cut carbs and if someone says they are cutting carbs, according to their experience it’s often a lie. It’s also possible that some of these doctors have indoctrinated themselves into believing this can never work.
- wrycoder 3y ago
  You have an unusual doctor! Listen to them.
  - sombragris 3y ago
    It's standard diabetology doctrine in Paraguay (South America). Most diabetologists do it. They say that the key to control blood sugar lies in a multi-faceted approach. It's not "carb abstinence", but "carb restriction". Carbohydrates should be greatly reduced and if you must eat them, eat complex carbs with a lot of fiber instead of sugars. But they should be reduced as much as possible.
verisimi 3y ago
There are possible causes that simply cannot be considered on account of the level of investment that big pharma has sunk into that sort of treatment. No investigations are undertaken whereas such a cause should be a consideration. IMO.
brigadier132 3y ago
> For Taubes, dietary fat wasn’t a problem at all. Instead, the real danger was carbohydrate, he asserted, sparking a backlash, and fuelling the ongoing conversation about what constitutes a “healthy diet” I've successfully lost 80 pounds in the past year after 10 years of yoyo dieting with low carb and counting calories. I did not become a healthy weight until I was counting calories on a HIGH CARB and HIGH PROTEIN diet and doing a significant amount of exercise 6 days a week. Meaning, 1 gram of protein per pound of lean body mass, 1 gram of fat per 1/3rd of your weight in pounds and as many carbs that fit in your calorie budget and at least 30 grams of fiber. Note, I'm not giving advice to people with diabetes but the reason there are so many people with metabolic disease in this country is not carbs. It's lack of exercise (and walking) and processed high calorie food. Those french fries you are avoiding, the reason they have so many calories is not because of carbs, it's because of fat. If you want to lose weight and you plan to also exercise, going low carb will hamstring you. The difference between running in the morning fasted and running after eating a single banana is the difference between feeling like you are being tortured and being able bounce around like a bunny. I was literally lying in bed all day with 0 mental energy on my diet because I went low carb. I failed my diet 3 times over 10 years because I believed the low carb bullshit. Go look around at how many people successfully lose weight, they all believe the same low carb stupidity. I'm running 30 miles a week and lifting 6 days a week, if I went low carb I would be tired in bed all day. If you don't have diabetes or some other metabolic disease, don't go low carb.
- hackernoteng 3y ago
  Too low carb can actually slow down thyroid and end up increasing both LDL and A1C because overall metabolism slows down too much. healthy carbs combined with lots of exercise works.
  - paulpauper 3y ago
    but isn't ketosis supposed to increase metabolism
- VirusNewbie 3y ago
  >you. The difference between running in the morning fasted and running after eating a single banana is the difference between feeling like you are being tortured and being able bounce around like a bunny. This seems really wrong for the vast majority of people. Is your average person really bottlenecked by their blood glucose levels and not say, cardiovascular health or lung capacity? I think most people get winded in a hard run way before their muscles are low on energy and they are feeling sluggish, no?
sgift 3y ago
I'm surprised a bit that this seems to be contentious/not already part of normal treatment in the US? Or is the article wrong? Yes, Insulin is the "last line of defense" for Diabetes 2, but at least here in Germany dietary change (e.g. Keto or at least less carbs) is an essential part of treatment. And so are other medications (e.g. Metformin). Insulin is given if there's no other option, cause well, not giving insulin if your blood sugar is really bad leads to very bad outcomes, but if there is any other option doctors will take it first.
- phanimahesh 3y ago
  This matches my experience in India. A dietician consultation is recommended on diagnosis of diabetes, however adherence to low carb diet is low. Still, insulin is considered last line of defence if diet control, drugs like metformin, glimiperide, sitagliptin etc are not sufficient to keep blood glucose in check. Indians typically follow either a rice based diet in southern regions or wheat based diet in northen regions. Doctors down south recommend eating limited or no rice and switching to wheat based roti, whereas northen doctors recommend switching to rice. I suspect this is to reduce overall consumption, in anecdotal experiences it works better than just asking people to limit their preferred grain. People eat less of unfamiliar foods.
kamikaz1k 3y ago
It’s pretty amazing how many different ways people approach this problem. The article scared me a little when there were anecdotes about people just using an insulin pump to keep levels in check…do people understand what insulin does? Diabetes Type 2 is an awful name and needs to be rebranded. Type 1 is fixed by insulin, Type 2 is slowed down(?) by insulin, they’re not the same thing. This is kind of like how calorie restrictions will fix your issues, how you achieve that restriction is the hard and very human problem that people endlessly debate about. So the only lesson to take away is that this is a solvable problem, and ultimately you gotta cut calories (and exercise). But how is important; so keep trying till you find something that works for you.
rafaelero 3y ago
Putting together a lot of different foods inside the category of "carbohydrates" is stupid, and telling people to restrict it is even more stupid.
n2d4 3y ago
Good article, but there's one thing that really bothers me: > perhaps because of his serious and scientific background – he has a physics degree from Harvard and studied aerospace engineering at Stanford [...] Which, for the thing he's doing now, is not a serious background! Knowledge isn't transferrable and there are plenty examples of people who transfer fields with unwarranted confidence and make totally bogus claims (see the Nobel disease [1]). I wish we would stop claiming the opposite, because especially in a field like nutritional sciences you can find some "evidence" for any theory (see eg. the Chemical Hunger drama [2]). [1] https://en.wikipedia.org/wiki/Nobel_disease https://en.wikipedia.org/wiki/Nobel_disease [2] https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-getting-contaminated-by-the-wrong-obesity-ideas https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-get...
- shermantanktop 3y ago
  It's like some kind of Gell-Mann effect corollary. Scientists and other educated experts quoted in a newspaper carry automatic authority unless you understand the target field well enough. But if you do, you realize they are no more trustworthy than a guy on the bus. Titles don't help. An "environmental engineer" might not have sufficient knowledge about zoology or bridges to support whatever they are talking about, but a layperson might not realize that.
  - nhinck2 3y ago
    Coined as mann-gell if I'm remembering this video correctly. https://m.youtube.com/watch?v=wBBnfu8N_J0 https://m.youtube.com/watch?v=wBBnfu8N_J0
  - sph 3y ago
    The Gell-Mann effect overrates having an academic degree and doesn't count the fact that people might become experts in something they haven't done formal studies for. How can you tell whether I am as trustworthy as a guy on the bus on matters of software engineering? I am a high school dropout. Likewise, I'm no medical doctor, but knowledge is a spectrum, and I believe I know more than the average Joe on matters of nutrition because it is something that fascinates me and I've read and researched a lot about. Given that I've read and heard about Taubes for 15 years, it is simplistic to say the least that he doesn't know anything because he's got a physics background. tl;dr: the Gell-Mann effect only makes sense in a vacuum and if you really want to believe that having a degree automatically makes you an expert with worthwhile ideas.
pedalpete 3y ago
The next phase of diabetes treatment just may be sleep. 30% of people get insufficient sleep, which directly leads to increased insulin resistance the following day, along with increased appetite and craving for sugary and fattier foods, and a decrease in willpower. Diabetes needs to be treated as a whole person health, diet is absolutely key, but so is sleep and particularly as we age, as slow-wave sleep decreases naturally with age (this is what we're working on). https://www.cdc.gov/sleep/index.html https://www.cdc.gov/sleep/index.html
- aantix 3y ago
  ~30% of the population are slow metabolizers of caffeine, yet the prevailing attitude is that coffee is considered a “net positive”. For those with slow caffeine metabolism, it’s killing your sleep, it’s making you anxious and eventually it’s going to cut your life short. If you’re a slow metabolizer of caffeine, your sleep quality is suffering. Cut out caffeine for two weeks - see how deeper your sleep becomes. “ Slow caffeine metabolisers are: Associated with a higher risk of heart disease [19] Associated with a higher risk of hypertension [20] Associated with impaired fasting glucose [21] May not have the protective effects against some cancers that it appears to for “fast metabolisers” [22,23] A recent umbrella review of 218 meta-analyses concluded that coffee presented statistical harm only in pregnancy and possible fracture risk for women. [4]” https://www.thesustainabletrainingmethod.com/tstm-blog/2021/2/24/why-caffeine-is-not-a-consistent-performance-aid-for-all-recreational-athletes https://www.thesustainabletrainingmethod.com/tstm-blog/2021/...
dvektor 3y ago
Who else read this as: Rethinking databases - ?
adaszko 3y ago
Here's [1] how well the references check out for Taube's previous book. Is there any reason I should believe his newer books are any better? Here's a study funded by Taubes himself (!) That disproves his earlier claims: https://examine.com/articles/low-fat-vs-low-carb-for-weight-loss/ https://examine.com/articles/low-fat-vs-low-carb-for-weight-... [1]: https://thescienceofnutrition.wordpress.com/2014/04/05/good-calories-bad-calories-a-critical-review-chapter-1-the-eisenhower-paradox/ https://thescienceofnutrition.wordpress.com/2014/04/05/good-...
kshacker 3y ago
So I have been at risk of diabetes for 8 years ... started tracking actively since I had a cardiac incident. My first 2 years of cardiac recovery were whole food vegetarian with zero added sugar and they were awesome. But then the discipline slipped and it has been one thing after the other with degrading health (mostly A1c, still not diabetic, and weight gained 30 pounds in the past 6 years). Went back to Whole Foods plant based diet since January 1st and have cut down sugar significantly. This time I am prepared by having a fridge stocked with fruits and other alternatives when I get tempted to eat. But based on what I am reading in the interview, and the other comments on this post, am I chasing a fool's errand? My personal experience says that any diet works as long as you are disciplined, and although in my social circles (work and family), it is hard to be sugar free, it is still possible (along with vegetarianism) as compared to low carb. However, I do not see any advocates for that here, are there? Btw I am planning for a modified version of something called LMK diet, LMK is not a doctor and is probably at the extreme edges of selling veganism, and I am definitely not going that far, but going as close as I can. Mentioning it just in case someone wants to counter or support it.
- zargon 3y ago
  Gary Taubes is not a good source of information. Someone else posted this [1] review of another of his books. If you define "work" as losing weight, then sure any diet can indeed "work" if you're able to stick to it. But personally that wouldn't be my sole criteria, especially if I had had a cardiac event. I have never heard of LMK. I couldn't find any actual description of what that means except for a graphic at the bottom at lmkhealth.com, which needs clarification. Why are you wanting to follow LMK and not any of the usual WFPB doctors (Greger, Essylstyn, Campbell, McDougall, Ornish, Barnard, Fuhrman, etc.)? [1] https://thescienceofnutrition.wordpress.com/2014/04/05/good-calories-bad-calories-a-critical-review-chapter-1-the-eisenhower-paradox/ https://thescienceofnutrition.wordpress.com/2014/04/05/good-...
  - kshacker 3y ago
    > Why are you wanting to follow LMK and not any of the usual WFPB doctors (Greger, Essylstyn, McDougall, Ornish, Fuhrman, etc.)? No reason. I was ready for a change to vegetarian lifestyle anyways and a friend independently added me to whatsapp group run by him. He follows all the names you mention anyways so it is all the same to me. And I am familiar with all of these names since I followed them for a while but then got confused by the alternatives. He has a few youtube videos which repeat what he says on whatsapp just that whatsapp morphs into local support groups on completing first 2 months. Not yet there. Although he is a vegan killjoy, reason to prefer him would be indianized recipes.
stevebmark 3y ago
Skip Taubes!
mlsu 3y ago
I'm confused. De-loading carbs for fat makes sense for overall wellness and health (since healthy things tend to be fatty and/or low carb), but it is not possible to "manage" T1 without insulin treatment. The fact that either he or this article does not seem to distinguish between the two types in this regard is a basic category error. The low carb "managing" of T1d before the 1920s was basically a permanent hyperglycemia which you could last months, maybe years. Once your honeymoon period ends you die a spectacularly brutal death -- your blood turns to acid and you starve in insatiable hunger. None of this is "manageable" through diet, since your body has a baseline rate of gluconeogenesis entirely independent of diet. Type 1 and Type 2 sharing the "diabetes" name has to be up there on "most frustrating lexical errors" ever.
- locallost 3y ago
  The article says the exact same thing. Quote: Another example, for Taubes, of how early researchers were mistaken, concerns the differences between type 1 and type 2 diabetes, which are so different they almost shouldn’t share a name. Type 1 diabetes is an autoimmune disease in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin, the hormone which regulates the level of glucose in our blood; people living with type 1 need insulin injections or an insulin pump, to survive. Like type 2, type 1 can cause complications such as heart, kidney or eye disease, and nerve damage. Type 2 diabetes accounts for about 90% of cases, and is a metabolic disorder in which the body either can’t make or can’t use insulin (AKA insulin resistance) to metabolise glucose, leading to persistently high levels in the blood. Ultimately, people living with type 2 diabetes may need insulin and other diabetes medications, too, but for a lot of people, diet and lifestyle modifications can defer that need.

135 points by prmph 3y ago

epgui 3y ago

[flagged]

alphazard 3y ago
Some fields attract higher levels of intellect and employ more rigorous methodologies than others. This is mostly a consequence of the economic value to be gained from working in a field, rather than anything deep about the nature of the problems in that field. There is plenty of low hanging fruit for smart people to pick by jumping over to a field that has less talent, and less sophisticated methodologies. For example many of the social sciences struggle to reproduce findings, and properly deploy the scientific method. There is no such crisis in experimental physics.
- epgui 3y ago
  There is not much low hanging fruit in biochem / medicine in 2024. It’s a gargantuan mountain of knowledge you have to get through before you have any hope of seeing the big picture.
- n2d4 3y ago
  > There is no such crisis in experimental physics. Then why do I keep hearing about superconductors on here? This sort of thinking comes from ignorance and arrogance. When you do research at the frontier of any subject, you won't compete with the average university graduate in that subject, you'll compete with people with the highest "intellect" who also studied this subject for their entire lives, and you're incredibly unlikely to find a breakthrough without doing that too. The amount of Nobel Prize winners who went on to support compete bogus theories in other fields is endless.
  - epgui 3y ago
    The comment... > There is no such crisis in experimental physics. ... also seems to completely miss that there is a spectrum from "hard" science to "soft" science (contrary to what many might expect, "soft" sciences are arguably much more difficult to work with), and that physics is the "hardest" (ie.: in many ways "most straightforward", although by this I do not mean to trivialize it at all) natural science there is. You need much more sophisticated statistical techniques & experimental design when you're dealing with complex systems (eg.: society, ecology, psychology, etc) than when you are dealing with simple systems (cue the joke about physicists assuming spherical cows).
emmanuel_1234 3y ago
He's not exactly new to the domain, now. One thing I appreciate with Taubes (having read his early books, not the more recent ones -- I really liked The case against sugar), is that he has an epistemologically correct approach to the problem. He looks at it through the eyes of a rigorous scientist, unlike most people in nutrition science. For the most part, he was very cautious in his claim and spent most of his time discussing why claims accepted as correct are completely full of shit. It's likely that, through time, he built a corpus of knowledge and understanding that allow him to be a bit more assertive today (again, I've not read his recent work), but really, his early books are, in my opinion, remarkable for their thoroughness and intellectual honesty.
- epgui 3y ago
  > He looks at it through the eyes of a rigorous scientist, unlike most people in nutrition science I don’t know where you get your nutrition science, but that’s a very bizarre perspective.
  - emmanuel_1234 3y ago
    See for example https://en.wikipedia.org/wiki/Seven_Countries_Study https://en.wikipedia.org/wiki/Seven_Countries_Study
    - deleted 3y ago
      [deleted]
    - epgui 3y ago
      There is no shortage of studies whose conclusions were later found out to be false or overly-simplistic. Nutrition science isn't bad because nutrition scientists are bad. The truth is that nutrition is a very very young science, and it also happens to be one of the most difficult health sciences. It will take a very long time for the body of knowledge in that field to take form.
dang 3y ago
"Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something." "Don't be snarky." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

kshahkshah 3y ago

Is this basically a book review? Anyway, keto is great. I wasn’t terribly overweight and lost 19lbs in 9 weeks with it with a cheat day included. It’s great because it’s a very simple set of very few rules. It’s easy to adhere to because it removes moment decision making around whether or not you “should” or “deserve” to have X food. It’s nearly impossible for you to eat enough calories to maintain your current weight on keto when you’re already overweight. Therefore a deficit is nearly guaranteed therefore weightless is guaranteed. On top of all that you do get better at burning fat and don’t get as hungry. The counterpoint is the tough piece - how do you come off that diet and reenter the real world where people eat carbs. How can you get pizza with friends, etc. I understand their are some who view keto as a lifestyle, good for them but most people aren’t going to do that. Beyond the simple reality of calories are calories, none of this other stuff around fat vs protein vs carbs is really very hard to understand. Simple carbs are rocket fuel, they provide a lot of energy over a very short period of time. If you’re not going to use it, once the sugar saturates your blood, the excess will be taken out and stored. Then you’ll get hungry again. Fats are slower burning, so it’s harder for you to saturate your blood quickly. This is an over simplification obviously but this is just not so hard to understand that it needs to be an endless debate over or be positioned as controversial in order to sell books. 1. Losing weight can and often will fix your diabetes. 2. Be conscious of the method you choose for weight loss, when you obtain your goal weight - what will you do long term?

drjasonharrison 3y ago
The problem with your simple model of carbs, fats, proteins is that in people with type 2 diabetes their dietary fats have clogged up their muscle cells ability to store blood sugars as glycogen. So while removing the "rocket fuel" from the diet its not clear that the underlying problem has been solved. At least not until the fats have been removed from the muscle cells. And yes, transitioning off of a keto diet may lead to the reversal of the positive gains (insulin sensitivity, body composition, average blood sugar level measured using red blood cell oxidation or A1C). And agreed, controversy gains attention which may lead to book sales.
pixl97 3y ago
Don't forget to add fiber on this... Modern foods are horrifically fiber deficient, as in it's removed and fed back to animals. One of the key things you said around this is... >once the sugar saturates your blood, This is the glycemic index. Our modern diet is filled with foods that are pretty much instantly available to the bloodstream. If like me you have a continuous blood sugar monitor you can see this in effect. Drink a soda and minutes later your sugar levels go up. Eat simple carbs and 15-20 minutes and it starts climbing. Move to more complex carbohydrates and items high in fiber that take a long time to break down and the ramp is slower and less steep. The problem for just about everyone is how do we get away from our simple carbohydrate based lifestyles.

coldcode 3y ago

As a newly diagnosed Type 2, but not overweight, I take metformin and have a carefully altered my diet to slow down my digestion and have few easily digestible carbs (i.e. such as the whites, flour, sugar, potatoes and rice). But it takes 3 months to see if my A1C goes down (a measure of the past 3 months of blood sugar), so I won't know for a couple more months. Going keto to me seems like using a shotgun to kill a fly on your foot, it is too hard to keep up with, and causes other issues, while simply understanding how carbs affect your blood sugar is much easier to do. Part of the problem is that all the tables of carbs assume you are only eating the one thing (which is how they make the tables), but the actual affect on blood sugar spikes is the sum of what you ate. For example, eating a boiled potato by itself will spike a Type 2 steeply, but eating it with lots of butter will not. I prefer to understand my health issues by reading a wide variety of information from people who specialize in them, not just read one guy's opinion.

chimeracoder 3y ago
> ). But it takes 3 months to see if my A1C goes down (a measure of the past 3 months of blood sugar), so I won't know for a couple more months. Yes, though depending on what your diagnosis is, you may be able to get a monitor which allows you to track your blood sugar in near-realtime. The technology has advanced a lot in the last 20 years.
- didgeoridoo 3y ago
  A1C represents the long-term glycation of hemoglobin due to blood sugar exposure. Even if you could measure it at home, it wouldn’t change fast enough for rapid tracking to be meaningful. You need to wait for red blood cells to be replaced (hence the 3 month cadence) before expecting any change in A1C.
  - chimeracoder 3y ago
    > A1C represents the long-term glycation of hemoglobin due to blood sugar exposure. You're not measuring HbA1C in real-time; you're measuring the blood sugar in real-time. HbA1C is a lagging indicator, used because it's a convenient and non-invasive diagnostic and a summary statistic. It's not the way you measure the short-term or medium-term effectiveness of interventions.

drjasonharrison 3y ago

Taub, a science writer, has a theory and book to sell. His theory that drugs instead of diet leads to later problems is pretty well established. I don't know if he also discusses how insulin resistance in type 2 diabetes starts, or how the ability of the pancreas to make insulin in adulthood can be damaged by fat soluble poisons leaking into and out of fat cells. As an alternative to his book, I suggest looking at the research on plant based diets fat toxity. https://nutritionfacts.org/topics/diabetes/ https://nutritionfacts.org/topics/diabetes/

ramraj07 3y ago
If nothing he says is fundamentally wrong, why not let this narrative be around. More people than not have a distaste in science nowadays and it’s beneficial to have multiple perspectives as long as they’re not scientifically inaccurate.

sgt101 3y ago

Great to see him (and this article) conflating Type 1 with Type 2. The kind of conflation that could kill someone. Good job, theguardian.

Orangeair 3y ago
[flagged]
- peterfirefly 3y ago
  Didn't mean to be a copycat. Hadn't seen your response when I wrote mine.
- dang 3y ago
  Please edit out swipes like "What are you talking about?" from your HN comments. They're never needed, and tend to degrade discussion. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
  - peterfirefly 3y ago
    Disagree in this case. It made the comment easier to read than my sibling comment that happened to use the exact same quote.
peterfirefly 3y ago
From the article: Another example, for Taubes, of how early researchers were mistaken, concerns the differences between type 1 and type 2 diabetes, which are so different they almost shouldn’t share a name.
- sgt101 3y ago
  From the article: >Taubes has published five books on sugar, fat and carbohydrate, including his latest, Rethinking Diabetes, in which he posits that low-carb diets have been under-used as a way to manage blood glucose in type 1 and type 2 diabetes, in favour of drug-heavy treatment regimes which, he suspects, may do more harm than good. So, it conflates and then says "we shouldn't conflate". It's not good enough. I currently live with a type-1 teenager who is not at all happy about her condition and my family simply does not need cross talk that can be selectively quoted back at us over the dinner table. This sort of wording and "questioning" is harmful and dangerous. Before my daughter was diagnosed she got scary thin, we were seriously frightened by the process and I have no doubt that without insulin she would have died before her 10th birthday. Taking insulin or not taking insulin is a life and death issue for us, this sort of article is not the right place for a debate of this sort - that debate should happen in the scientific community. This isn't a popularity contest.

sombragris 3y ago

Type 2 here. The article text sounds strange to me, maybe because I live elsewhere than the US/UK. From Day 1 of my diagnosis (in 2009) I was prescribed a low-carb diet alongside with medication and, eventually, insulin. I was never told I could just manage my blood sugar with insulin and medication without a low-carb diet. So this guy comes across to me as preaching to the choir.

emmanuel_1234 3y ago
From all the diabetic I know, in France, Asia or North America, you're the only one I ever heard of with such recommendation. A friend of mine in France was actively advised _against_ a low-carb diet to control her diabetes. She did it anyway and saw incredible results. Nevertheless, and despite improvement on all indicators in her blood test, her doctor advised her to return to a normal diet and control it with insulin and "complex" carbs. That was in 2019.
- ramraj07 3y ago
  My mother’s doctors do similar things - partly because they have internalized the “cultural impossibility” of old Asians to cut carbs and if someone says they are cutting carbs, according to their experience it’s often a lie. It’s also possible that some of these doctors have indoctrinated themselves into believing this can never work.
wrycoder 3y ago
You have an unusual doctor! Listen to them.
- sombragris 3y ago
  It's standard diabetology doctrine in Paraguay (South America). Most diabetologists do it. They say that the key to control blood sugar lies in a multi-faceted approach. It's not "carb abstinence", but "carb restriction". Carbohydrates should be greatly reduced and if you must eat them, eat complex carbs with a lot of fiber instead of sugars. But they should be reduced as much as possible.

verisimi 3y ago

There are possible causes that simply cannot be considered on account of the level of investment that big pharma has sunk into that sort of treatment. No investigations are undertaken whereas such a cause should be a consideration. IMO.

brigadier132 3y ago

> For Taubes, dietary fat wasn’t a problem at all. Instead, the real danger was carbohydrate, he asserted, sparking a backlash, and fuelling the ongoing conversation about what constitutes a “healthy diet” I've successfully lost 80 pounds in the past year after 10 years of yoyo dieting with low carb and counting calories. I did not become a healthy weight until I was counting calories on a HIGH CARB and HIGH PROTEIN diet and doing a significant amount of exercise 6 days a week. Meaning, 1 gram of protein per pound of lean body mass, 1 gram of fat per 1/3rd of your weight in pounds and as many carbs that fit in your calorie budget and at least 30 grams of fiber. Note, I'm not giving advice to people with diabetes but the reason there are so many people with metabolic disease in this country is not carbs. It's lack of exercise (and walking) and processed high calorie food. Those french fries you are avoiding, the reason they have so many calories is not because of carbs, it's because of fat. If you want to lose weight and you plan to also exercise, going low carb will hamstring you. The difference between running in the morning fasted and running after eating a single banana is the difference between feeling like you are being tortured and being able bounce around like a bunny. I was literally lying in bed all day with 0 mental energy on my diet because I went low carb. I failed my diet 3 times over 10 years because I believed the low carb bullshit. Go look around at how many people successfully lose weight, they all believe the same low carb stupidity. I'm running 30 miles a week and lifting 6 days a week, if I went low carb I would be tired in bed all day. If you don't have diabetes or some other metabolic disease, don't go low carb.

hackernoteng 3y ago
Too low carb can actually slow down thyroid and end up increasing both LDL and A1C because overall metabolism slows down too much. healthy carbs combined with lots of exercise works.
- paulpauper 3y ago
  but isn't ketosis supposed to increase metabolism
VirusNewbie 3y ago
>you. The difference between running in the morning fasted and running after eating a single banana is the difference between feeling like you are being tortured and being able bounce around like a bunny. This seems really wrong for the vast majority of people. Is your average person really bottlenecked by their blood glucose levels and not say, cardiovascular health or lung capacity? I think most people get winded in a hard run way before their muscles are low on energy and they are feeling sluggish, no?

sgift 3y ago

I'm surprised a bit that this seems to be contentious/not already part of normal treatment in the US? Or is the article wrong? Yes, Insulin is the "last line of defense" for Diabetes 2, but at least here in Germany dietary change (e.g. Keto or at least less carbs) is an essential part of treatment. And so are other medications (e.g. Metformin). Insulin is given if there's no other option, cause well, not giving insulin if your blood sugar is really bad leads to very bad outcomes, but if there is any other option doctors will take it first.

phanimahesh 3y ago
This matches my experience in India. A dietician consultation is recommended on diagnosis of diabetes, however adherence to low carb diet is low. Still, insulin is considered last line of defence if diet control, drugs like metformin, glimiperide, sitagliptin etc are not sufficient to keep blood glucose in check. Indians typically follow either a rice based diet in southern regions or wheat based diet in northen regions. Doctors down south recommend eating limited or no rice and switching to wheat based roti, whereas northen doctors recommend switching to rice. I suspect this is to reduce overall consumption, in anecdotal experiences it works better than just asking people to limit their preferred grain. People eat less of unfamiliar foods.

kamikaz1k 3y ago

It’s pretty amazing how many different ways people approach this problem. The article scared me a little when there were anecdotes about people just using an insulin pump to keep levels in check…do people understand what insulin does? Diabetes Type 2 is an awful name and needs to be rebranded. Type 1 is fixed by insulin, Type 2 is slowed down(?) by insulin, they’re not the same thing. This is kind of like how calorie restrictions will fix your issues, how you achieve that restriction is the hard and very human problem that people endlessly debate about. So the only lesson to take away is that this is a solvable problem, and ultimately you gotta cut calories (and exercise). But how is important; so keep trying till you find something that works for you.

rafaelero 3y ago

Putting together a lot of different foods inside the category of "carbohydrates" is stupid, and telling people to restrict it is even more stupid.

n2d4 3y ago

Good article, but there's one thing that really bothers me: > perhaps because of his serious and scientific background – he has a physics degree from Harvard and studied aerospace engineering at Stanford [...] Which, for the thing he's doing now, is not a serious background! Knowledge isn't transferrable and there are plenty examples of people who transfer fields with unwarranted confidence and make totally bogus claims (see the Nobel disease [1]). I wish we would stop claiming the opposite, because especially in a field like nutritional sciences you can find some "evidence" for any theory (see eg. the Chemical Hunger drama [2]). [1] https://en.wikipedia.org/wiki/Nobel_disease https://en.wikipedia.org/wiki/Nobel_disease [2] https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-getting-contaminated-by-the-wrong-obesity-ideas https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-get...

shermantanktop 3y ago
It's like some kind of Gell-Mann effect corollary. Scientists and other educated experts quoted in a newspaper carry automatic authority unless you understand the target field well enough. But if you do, you realize they are no more trustworthy than a guy on the bus. Titles don't help. An "environmental engineer" might not have sufficient knowledge about zoology or bridges to support whatever they are talking about, but a layperson might not realize that.
- nhinck2 3y ago
  Coined as mann-gell if I'm remembering this video correctly. https://m.youtube.com/watch?v=wBBnfu8N_J0 https://m.youtube.com/watch?v=wBBnfu8N_J0
- sph 3y ago
  The Gell-Mann effect overrates having an academic degree and doesn't count the fact that people might become experts in something they haven't done formal studies for. How can you tell whether I am as trustworthy as a guy on the bus on matters of software engineering? I am a high school dropout. Likewise, I'm no medical doctor, but knowledge is a spectrum, and I believe I know more than the average Joe on matters of nutrition because it is something that fascinates me and I've read and researched a lot about. Given that I've read and heard about Taubes for 15 years, it is simplistic to say the least that he doesn't know anything because he's got a physics background. tl;dr: the Gell-Mann effect only makes sense in a vacuum and if you really want to believe that having a degree automatically makes you an expert with worthwhile ideas.

pedalpete 3y ago

The next phase of diabetes treatment just may be sleep. 30% of people get insufficient sleep, which directly leads to increased insulin resistance the following day, along with increased appetite and craving for sugary and fattier foods, and a decrease in willpower. Diabetes needs to be treated as a whole person health, diet is absolutely key, but so is sleep and particularly as we age, as slow-wave sleep decreases naturally with age (this is what we're working on). https://www.cdc.gov/sleep/index.html https://www.cdc.gov/sleep/index.html

aantix 3y ago
~30% of the population are slow metabolizers of caffeine, yet the prevailing attitude is that coffee is considered a “net positive”. For those with slow caffeine metabolism, it’s killing your sleep, it’s making you anxious and eventually it’s going to cut your life short. If you’re a slow metabolizer of caffeine, your sleep quality is suffering. Cut out caffeine for two weeks - see how deeper your sleep becomes. “ Slow caffeine metabolisers are: Associated with a higher risk of heart disease [19] Associated with a higher risk of hypertension [20] Associated with impaired fasting glucose [21] May not have the protective effects against some cancers that it appears to for “fast metabolisers” [22,23] A recent umbrella review of 218 meta-analyses concluded that coffee presented statistical harm only in pregnancy and possible fracture risk for women. [4]” https://www.thesustainabletrainingmethod.com/tstm-blog/2021/2/24/why-caffeine-is-not-a-consistent-performance-aid-for-all-recreational-athletes https://www.thesustainabletrainingmethod.com/tstm-blog/2021/...

dvektor 3y ago

Who else read this as: Rethinking databases - ?

adaszko 3y ago

Here's [1] how well the references check out for Taube's previous book. Is there any reason I should believe his newer books are any better? Here's a study funded by Taubes himself (!) That disproves his earlier claims: https://examine.com/articles/low-fat-vs-low-carb-for-weight-loss/ https://examine.com/articles/low-fat-vs-low-carb-for-weight-... [1]: https://thescienceofnutrition.wordpress.com/2014/04/05/good-calories-bad-calories-a-critical-review-chapter-1-the-eisenhower-paradox/ https://thescienceofnutrition.wordpress.com/2014/04/05/good-...

kshacker 3y ago

So I have been at risk of diabetes for 8 years ... started tracking actively since I had a cardiac incident. My first 2 years of cardiac recovery were whole food vegetarian with zero added sugar and they were awesome. But then the discipline slipped and it has been one thing after the other with degrading health (mostly A1c, still not diabetic, and weight gained 30 pounds in the past 6 years). Went back to Whole Foods plant based diet since January 1st and have cut down sugar significantly. This time I am prepared by having a fridge stocked with fruits and other alternatives when I get tempted to eat. But based on what I am reading in the interview, and the other comments on this post, am I chasing a fool's errand? My personal experience says that any diet works as long as you are disciplined, and although in my social circles (work and family), it is hard to be sugar free, it is still possible (along with vegetarianism) as compared to low carb. However, I do not see any advocates for that here, are there? Btw I am planning for a modified version of something called LMK diet, LMK is not a doctor and is probably at the extreme edges of selling veganism, and I am definitely not going that far, but going as close as I can. Mentioning it just in case someone wants to counter or support it.

zargon 3y ago
Gary Taubes is not a good source of information. Someone else posted this [1] review of another of his books. If you define "work" as losing weight, then sure any diet can indeed "work" if you're able to stick to it. But personally that wouldn't be my sole criteria, especially if I had had a cardiac event. I have never heard of LMK. I couldn't find any actual description of what that means except for a graphic at the bottom at lmkhealth.com, which needs clarification. Why are you wanting to follow LMK and not any of the usual WFPB doctors (Greger, Essylstyn, Campbell, McDougall, Ornish, Barnard, Fuhrman, etc.)? [1] https://thescienceofnutrition.wordpress.com/2014/04/05/good-calories-bad-calories-a-critical-review-chapter-1-the-eisenhower-paradox/ https://thescienceofnutrition.wordpress.com/2014/04/05/good-...
- kshacker 3y ago
  > Why are you wanting to follow LMK and not any of the usual WFPB doctors (Greger, Essylstyn, McDougall, Ornish, Fuhrman, etc.)? No reason. I was ready for a change to vegetarian lifestyle anyways and a friend independently added me to whatsapp group run by him. He follows all the names you mention anyways so it is all the same to me. And I am familiar with all of these names since I followed them for a while but then got confused by the alternatives. He has a few youtube videos which repeat what he says on whatsapp just that whatsapp morphs into local support groups on completing first 2 months. Not yet there. Although he is a vegan killjoy, reason to prefer him would be indianized recipes.

stevebmark 3y ago

Skip Taubes!

mlsu 3y ago

I'm confused. De-loading carbs for fat makes sense for overall wellness and health (since healthy things tend to be fatty and/or low carb), but it is not possible to "manage" T1 without insulin treatment. The fact that either he or this article does not seem to distinguish between the two types in this regard is a basic category error. The low carb "managing" of T1d before the 1920s was basically a permanent hyperglycemia which you could last months, maybe years. Once your honeymoon period ends you die a spectacularly brutal death -- your blood turns to acid and you starve in insatiable hunger. None of this is "manageable" through diet, since your body has a baseline rate of gluconeogenesis entirely independent of diet. Type 1 and Type 2 sharing the "diabetes" name has to be up there on "most frustrating lexical errors" ever.

locallost 3y ago
The article says the exact same thing. Quote: Another example, for Taubes, of how early researchers were mistaken, concerns the differences between type 1 and type 2 diabetes, which are so different they almost shouldn’t share a name. Type 1 diabetes is an autoimmune disease in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin, the hormone which regulates the level of glucose in our blood; people living with type 1 need insulin injections or an insulin pump, to survive. Like type 2, type 1 can cause complications such as heart, kidney or eye disease, and nerve damage. Type 2 diabetes accounts for about 90% of cases, and is a metabolic disorder in which the body either can’t make or can’t use insulin (AKA insulin resistance) to metabolise glucose, leading to persistently high levels in the blood. Ultimately, people living with type 2 diabetes may need insulin and other diabetes medications, too, but for a lot of people, diet and lifestyle modifications can defer that need.