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FOREWORD

IN JUST A generation, diabetes has gone from rarity to epidemic, a catastrophic turn that presents urgent questions: Why are so many suffering, and so suddenly? And how have our health authorities failed to offer an explanation or treatment for so devastating a scourge, despite spending billions? They have, instead, essentially given up on finding a cure, pronouncing type 2 diabetes¹ a chronic, progressive disease that promises a life of slow, painful decline and early death.

Tragically, diabetes authorities worldwide have come to the consensus that the best hope for sufferers is merely to control or delay the disease through a lifelong dependence on medications combined with medical devices and surgery. There is no emphasis on better nutrition. Instead, some forty-five international medical and scientific societies and associations around the world declared in 2016 that bariatric surgery, which is both expensive and risky, should be the first option for diabetes treatment. Another recently approved idea is a new weight-loss procedure in which a thin tube, implanted in the stomach, ejects food from the body before all the calories can be absorbed, which some have termed “medically sanctioned bulimia.” And all this is in addition to the basic regimen for diabetes sufferers: multiple medications, which cost hundreds of dollars a month, and which include insulin, a drug that paradoxically often causes weight gain.

These techniques for managing diabetes are expensive, invasive, and do nothing to reverse diabetes—because, as Dr. Jason Fung explains in The Diabetes Code, “you can’t use drugs [or devices] to cure a dietary disease.”

The groundbreaking idea Dr. Fung presents in these pages is that diabetes is caused by our bodies’ insulin response to chronic overconsumption of carbohydrates and that the best and most natural way to reverse the disease is to reduce consumption of those carbohydrates. A low-carbohydrate diet for treating obesity is not only being practiced now by hundreds of doctors around the world but is supported by more than seventy-five clinical trials, conducted on altogether thousands of people, including several trials of two years’ duration, which establish the diet as safe and effective.

Remarkably, the practice of carbohydrate restriction for diabetes dates back more than a century, when the diet was considered standard treatment. According to a 1923 medical text by the “father of modern medicine,” Sir William Osler, the disease could be defined as one in which “the normal utilization of carbohydrate is impaired.” Yet soon thereafter, when pharmaceutical insulin became available, that advice changed, allowing a higher-carbohydrate intake to again become the norm.

Osler’s idea would not be revived until science journalist Gary Taubes unearthed and developed it into a comprehensive intellectual framework for the “carbohydrate-insulin” hypothesis, in his seminal 2007 book Good Calories, Bad Calories. And the modern-day clinical model for diabetics was set forth by scientists Stephen D. Phinney and Jeff S. Volek, as well as the physician Richard K. Bernstein.²

In an exciting recent development, clinical trial evidence specifically on diabetics is now emerging. As of this writing, at least one trial, involving some 330 people, is underway for the treatment of the disease with a very low-carbohydrate diet. At the one-year mark, researchers found that some 97 percent of patients had reduced or halted their insulin use, and 58 percent no longer had a formal diagnosis of diabetes.³ In other words, these patients successfully reversed their diabetes simply by restricting carbohydrates—findings that ought to be compared to the official standard of care for diabetics, which states with 100 percent certainty that the condition is “irreversible.”

Dr. Fung, a practicing nephrologist who gained renown by introducing intermittent fasting for the control of obesity, is a passionate and articulate proponent of the low-carbohydrate approach. In addition to his fascinating insights, he has a gift for explaining complex science clearly and delivering it with the perfect, telling anecdote. One never forgets, for instance, the image of Japanese rush-hour commuters being shoved into overstuffed subways cars as a metaphor for excessive circulating glucose packed into each and every corporeal cell. We get the point: the body cannot handle so much glucose! Dr. Fung explains the relationship between glucose and insulin and how these together drive not only obesity and diabetes but also, quite likely, a host of other related chronic diseases as well.

The obvious question is why this low-carbohydrate approach is not more widely known. Indeed, in the six months prior to my writing this foreword, major review articles on obesity appeared in such respected publications as the New York Times, Scientific American, and Time magazine, yet among the thousands of words written, there was barely a mention of the word that can explain so much: insulin. This oversight is perplexing but is also, unfortunately, the reflection of genuine bias pervading an expert community that has for half a century endorsed a very different approach.

That approach, of course, has been to count calories and avoid fat. In recent years, authorities including the U.S. Department of Agriculture and Department of Health and Human Services, which jointly publish Dietary Guidelines for Americans, as well as the American Heart Association, have backed off the “low-fat” diet, yet they still believe weight control can be explained by little more than a model of Calories In, Calories Out. A good deal of rigorous science debunks this notion, and the epidemics of chronic disease have not, to date, been curbed by it, but its captivating simplicity and widespread expert support allow it to endure.

There is also the stark reality that most medical associations today are significantly funded by pharmaceutical and device companies, which have no interest in a dietary solution to disease. Indeed, a nutritional fix that reverses disease and ends the need for medication puts them squarely out of business. This must explain why attendees at recent annual meetings of the American Diabetes Association (ADA) have reported that amidst a sea of presentations on medical devices and surgeries, there’s a near-complete absence of any information on low-carbohydrate diets. And this fact must explain why, when the medical directors of two obesity clinics (including one at Harvard University) wrote an op-ed published in the New York Times about the lack of discussion on diet at the 2016 ADA conference, the ADA itself shot them down.⁴ One might assume also that, in addition to financial conflicts of interest, the cognitive dissonance must be overwhelming for experts confronting information implying that their knowledge and advice of the past fifty years is simply wrong. In fact, more than wrong: harmful.

For this is the unvarnished truth: the success of carbohydrate restriction directly implies that the last several decades of low-fat, high-carbohydrate nutrition advice has almost certainly fueled the very obesity and diabetes epidemics it was intended to prevent. This is a devastating conclusion to half a century of public health efforts, but if we are to have any hope of reversing these epidemics, we must accept this possibility, begin to explore the alternative science contained in this book, and start on a new path forward—for the sake of truth, science, and better health.

NINA TEICHOLZ

AUTHOR OF THE international bestseller, The Big Fat Surprise (Simon & Schuster 2014)