The Diabetes Code. Dr. Jason Fung

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)

HOW TO REVERSE AND PREVENT TYPE 2 DIABETES: THE QUICK START GUIDE

      THIRTY YEARS AGO, home electronics, such as a brand new VCR, came with a thick instruction manual. “Read thoroughly before proceeding,” it implored, and then launched into detailed setup procedures and troubleshooting guides that painstakingly described everything that could possibly go wrong. Most of us ignored this manual, plugged in our new purchase, and then tried to figure out the rest when the time clock began to blink 12:00.

      Today, new electronics come with a quick start guide that outlines a few basic steps to get your machine working. Everything else is still referenced in a detailed instruction manual, now often found online, but there’s really no need to consult it until you want your machine to perform more complex functions. Instruction manuals are just so much more useful this way.

      Consider this section of the book the quick start guide for reversing and preventing type 2 diabetes. It’s a brief introduction to the disease: what it is, why conventional treatment approaches don’t work, and what you can do today to start effectively managing your health.

       FACT: TYPE 2 DIABETES IS FULLY REVERSIBLE AND PREVENTABLE

      MOST HEALTH PROFESIONALS consider type 2 diabetes to be a chronic and progressive disease. This promotes the idea that type 2 diabetes is a one-way street, a life sentence with no possibility of parole: the disease continually gets worse until you eventually require insulin injections.

      But this is actually a great big lie, which is excellent news for anyone who has been diagnosed with prediabetes or type 2 diabetes. Recognizing the fallacy of this belief is the crucial first step in reversing the disease. Actually, most people already instinctively recognize this. It’s ridiculously easy to prove that type 2 diabetes is almost always reversible.

      Suppose you have a friend who is diagnosed with type 2 diabetes, meaning the level of glucose in his blood is continuously above normal levels. He works hard to lose 50 pounds, which enables him to stop taking his glucose-lowering medications because the levels in his blood are now normal. What would you say to him? Probably something like “Great job. You’re really taking care of yourself. Keep it up!”

      What you wouldn’t say is something like “You’re such a filthy liar. My doctor says this is a chronic and progressive disease so you must be lying.” It seems perfectly obvious that the diabetes reversed because your friend lost all that weight. And that’s the point: type 2 diabetes is a reversible disease.

      We’ve intuitively sensed this truth all along. But only diet and lifestyle changes—not medications—will reverse this disease, simply because type 2 diabetes is largely a dietary disease. The most important determinant, of course, is weight loss. Most of the medications used to treat type 2 diabetes do not cause weight loss. Quite the contrary. Insulin, for example,