The Diabetes Code

Foreword

Overview

The foreword frames type 2 diabetes as a modern epidemic fueled by a catastrophic failure of conventional medical wisdom. It charges that health authorities, despite massive spending, have abandoned the search for a cure, instead consigning patients to a lifetime of expensive medications, invasive devices, and surgeries that only manage symptoms. This approach is contrasted with a century-old, evidence-based dietary solution: reducing carbohydrate intake to lower insulin levels. The introduction positions Dr. Jason Fung’s book as a crucial challenge to the prevailing, failed paradigm, arguing that decades of low-fat, high-carbohydrate advice have directly fueled the diabetes crisis, a truth obscured by financial conflicts and institutional bias within the medical establishment.

The Core Idea: A Dietary Disease Requires a Dietary Cure

The central premise introduced is that type 2 diabetes is a "dietary disease" rooted in the body's insulin response to chronic overconsumption of carbohydrates and sugar. The failure of drugs to cure it is presented as logical: "you can't use drugs to cure a dietary disease." This idea is not new but a revival of a treatment standard from the early 20th century, later buried by the advent of pharmaceutical insulin. Modern proponents like Gary Taubes, and researchers like Phinney and Volek, have rebuilt the scientific case for the carbohydrate-insulin model, which is now supported by numerous clinical trials showing dramatic reversal of diabetes through dietary change alone.

Institutional Resistance and the Path Forward

A perplexing question is addressed: why isn't this effective, low-cost dietary approach widely adopted? The text points to a combination of deep-seated institutional bias, the captivating simplicity of the failed "Calories In, Calories Out" model, and significant financial conflicts of interest. Major medical associations, significantly funded by pharmaceutical and device companies, have little incentive to promote a nutritional fix that would render their products obsolete. This has created a system where conferences like those of the American Diabetes Association focus on gadgets and drugs while ignoring dietary solutions, a silence that protects a half-century of harmful public health advice.

A New Paradigm: Diabetes as an Overflow Phenomenon

The "Quick Start Guide" shifts to a direct, actionable explanation. It first dismantles the myth of diabetes as a chronic, progressive life sentence, asserting it is fully reversible and preventable. The disease is framed as a simple "overflow" problem: the body's cells, after years of excessive sugar and refined carbohydrate intake, become so full of glucose they cannot accept more. Insulin's job is to force glucose into cells; when cells are full, "insulin resistance" develops. Blood sugar rises only when this overflow can no longer be hidden, leading to a diagnosis. Conventional medications, especially insulin, worsen the core problem by forcing more sugar into already overstuffed cells, making the disease worse even as blood sugar numbers temporarily improve.

The Consequences of Hiding the Problem

This flawed strategy of hiding glucose instead of eliminating it has devastating long-term consequences. Excess glucose, packed into organs over years, causes systemic damage—what the text vividly describes as every organ in the body beginning to "rot." This explains why diabetes leads to heart disease, kidney failure, blindness, nerve damage, and Alzheimer's. Critically, it notes that large-scale trials have proven that standard glucose-lowering drugs do not reduce heart disease, the main killer of diabetics, underscoring the fatal flaw of treating a symptom instead of the cause.

The Two-Step Natural Solution

The logical solution emerges directly from understanding the cause: rid the body of excess sugar. This is achieved through two free, natural steps:

1. Put less sugar in: Eliminate added sugars and refined carbohydrates (like white bread, pasta, and rice). Adopt a diet of whole, unprocessed foods that is low in refined carbs, moderate in protein (avoiding processed protein supplements), and high in natural fats (like those from avocados, olive oil, and eggs), which have minimal impact on insulin and promote satiety.
2. Burn off the remaining sugar: While exercise helps, the most powerful tool is fasting—the body's natural state for burning stored energy. By incorporating periods of fasting (such as 24-hour fasts a few times a week or daily 16-hour fasts), the body is forced to deplete its overloaded glucose stores.

Key Takeaways

• Type 2 diabetes is a reversible dietary disease, not a mandatory life sentence of progressive decline.
• The root cause is chronic excess sugar and refined carbohydrates, leading to elevated insulin and cellular "overflow" (insulin resistance).
• Standard drug treatments, particularly insulin, often worsen the disease long-term by increasing the body's toxic sugar load while masking high blood sugar.
• Lasting reversal requires treating the cause: reducing dietary sugar intake and burning stored sugar through practices like intermittent fasting.
• A systemic bias toward pharmaceutical and surgical solutions, fueled by financial conflicts and institutional inertia, has suppressed this effective dietary approach for decades.

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Chapter 1: How Type 2 Diabetes Became an Epidemic

Overview

This chapter tracks the transformation of type 2 diabetes from a relatively rare condition into a global pandemic. It begins by establishing the staggering scale of the modern problem, noting a quadrupling of worldwide cases since 1980. The narrative then traces the ancient history of the disease, the discovery of insulin as a treatment (but not a cure), and critically, the shift in dietary guidelines in the late 20th century that unwittingly fueled the epidemic by promoting a high-carbohydrate, low-fat diet.

The chapter opens with the sobering 2016 World Health Organization report declaring diabetes a global disaster, its prevalence having quadrupled worldwide since 1980. This sets the stage for a central question: how did this ancient ailment become a 21st-century plague?

Ancient Recognition and Early Missteps The disease has been known for millennia, with descriptions found in ancient Egyptian and Hindu texts noting the sweet, urine-attracting-to-ants symptom. For centuries, it was a fatal wasting disease, particularly in children (what we now call type 1). Early treatments were a mix of insight and error. In 1797, John Rollo found success with an all-meat, low-carbohydrate diet, while later, Pierre Piorry's advice to eat large amounts of sugar to replace urinary losses proved fatal. By the late 19th and early 20th centuries, physicians like Apollinaire Bouchardat, Frederick Allen, and Elliott Joslin championed strict, low-carbohydrate or starvation diets as the only somewhat effective therapy before insulin.

The Insulin Breakthrough and a New Understanding The 1921 discovery of insulin by Banting, Best, and Macleod was revolutionary, saving the lives of type 1 diabetics and creating widespread belief that diabetes was cured. However, it became clear that not all diabetes was the same. By 1959, two types were formally recognized: type 1 (an autoimmune destruction of insulin-producing cells) and type 2 (characterized by the body's resistance to insulin's effects).

The Dietary Shift that Sparked an Epidemic The chapter identifies a pivotal turning point in the 1950s-1970s. To combat rising heart disease, dietary fat was demonized without strong evidence. This led to the 1980 U.S. Dietary Guidelines, which advised reducing fat intake and increasing carbohydrates to 55-60% of the diet. This policy birthed the "food pyramid," placing refined grains and carbohydrates at its base. The immediate and parallel rise in obesity (starting in the 1980s) and then diabetes (starting in the 1990s) is presented as a direct consequence of this dietary shift, which chronically elevated blood glucose and insulin levels.

The Modern Pandemic Today, type 2 diabetes is a defining global epidemic. It affects all demographics, with rates skyrocketing in developing nations like China, where prevalence jumped from 1% in 1980 to over 11% by 2013. In the U.S., more than half the adult population now has either diabetes or prediabetes. The economic costs are staggering, threatening healthcare systems. The chapter concludes with a powerful indictment: despite medical advances, we are powerless against the disease's complications because we have fundamentally misunderstood its root cause. The epidemic is not genetic but lifestyle-driven, necessitating a return to first principles to understand its true etiology.

Key Takeaways

• Type 2 diabetes has undergone a meteoric rise, quadrupling in global prevalence since 1980, making it a modern pandemic.
• Historically, low-carbohydrate diets were the primary treatment for diabetes until the lifesaving discovery of insulin for type 1 diabetes in 1921.
• The critical catalyst for the epidemic was the late-20th-century public health shift to low-fat, high-carbohydrate diets, epitomized by the U.S. Food Pyramid, which led directly to rising obesity and diabetes rates.
• The disease is now a global crisis, with devastating human and economic costs, and its rapid increase points overwhelmingly to lifestyle and dietary factors, not genetics or normal aging.
• The chapter argues that current treatments fail to prevent complications because the root cause of type 2 diabetes has been misunderstood, requiring a fundamental re-examination of the disease.

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The Diabetes Code

Chapter 2: The Differences between Type 1 and Type 2 Diabetes

Overview

Overview

Diabetes mellitus isn't a single disease but a collection of metabolic disorders all sharing the hallmark of chronically elevated blood glucose, known as hyperglycemia. Among its various forms—including gestational diabetes and other rare types—type 1 and type 2 diabetes stand out as the most significant, with type 2 comprising roughly 90% of all cases. This chapter unravels the distinct stories behind these two conditions, from their symptoms and diagnosis to their underlying causes, highlighting why understanding these differences is crucial for effective management and the pursuit of a cure.

Diabetes Symptoms: The Common Thread

Whether it's type 1 or type 2, hyperglycemia manifests through a recognizable set of symptoms. When blood glucose levels exceed the kidney's capacity to reabsorb sugar, it spills into the urine, leading to frequent urination and intense thirst. The body, losing precious calories, may respond with rapid weight loss and increased hunger, often accompanied by fatigue. These signs are more acute in type 1 diabetes, where onset is sudden. In severe cases, type 1 can escalate to diabetic ketoacidosis—a dangerous acid buildup from insulin deficiency—with symptoms like confusion, fruity breath, and unconsciousness. Type 2, progressing gradually, might not show symptoms early on, but in advanced stages, it can lead to hyperosmolar non-ketotic syndrome, characterized by severe dehydration and coma due to extremely high blood glucose.

Diagnosing Diabetes: Tests and Thresholds

Identifying diabetes hinges on straightforward blood tests. The hemoglobin A1C test has become a favored screening tool because it reflects average blood glucose over three months and doesn't require fasting. An A1C below 5.7% is normal, 5.7% to 6.4% indicates prediabetes, and 6.5% or higher confirms diabetes. Prediabetes signals a high risk—25% to 50% chance of progressing to full diabetes within five years. Alternatively, doctors use fasting blood glucose (over 7.0 mmol/L or 126 mg/dL) or an oral glucose tolerance test (over 11.1 mmol/L or 200 mg/dL after two hours). Despite the convenience of A1C, all methods are reliable. It's fascinating to consider that the total glucose in our blood at any moment is only about a teaspoonful, tightly regulated by hormones like insulin, which ushers glucose into cells for energy or storage in the liver.

Type 1 Diabetes: An Autoimmune Attack

Often called juvenile diabetes due to its frequent onset in childhood, type 1 can actually appear at any age. Its incidence is rising globally, increasing by up to 5.3% annually in some regions. This condition is autoimmune, where the body's immune system mistakenly destroys the insulin-producing islet cells in the pancreas. Genetic factors play a role, but triggers like infections or environmental elements such as cow's milk sensitivity remain uncertain. The result is a severe insulin deficiency, making insulin replacement therapy the cornerstone of treatment. While insulin injections transformed type 1 diabetes from a death sentence, they're not a cure; long-term complications, including heightened heart disease risk and reduced life expectancy, persist.

Type 2 Diabetes: The Rise of Insulin Resistance

In contrast, type 2 diabetes has historically affected older adults but is now surging in children, paralleling the obesity epidemic. For instance, new cases in adolescents jumped from less than 3% to 45% in just a decade. This disease unfolds slowly, evolving from normal blood sugar to prediabetes and then diabetes. The core issue isn't lack of insulin but insulin resistance—where cells fail to respond to insulin's signals. The pancreas compensates by pumping out more insulin, leading to high insulin levels, but eventually, it can't keep up, and blood glucose climbs. This insulin resistance is the central puzzle, as its cause remains poorly understood, leaving treatment focused on symptoms rather than the root problem.

Contrasting Causes and Treatment Challenges

At their heart, type 1 and type 2 diabetes are opposites: one features too little insulin, the other too much. Yet, standard drug therapies often aim similarly at lowering blood glucose by boosting insulin, which helps type 1 but doesn't address type 2's insulin resistance. This mismatch highlights a critical gap in our approach. Without grasping why insulin resistance occurs, reversing type 2 diabetes remains elusive. The chapter sets the stage for this challenge, inviting us to look beyond symptoms to the underlying mechanisms, where the promise of a true cure lies.

Key Takeaways

• Diabetes mellitus is characterized by hyperglycemia, with type 2 accounting for 90% of cases and type 1 being less common but more acute in onset.
• Symptoms like thirst, frequent urination, and weight loss are shared, but type 1 often presents severely with ketoacidosis, while type 2 may be asymptomatic initially.
• Diagnosis relies on tests like A1C (reflecting three-month averages) or blood glucose measurements, with clear thresholds for prediabetes and diabetes.
• Type 1 diabetes is an autoimmune disease causing insulin deficiency, requiring lifelong insulin replacement.
• Type 2 diabetes is driven by insulin resistance and high insulin levels, evolving gradually and linked to obesity and age.
• The fundamental difference in causes—low insulin vs. high insulin—isn't fully addressed in current treatments, underscoring the need to understand insulin resistance for curing type 2 diabetes.

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Chapter 3: The Whole Body Effect

Overview

This chapter establishes diabetes not as a localized disorder, but as a systemic disease capable of damaging virtually every organ system in the body. It systematically details the extensive complications, categorized by the size of the blood vessels affected, and builds a compelling case that the medical community's focus on treating high blood sugar is addressing a symptom while ignoring the root cause: insulin resistance.

The Two Pathways of Damage: Microvascular and Macrovascular

The complications of diabetes are primarily driven by damage to blood vessels, which is classified into two types. Microvascular diseases result from injury to small blood vessels, which particularly affects organs like the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy). Macrovascular diseases stem from atherosclerosis—the buildup of plaque—in large blood vessels, leading to heart attacks, strokes, and peripheral vascular disease in the legs.

Microvascular Complications

• Retinopathy: As the leading cause of blindness in the U.S., this eye disease involves the weakening and leaking of retinal blood vessels. The body attempts to grow new, fragile vessels, which can bleed and form scar tissue, potentially detaching the retina. Laser treatment can help, but prevention is paramount.
• Nephropathy: Diabetic kidney disease is the top cause of end-stage renal failure, often requiring lifelong dialysis or transplantation. The kidneys slowly lose their ability to filter toxins from the blood over 15-25 years, a process that is often silent until advanced stages.
• Neuropathy: Affecting up to 70% of patients, this nerve damage most commonly causes pain, tingling, or numbness in a "stocking-and-glove" pattern in the extremities. The loss of protective sensation can lead to severe joint destruction (Charcot foot) and ulcers. Autonomic nerve damage can disrupt digestion, heart rate, and blood pressure control. Current treatments only manage symptoms but cannot reverse the damage.

Macrovascular Complications

• Atherosclerosis: The chapter corrects the common misconception of arteries "clogging" like pipes. Instead, it describes a process where injury to the artery wall triggers inflammation, cholesterol infiltration, and plaque formation. A ruptured plaque can cause a sudden, clot-induced blockage.
• Heart Disease & Stroke: Diabetes increases the risk of heart attack two- to fourfold, with most diabetic seniors dying from heart disease or stroke. Improvements in cardiac care have notably lagged for diabetic patients. Similarly, diabetes independently raises stroke risk by 150-400%.
• Peripheral Vascular Disease (PVD): Atherosclerosis in the legs reduces blood flow, causing pain while walking and, in severe cases, pain at rest. Poor circulation impedes healing, making minor foot injuries prone to infection, gangrene, and amputation. Diabetes is one of the strongest risk factors for PVD.

A Cascade of Other Complications

Beyond vascular damage, diabetes is linked to a wide array of other serious conditions:

• Alzheimer’s Disease: The connection is so strong that some researchers call it "type 3 diabetes," suggesting a problem with the brain's ability to use glucose.
• Cancer: Type 2 diabetes increases the risk and worsens the prognosis of many common cancers.
• Fatty Liver Disease: An estimated 75% of type 2 diabetics have non-alcoholic fatty liver disease (NAFLD), which can progress to cirrhosis.
• Infections: High blood sugar impairs the immune system, and poor circulation hinders healing, leading to more frequent and severe infections, particularly dangerous foot ulcers.
• Skin & Nail Conditions: Issues like acanthosis nigricans (darkened skin) and skin tags are common external markers of insulin resistance.
• Erectile Dysfunction: Poor circulation significantly increases the risk of impotence in diabetic men.
• Polycystic Ovarian Syndrome (PCOS): Driven by insulin resistance, PCOS shares many features with type 2 diabetes and greatly increases a woman's risk of developing it.

Treat the Cause, Not the Symptom

The chapter concludes with a powerful critique of standard diabetes care. It notes that despite centuries of study, complications are worsening. This paradox points to a fundamental flaw: the medical system focuses obsessively on lowering blood glucose, which is merely a symptom. The true root cause of type 2 diabetes is insulin resistance. The author argues that until treatments address this core issue, the epidemic will continue to grow. The chapter ends with two patient stories (Simon and Bridget) who achieved dramatic reversals of their diabetes and its complications through dietary interventions aimed at reducing insulin resistance, not just sugar levels.

Key Takeaways

• Diabetes is a whole-body systemic disease, not merely a disorder of blood sugar.
• Complications are vast and categorized by damage to small vessels (eyes, kidneys, nerves) and large vessels (heart, brain, legs).
• The disease is also strongly linked to Alzheimer's, cancer, fatty liver, infections, and more.
• The conventional focus on treating high blood glucose manages a symptom but ignores the root cause: insulin resistance.
• Reversing insulin resistance, not just controlling sugar, is presented as the necessary path to truly combat the disease and its devastating complications.

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