Dr. George Lundberg, a self-described “ultimate [medical establishment] insider” and former (longtime) Editor-in-Chief of the Journal of the American Medical Association (JAMA), recently issued an opinion piece entitled, “Could it be the sugar?” A couple of months ago, Dr. Lundberg launched what appears to be a series of Medscape musings with a piece entitled “It’s not the fat that makes us unhealthy,” and this new installment builds on the first. You can watch the 7 minute video or save a little time and read the transcript provided.
Both pieces depict an elder statesman who has broken with the mainstream views of his tribe. We see a senior physician grappling with changing his mind after practicing under a dated, flawed paradigm for decades. When confronted with fresh evidence, Dr. Lundberg decides that truth-seeking is more important than fitting in with his lifelong colleagues.
In the current piece, Lundberg moves away from the subject of his first soliloquy — the pathogenesis of heart disease — and focuses his second editorial on obesity and diabetes:
The next and current big battle is over diabetes mellitus, insulin resistance, and obesity. How are they related? What can be done to stem the worldwide epidemic and prevent it from worsening? The stakes are very high, including the lives of millions of human beings and hundreds of billions of dollars…
…Various groups look at this conundrum in greatly disparate ways. One holds that obesity and diabetes are so intertwined that, since insulin is obviously tied to diabetes and since insulin is a hormone, they must together be an endocrinologic disorder. But if that is true, why haven’t the endocrinologists figured it out? Could it be because they have been so busy reaping the financial rewards of caring for a bonanza of diabetic patients as well as chasing incidental thyroid nodules? Or does Big Pharma love profiting from the many expensive new diabetes drugs—and crave new obesity drugs?
…The notion that obesity is primarily caused by the ability of carbohydrates to increase insulin secretion, which reduces levels of circulating fuels (glucose and free fatty acids); shunts fat into fat cells; and makes us fat, hungry, and sluggish, is buttressed by a 2018 article in JAMA by Ludwig and Ebbeling that lays out their argument for the carbohydrate-insulin model, or CIM, as they refer to it. Guyenet argues that the puzzle is far more complicated than any of these proposals.
In the end, Lundberg leaves the answer to his question, “Could it be the sugar?” somewhat open-ended. We will have to stay tuned for the next installment for more answers.