Chad T. Lewis is not a doctor or diabetes expert – he’s just a man that has lived with diabetes for a very long time. Lewis has had type 1 diabetes for over fifty years (he was awarded a Joslin medal). He lived through the dark ages of diabetes treatment – before home glucose monitoring, before basal-and-bolus insulin – and is still here, full of vim and vigor, with good health and well-controlled blood sugars. Anyone with that history must be doing something right.
Lewis is the author of a new book that distills his decades of wisdom into one book: Doing Diabetes Differently. He’s had a lot of time to think about what works best, and years of advocacy have helped Lewis connect with some of the important voices in the diabetes community. He is also lucky enough to be a patient of the eminent endocrinologist Dr. Irl Hirsch, who wrote a foreword for the new book. Lewis does his best to consider all of their opinions and distill them into a single flexible but coherent diabetes management philosophy.
Doing Diabetes Differently is written for readers with both type 1 and type 2 diabetes. It addresses diet, exercise, and medication. It’s a breezy book, with fewer than 200 pages, and never gets bogged down in heavy science, history, or anecdotes. Lewis recommends other, more detailed resources effusively – the book can be seen as a roadmap for readers that want to dive into its various topics in greater depth.
An Uncompromising Approach
Lewis seems like an understanding and open-minded fellow, but he will be quite blunt when he feels it’s necessary. He believes that people with diabetes are done a grand injustice when they’re told (or when they tell themselves) that they are not defined by their disease. Instead, he wants readers to come to terms with their dysfunction in order to approach it honestly and productively:
“If you can see yourself as a person who lives in an abnormal disease state … you’ll significantly improve your expectations and motivation. You’ll be well on your way to positive change.”
He doesn’t even like the fact that the term “person with diabetes” has replaced the noun “diabetic,” even though he respects the new custom throughout his book. Lewis writes that “The fallacy of normalcy is promoted when the language is softened.”
Nowhere is the “fallacy of normalcy” more important than in the field of nutrition. This is an age-old debate in the diabetes community: are people with diabetes entitled to a normal diet? Should we use technology and medication to live as normally as possible? Or should we accept that our conditions mean that we need to live with restrictions? Lewis comes down hard on one side:
“Normal eating isn’t in the cards for those of us with diabetes, despite what some experts may have us believe. We need to get this part right.”
Diabetes and Sugar Addiction
Lewis reviews current thought on diabetes metabolism and the obesity epidemic that has rapidly expanded waistlines all across the world. He (mostly uncontroversially) concludes that the least healthy food is the highly-processed junk that combines lots of both carbohydrates and fat. A high-fat diet or a high-carbohydrate diet, he reasons, can lead to a healthy metabolism, but high-fat and high-carb at the same time spells trouble.
Lewis decides that most people with diabetes should be eating a low-carbohydrate diet, which can lead to unsurpassed glycemic control. A minority of readers, though, might also benefit from a high-carb and low-fat diet, which can take form of the “rural Asian diet” advanced by one Joslin Diabetes Center expert, or the fruit-heavy vegan diet promoted by the Mastering Diabetes program. He tries to emphasize the way that these very different diets overlap, including a restriction on added sugar.
While most people with diabetes will readily acknowledge the wisdom of staying away from junk food and added sugar, fewer will agree with Lewis’ uncompromising approach:
“It’s well-established in the literature that alcoholics need to stop drinking. The situation with added sugar is no different for people with diabtes, particularly the majority who are overweight or obese from a lifetime of sugar-drenched eating habits.”
Lewis argues that sugar is both addictive enough and unhealthy enough that the only reasonable plan is complete abstinence:
“To the expert claim that, ‘You can have it!,’ I have to say, ‘No, you can’t (or shouldn’t).’ Because you have diabetes. Your metabolism isn’t normal.”
Perhaps the most interesting perspective that Lewis brings to his book are his frequent references to the 12-step program of Alcoholics Anonymous. I don’t recall ever seeing diabetes framed quite this way. Undoubtedly, many diabetes experts would bristle at the comparison, but the AA program is a powerful one for behavior modification, and some people with diabetes might benefit from the intense approach.
The 12-step program isn’t just about abstinence – it also emphasizes the importance of sharing the journey with others, and even of surrendering to a higher power. Lewis thinks that these guidelines are also important to set up people with diabetes for success. If you’re going to wake up every day fixated on your disease and dysfunction, as Lewis thinks is best, maybe it helps to share the emotional burden as much as possible.
He also takes a slightly counterintuitive position on exercise motivation. Most authorities encourage us to choose exercises that we enjoy, in order to maximize the odds that we actually get up off the couch. But Lewis wants you to embrace your dislike of exercise: “Start out viewing exercise for health as a chore, and don’t expect to have fun. Think of it as a chore you accomplish regularly, like mowing the lawn.”
Lewis believes that weight loss, for those who need it, will follow naturally from the good diet and exercise decisions that lead to tighter glycemic control, improved insulin sensitivity, and reduced use of pharmaceuticals. Weight loss “should be viewed as a by-product of healthy diabetic living, not the purpose of a diet.”
As for advanced diabetes medication and technology, from continuous glucose monitors and closed-loop pumping systems to GLP-1 receptor agonists? Lewis thinks they’re great, but that they should never be used in order to make it easier for people with diabetes to make suboptimal diet and exercise choices. The whole goal of his approach is to reduce the need for costly medical intervention. The right diet, especially, makes glucose management easier, and other health benefits should follow.
Despite the unconventional approach, Lewis also underlines the importance of collaborating with a medical professional. Each chapter ends with a list of questions for readers to ask their doctors, in the hopes that they can get on the same page.
Who would benefit from this book? If you’ve already read one of the major tomes of the low-carb approach to diabetes, such as Dr. Richard Bernstein’s Diabetes Solution or Dr. Jason Fung’s The Diabetes Code, you’re probably familiar with many of the arguments that Lewis covers. But if terms like “the law of small numbers” and “sugar surfing” are new to you – and especially if you’re struggling with mainstream diabetes management recommendations and looking for a little tough love – this book could be a good first step in exploring a new approach.
Sales from the book will go to Diabetes Daily Grind, a nonprofit organization that produces a podcast and other resources for people with diabetes. (Diabetes Daily Grind is not affiliated with this website)