You Are the Only Control Group You Get

The one experiment in this subject that returns an answer, and the single thing to stop.

Five years ago I changed what I ate.

Not as a cause, not as a protest, and not because anybody asked me to. I was sixty-six. I was heavy, exhausted, in constant pain, and doing exactly what I had been told to do. One man, one change, nobody watching and nobody informed.

It worked. That is the part I could not have known in advance, and the part nobody could have told me with enough authority to be worth believing. I had to find out in the only laboratory available to me.

Then I wrote about it, because by then I had something to report rather than a theory to float.

And what comes back now is mostly not questions. It is people telling me what happened when they changed something.

A man with type 1 diabetes who was taking more than a hundred units of insulin a day, now under forty. A woman who had spent most of her adult life with three overlapping autoimmune conditions, whose cardiologist cut her medications in half. A couple in their late seventies, five years in, seventy pounds each, off everything they had been taking.

None of that was solicited and none of it is mine. It arrives because something worked and the person wanted somebody to know. It is also a great deal harder to stay at the desk once people start reporting back, which is why I have lately been doing more than writing.

Notice the order, because it is the whole argument of this post and I did not plan it that way. One person acted. The result came back. Then it was worth saying out loud. Then other people acted, and reported. Nothing about that sequence could have started at the other end.

And when a question does come, it is some version of the same one: what am I supposed to do about it?

Here is the honest version of my answer, including the parts that do not flatter it.

It begins with you, and with nobody else.

Your first responsibility in this is to yourself. Not to a movement, not to a boycott, not to me. Before any of this becomes a public matter it is a private one — a question of what you are going to eat tomorrow morning, decided by you, for your own reasons, in your own kitchen, with no audience.

That is not modesty about the larger argument. It is the order the thing actually works in, and there are two reasons for it.

The first reason is that it is the only place the evidence works

Everything else that might fix this operates on a horizon of years and delivers a benefit nobody can feel.

I filed a comment on a federal rulemaking last week. If that rule is finalized it will not take effect before 2029, and if it works perfectly no individual will ever know it helped them. Industrial trans fats left the American food supply by federal determination in 2015, with a compliance deadline in 2018 — a real improvement affecting everyone who eats, and not one person felt it happen.

Changing what you eat is the only intervention in this entire subject that returns a verified result to the person who made it, in their own body, inside a year.

That is not a small advantage. It is the only place in this problem where the measurement actually works.

I have written here before that a cause present in nearly everybody cannot be found by studying variation across a population, because there is no unexposed group to compare against. That is true, and it is why the population-level evidence in this field will stay thin no matter how long anyone waits for it. But the same fact that makes the population unmeasurable makes the individual measurable. A person who changes one variable becomes their own control. You get a before and an after in the same body, and nobody has to run a trial to show it to you.

So the evidence you cannot get out of the literature, you can get out of yourself. In months. Without trusting me, or a guideline, or anyone with something to sell.

The second reason is that nothing else is available to you until you have done it

Nobody persuades anybody of something they have not done themselves. Not because it would be hypocritical — because it would be unconvincing, and because you would not know what you were talking about.

It is also why this travels when nothing else does. A person who got a result does not need to be convinced of anything, and tends to tell somebody. That is how every account at the top of this page reached me, none of them in response to a request. It is how the whole thing reached me five years ago, at a dinner where nobody was selling anything. And it is the only reason I am any use to you now — not because I read about it, but because I did it first and it happened to work.

What it is worth, in numbers

Forty million Americans have diabetes — about one in eight of us. A hundred and fifteen million adults have prediabetes, which is more than two in five. The annual cost of diagnosed diabetes runs around $640 billion, and in 2021 the condition accounted for roughly a quarter of all health care spending in the United States.

One condition. A quarter of everything we spend on being sick.

That is not a line item. It is prescriptions, clinic visits, test strips, specialist referrals, procedures, hospital stays, amputations and dialysis chairs. It is an enormous industry, and every dollar in it is downstream of something that was eaten.

Whether changing the input changes the output is answerable by a trial rather than by an opinion, and a good one exists.

It is called DiRECT — the Diabetes Remission Clinical Trial — run by Roy Taylor at Newcastle University and Mike Lean at Glasgow, and published in the Lancet in December 2017. Diabetes UK paid for it. That is a charity rather than a company, and it put more than £2.8 million into the question.

The trial enrolled 306 adults who already had type 2 diabetes and ran them through forty-nine ordinary primary care practices across Scotland and northern England — not a research unit, but the kind of surgery you would actually walk into. Half continued with their usual care. The other half went onto a managed weight-loss program, and — this is the part that matters — every one of their oral diabetes drugs was stopped on day one.

At twelve months, seventy-four percent of them were taking no diabetes medication at all. In the control group the figure was eighteen percent, and eight of those people started medication during the year.

Remission was defined strictly: blood sugar back in the normal range after at least two months off all diabetes drugs. Forty-six percent of the intervention group met it. Four percent of the controls did.

It was open-label, a quarter of participants dropped out, and it was one trial. I am not going to oversell it. But it is a randomized comparison in which three out of four people walked away from their medication and nearly half no longer had the disease, and nothing whatsoever was added to achieve it.

That is what a successful outcome looks like, and it is not measured on a stock ticker. It is measured in prescriptions that never get written and appointments nobody needs.

So here is the thing to stop

Not a brand and not a company. A category, and the category is refined carbohydrate.

Sugar, and the starches that have had their structure stripped out so that they arrive in the bloodstream at a speed nothing was built to handle. It has to go, or be cut hard, because the rate of arrival is the entire mechanism and there is no version of this that survives leaving it in place.

I want to be exact, because exactness here is what makes it actionable, not what softens it. The refined forms go — all the way out, no remaining quantity that counts as acceptable. Milling and refining take the brakes off. They perform the work of digestion in advance, in a factory, so that what arrives in you is glucose with nothing left to slow it down. There is no responsible serving size of that, and the industry’s entire defense rests on persuading you there is one.

The rest of the carbohydrate — the potato with its skin on, the fruit, the bowl of rice — is a different event in a body, and it is still a load. It does not get a pass. It gets cut hard, and how hard is the thing you are going to have to determine on yourself, because nobody has determined it for you. That is the whole structure: the refined goes, the remainder comes down sharply, and you find out where your own floor is.

Stop buying refined carbohydrate. Not one item off the shelf. Not most of it. The category.

I am not going to dress that up as something gradual, because it was not gradual for me and it was not gradual in the trial above, where every oral diabetes drug came out on day one. The rate of arrival is the mechanism. A smaller dose of the mechanism is still the mechanism, and a half-measure produces a half-answer you will not be able to read.

So it comes out of the cart. The cereal, the bread, the soda, the juice, the pasta, the crackers, the thing in the cupboard you reach for without deciding to. All of it, this week. Then find out what happens in your own body over the next few months, which is the only evidence in this entire subject that will ever actually belong to you.

One caution, and it is not a hedge. If you take medication for diabetes or blood pressure, taking the carbohydrate out while the dose stays where it is can put you too low. That is precisely why DiRECT managed the drugs and the food together, on day one, with a physician watching. Do it the same way. The change is the point — but making it without telling the person who writes your prescriptions is not boldness, it is just a worse experiment.

That is the whole of what I am asking anybody to do, and it is deliberately the smallest version. One person, one change, in one kitchen, with nobody watching. It is also the only part of this that returns an answer you can actually read.

What happens when enough people do it is a different argument, and a longer one. It involves a volume number that has already stopped growing, an industry that cannot be abandoned the way people assume, and four occasions on which somebody paid for the appearance of evidence. That is Saturday.