From Hyperbole to Understatement

A 2012 warning about carbohydrates and diabetes reads very differently today.

A passage from a 2012 nutrition text reads very differently in light of today’s metabolic health perspectives.

I recently acquired a copy of Evolving Human Nutrition: Implications for Public Health.¹ Like many books, I began by skimming—turning first to the chapters most aligned with my interests. Unsurprisingly, I went straight to Chapter 11: Feed the World with Carbohydrates.

It closes with a passage that stopped me cold — not because it sounded exaggerated, but because of how it reads today.

The world’s population is currently experiencing an epidemic of Type 2 diabetes (Wild, et al. 2004)² , and this disease is currently the fifth most common cause of death in the world (Roglic, et al. 2005).³ Predictions are that rates will carry on increasing. Meanwhile the food industry continues to produce foods that contribute to an excess mortality of 2.9 million people per year due to this disease alone. This is above the upper range of mortality estimates for the ten most deadly wars during the decade of the 1990s, where estimates range from 0.8 million to 2.9 million deaths in Rwanda, Angola, Somalia, Bosnia, Liberia, Burundi, Chechnya, Tajikistan, Algeria and the Gulf war combined (Murray, et al. 2002).⁴ This makes Type 2 diabetes at least ten times more deadly than warfare. And it makes the producers of refined carbohydrates, such as HFCS [High Fructose Corn Syrup], more potentially complicit in deaths due to this disease than arms manufacturers are in deaths in war. Page 319 [footnotes added, emphasis mine]

That’s quite a closing statement.

The book was published in 2012, drawing on mortality estimates available at the time. What struck me most rereading it today is not how provocative the claim sounded - but how arguable restrained it now appears.

The International Diabetes Federation’s 2025 Diabetes Atlas⁵ estimates roughly 3.4 million deaths in 2024 attributable to diabetes among adults aged 20–79 — about one in every eleven adult deaths worldwide, or roughly one death every nine seconds.

The world’s population is currently experiencing an epidemic of Type 2 diabetes… This makes Type 2 diabetes at least ten times more deadly than warfare… and makes producers of refined carbohydrates potentially more complicit in deaths than arms manufacturers. (p. 319)

What once read like rhetorical exaggeration now looks uncomfortably close to description.

Yet even these numbers likely understate the problem.

Most individuals with insulin resistance and compensatory hyperinsulinemia - chronically elevated insulin levels often present years before diabetes diagnosis - do not know they have it. The condition progresses silently until metabolic dysfunction becomes clinically visible.

Even more concerning, in the United States—and likely elsewhere—the fastest growth in Type 2 diabetes is now occurring among children and adolescents.

Increasingly, insulin resistance is understood not merely as a precursor to diabetes but as a shared upstream physiology linking several seemingly distinct conditions:

• hyperglycemia and Type 2 diabetes,

• atherogenic dyslipidemia and cardiovascular disease,

• hypertension and fluid dysregulation,

• and pro-growth signaling pathways implicated in several cancers.

Viewed through this lens, diabetes mortality statistics capture only the visible downstream tip of a much larger metabolic iceberg.

For that reason, the authors’ comparison - dramatic as it may have seemed at the time – is actually a substantial understatement.

If insulin resistance and chronic hyperinsulinemia are central drivers of metabolic disease, then effective interventions must address insulin exposure itself rather than its downstream manifestations. Therapeutic carbohydrate restriction and well-formulated ketogenic diets do precisely this: reducing insulin signaling, restoring metabolic flexibility, and improving clinical markers often independent of weight loss.

The encouraging implication is that the same food system capable of contributing to metabolic dysfunction also contains the tools needed to reverse it.

The question is whether we are prepared to reconsider long-standing assumptions about what it means to “feed the world.”

1. From Ulijaszek, S. J., N. Mann, and S. Elton. 2012. Evolving human nutrition: implications for public health. Vol. 64. Cambridge University Press. https://a.co/d/049X5uuC (US Amazon link)

2. Wild, S., G. Roglic, A. Green, R. Sicree, and H. King. 2004. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):1047–1053. https://doi.org/10.2337/diacare.27.5.1047

3. Roglic, G., et al. 2005. The Burden of Mortality Attributable to Diabetes : Realistic estimates for the year 2000. Diabetes Care 28(9):2130–2135. https://doi.org/10.2337/diacare.28.9.2130

4. Murray, C. J. L., G. King, A. D. Lopez, N. Tomijima, and E. G. Krug. 2002. Armed conflict as a public health problem. BMJ 324(7333):346–349. https://www.bmj.com/content/324/7333/346

5. https://diabetesatlas.org/data-by-indicator/mortality-attributable-to-diabetes-20-79-y/deaths-attributable-to-diabetes/