As a middle-aged woman who gained and lost 30 pounds over and over again over many years, I found myself with pre-diabetes, skyrocketing cholesterol and high blood pressure. If it had been as easy to get healthy by changing what I was eating, I would have. In fact, I did, many times, but could not sustain it. Few chronically obese people can.

Seven years ago, I had lap-band surgery, which enabled me to lose more than 100 pounds and stop the cycle of illness I was unable to stem with dieting.

While cutting carbs is a helpful tool (I recently used it to lose another 10 pounds), negating the other tools available surgically seems unhelpful. And any cost-benefit analysis of bariatric surgery must include the nearly immediate return to health that most of us experience.

The year after my surgery, the cost of my medical care dropped 80 percent versus what it had been before and has continued to be very modest.

The only way we are going to control the epidemic of diabetes is to avoid the eating habits that many of us developed during our lives and to use all of the tools available to help those who don’t.

Although medication and lifestyle changes are advisable first lines of treatment for patients with obesity and Type 2 diabetes, weight-loss surgery and low-carbohydrate diets are not interchangeable treatment options.

The medical literature has repeatedly affirmed that well-established bariatric procedures like sleeve gastrectomy and gastric bypass are more effective and durable than dietary and medical interventions when treating diabetes associated with severe obesity.

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Furthermore, bariatric surgical interventions induce remission of other associated life-threatening diseases like hyperlipidemia, high blood pressure and sleep apnea, which low-carb diets may fail to significantly treat.

These findings, coupled with the strong safety record, are the reasons the American Diabetes Association, in conjunction with 44 other scientific societies, has endorsed bariatric surgery, or what has become known as metabolic surgery, as a safe and effective treatment option for patients with obesity and Type 2 diabetes.

I adopted a low-carb diet some years ago influenced by friends in our Suppers Group in Princeton, N.J., and turned to eating greens and protein. A result was a lessening of my pre-diabetes and an improvement in my thyroid disease to subclinical, something I could not achieve with medications.

And let’s not forget exercise: I walk every day outdoors and practice tai chi. And here’s the real incentive for the less ambitious: I lost inches off my waistline without those carbs. Patients, heal thyselves!

My own pre-diabetes was greatly helped by a low-carb diet. Why does the American Diabetes Association not simply tell everyone to go on a low-carb diet? Its website is so complicated, with descriptions of the many forms of carb intake, but it does not recommend this very simple dietary fix.

Why are expensive, problematic solutions like bariatric surgery recommended so often? Is it because a change to a low-carb diet will not make money for the drug industry or the surgical establishment? Why is this diet controversial (my own otherwise well-informed primary-care doctor was less than enthusiastic)?

Does the solution to one of our most troublesome public health problems require a bit more publicity so that the entire public will see?

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I got a shocking diagnosis of pre-diabetes at 64. With no family history of diabetes, I didn’t fit the profile. I’m not obese, not even overweight. Exercise? Six days a week, 30 minutes a day. A diet carefully orchestrated to regulate blood sugar, weight and cardiovascular health. Complex carbs as a rule. Yet my A1C, the average measure of my blood sugar over three months, was climbing. There had to be other factors at work.

It is not unusual that I am lactose-intolerant. I am African-American. But I never considered the gas, the indigestion and general discomfort an immune-system response to something I shouldn’t eat until I began studying about chronic inflammation as a root of many diseases, including diabetes. What did I have to lose by giving up my yogurt, whey protein, cheese and other milk by-products? I notified my doctor of my intent to fast the aforementioned dairy products for a month. To my surprise and hers, my A1C went down!

Our bodies are unique. We need knowledge, discipline and support to become our own best health advocates. Thank you, Drs. Hallberg and Hamdy, for sharing an unpopular truth: Pills should not be our first line of defense.

Americans consume too much glucose, as indicated by obesity and increasing rates of diabetes and cardiovascular disease. The article notes that while many medicines are available to diminish glucose (sugar) and limit its ravages on our body, when consumed in excess, the best way is to limit glucose intake.

Data gathered over the last decade show that we should add age-related macular degeneration, the major blinding disease of the elderly, to the list of debilities that can be alleviated by lowering glucose intake.

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Nobody wants to lose vision, and diminishing simple sugar intake would seem to be a low price for extended vision. We must just plan our diet in advance.

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