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A reader with Type-2 diabetes joins the one with Type 1 to divorce the disease from obesity:

Your dissenting reader with the Type-1 diabetic child tells a compelling story, but the implicit conclusion you reach is all wrong. No, we shouldn’t let people with Type 1 off the “diabetes=obesity” hook. We should throw away the hook!

For one thing, the mechanism of diabetes causation is not well understood, so we simply cannot say that obesity causes Type-2 diabetes at all. The two are strongly correlated, but research strongly hints at a cluster of shared causes, rather than a straightforward chain of get fat -> stay fat for X time -> develop the diabetes you’ve earned by being fat, you obese loser that is so widely assumed, including by most press accounts.

For another thing, not everyone who develops Type-2 diabetes is or was ever overweight, or has a family history of obesity or diabetes. I know – I was diagnosed with Type 2 at age 36. I’ve never had a body-mass index over 24, and for most of my life I’ve been skinny as a string bean, as are most of the men in my diabetes-free family tree.

The first thing my doctor did after my diagnosis was pack me off to a so-you’ve-got-diabetes class at the local hospital. The class, like just every online and print resource I could find, focused its advice not on managing glucose intake and natural insulin function, but on weight loss. But I didn’t need to lose weight!

I’m 6’0″, and was down to 150. My doctor wanted me to try to gain 10 pounds! In the meantime, I was asking a question that confounded every doctor, dietitian, and American Diabetes Association hotline expert I talked to: What should I eat for breakfast? If I needed to lose weight, they had answers. If I was on insulin, they had answers. But if I was at an appropriate weight, and just wanted to find a plate of foods that my weakened insulin system could handle without unhealthy blood-glucose spikes, breakfast was a stumper. Our cultural faith in the diabetes=obesity myth runs so deep that the medical and diabetes-research professions cannot even answer the question, “What should a diabetic eat for breakfast, if he’s not fat?”

Now for the good news: I’ve managed my diabetes with diet changes, exercise, and minimal medication. I’ve kept my A1C well below 7, often below 6, since my diagnosis. The keys seemed to be significantly reducing, but also more evenly distributing, my carbohydrate intake. Chiefly, no liquid carbs (except wine and beer, because, come on). No soda, minimal juice, no sugar or flavored syrups in coffee. (Advice to your non-diabetic readers: Stop drinking sugar. Don’t go soft like Bloomberg and reduce your serving size; just don’t drink anything with sugar or corn syrup on the ingredient list.)

Yes, I miss the great big glasses of orange juice that used to start my day, and the tall glass of milk with supper, and the heaping plates of pasta too. But I’m healthier and fitter than ever before, except for, you know, diabetes. The problem is, I had to figure this out by myself, because I didn’t fit the assumed paradigm of diabetes=obesity. Riding in the annual diabetes fundraiser bike event Tour de Cure, I’ve met many people who, like me, had to figure out treatment plans themselves because their problem was having diabetes, not being fat.

I don’t see much evidence that the focus on treating obesity is actually helping people who are both fat and diabetic, but I do see evidence that this focus harms those with diabetes for whom weight is not also a crisis. Yes, people, especially kids, with Type-1 diabetes are the primary victims of the diabetes=obesity myth, but so to are a good number of adults with Type 2. So don’t just exempt the kiddos from the stigma. End the overall stigma of diabetes=obesity=you earned it.

A reader writes:

The comment from your reader who was a butch little girl broke my heart a little. I have an8 year old who is a little gender-queer, but not trans, and probably not gay, and he had a terrible time at school this year.  My son is an awesome kid – sweet, smart, and funny. He is both one of the butchest boys I know and one of the most gender-queer. He truly has no regard for gendered clothing, shows, or interests. He loves karate and superheroes and video games and Spongebob and Star Wars: Clone Wars. He also loves sparkly, brightly colored clothing and nail polish and hair color and My Little Ponies and Tinker Bell. He has been both Samurai Jack for Halloween and a fairy. He plays with girls and boys.

This year, I allowed him to paint his nails black and orange just before Halloween.  I didn’t think anything about it. It was the week before Halloween! His second grade classmates taunted him for it and called him a girl. One of them punched him in the balls. None of the boys would play with him any more. Only one girl would play with him.  My son has a rebellious streak and decided to respond by bringing “girl books” to school and wearing pink shirts and more fingernail polish. The bullying continued. Despite an anti-bullying policy, the school’s main intervention was to advise us to get him to tone down the gender non-conformity.  We did, but I can’t help but think that the message that my son got was that gender bullying is okay and that it was somehow his fault if someone bullies him for being a nonconformist.

We’re transferring schools this year. I can’t take it and my son shouldn’t have to.

Another:

I’m now a 60-year-old gay man, partnered for almost 25 years and living a reasonably happy life. When I was little, I was a mama’s boy and definitely not considered a typical boy.

I played with dolls, like to dress up and loved doing whatever Mom was doing. In my baby book, Mom even recorded my atypical personality at the age of three, “Ricke is still a little girl at heart.” I knew that I was different from my other little male friends, but it didn’t seem to make much difference until about 3rd grade. It was then that I began to be bullied at school for being a sissy. Feeling miserable and lonely, I began to pray nightly that God would change me into a girl during the night and that I’d wake up feeling that everything in my life would be OK. That was the only solution that came to my young mind back in the 1950s. I knew nothing about homosexuality and on my own, couldn’t see any other way for me to fit in.

Well, that obviously didn’t happen. In high school I began to understand that I was gay and by college fully accepted it and began to live my life. I grew up to be a man who can take care of himself. Thanks to Mom, I can cook, bake, iron, sew, knit, hang wallpaper, paint a room or an entire house, and in general do what needs to be done. But it does make me wonder about the current trend toward diagnosing transsexualism in young children. I certainly don’t feel like a woman trapped in a man’s body now.

Another:

I am really appreciating all of the posts you’ve had in the last year or so on trans experiences.  I don’t recall there being so many in the past, and your uptick coincides with my own son’s transition (from Laura to Lucas). I’ve also become acquainted with a young woman at our church who has a young son who is a “princess boy.”  She is very supportive, but her ex-husband is So Very Not.  I’ve been passing on all of your posts to her and they have been very helpful.  So thank you on behalf of both of us, plus the many other family members and friends who have also found various of your posts so enlightening.

David Graeber explains the origin of “please” and “thank you”:

The English “please” is short for “if you please,” “if it pleases you to do this” — it is the same in most European languages (French si il vous plait, Spanish por favor). Its literal meaning is “you are under no obligation to do this.” “Hand me the salt. Not that I am saying that you have to!” This is not true; there is a social obligation, and it would be almost impossible not to comply. But etiquette largely consists of the exchange of polite fictions (to use less polite language, lies). When you ask someone to pass the salt, you are also giving them an order; by attaching the word “please,” you are saying that it is not an order. But, in fact, it is.

In English, “thank you” derives from “think” …

[I]t originally meant, “I will remember what you did for me” — which is usually not true either — but in other languages (the Portuguese obrigado is a good example) the standard term follows the form of the English “much obliged” — it actually does means “I am in your debt.” The French merci is even more graphic: it derives from “mercy,” as in begging for mercy; by saying it you are symbolically placing yourself in your benefactor”s power — since a debtor is, after all, a criminal. Saying “you’re welcome,” or “it’s nothing” (French de rien, Spanish de nada) — the latter has at least the advantage of often being literally true — is a way of reassuring the one to whom one has passed the salt that you are not actually inscribing a debit in your imaginary moral account book. So is saying “my pleasure” — you are saying, “No, actually, it’s a credit, not a debit — you did me a favor because in asking me to pass the salt, you gave me the opportunity to do something I found rewarding in itself!”

Following the second murder of an Tunisian opposition figure in six months, Fadil Aliriza spotlights mounting tension in the original “Arab Spring” nation:

In the background of Tunisia’s political scene, there is a steady hum of anger and frustration. Any big event risks tapping into that well of anger. Tunisians are angry that there has been little progress since the revolution. The economy has not improved and has, in some sectors, weakened. Unemployment refuses to decrease. Corruption is still integral to every facet of Tunisian life. Government and municipal services remain inaccessible and unresponsive to most of the population. Police brutality continues. Stark economic inequalities between people of different economic classes, and between developed coastal regions and underdeveloped interior regions, persist. Political divisions tend to fall along sharp ideological lines, and, despite Tunisia’s woes, assembly members take regular breaks from their task of drafting the constitution.

In this tinderbox, the second political assassination in six months has acted like a spark, and people are looking for someone to blame.

Meanwhile, Juan Cole surveys the chaos in Libya, where “over the weekend, all hell broke loose”:

The assassination of a militant secularist nationalist in Benghazi just after the assassination of of a militant leftist secularist in Tunis raised the question of whether the extremist Libyan and Tunisian devotees of political Islam coorinated the attacks so as to foment turmoil that might form a path whereby they could take over the country.

It seems obvious that the Libyan government needs to swallow its pride and get outside help in accelerating the training of new security forces. What were probably extremist fundamentalist terror cells bombed the courthouse in Benghazi, in front of which crowds gathered on Feb. 17, 2011, to kick off the revolution, was bombed and partially destroyed. Another bomb was set off Sunday evening in Benghazi, as well. …

And no, these problems of transition would not justify having kept the totalitarian and murderous dictatorship of Muammar Gaddafi in place. In fact, many of the extremist fundamentalists were provoked to a life of violence by his oppression. I have a bad feeling about this.

Previous Dish on the recent upheavals in the Arab world here.

Noam Scheiber responds to critics of his piece on the decline of corporate law firms:

Big Law boosters point to the fact that revenue at the country’s 100 biggest firms grew by 3.4 percent last year—a reasonable increase, if hardly the 8-12 percent increases of the early-to-mid-2000s. But when you unpack the number a bit, it looks even less impressive. It turns out that the bump was driven primarily by a huge fourth quarter after three middling ones. And that big fourth quarter was, in turn, the result of some idiosyncratic factors—like a rush by corporations to complete transactions before the dreaded fiscal cliff took effect on January 1, and law firms aggressively seeking payment before the end of the year (for similar reasons).

Meanwhile, other data show the problems for the legal profession continuing. Of the law students who graduated in 2008, 75 percent of found a legal job within nine months, according to the National Association for Law Placement (NALP). For those who graduated in 2012, the number had fallen to 64 percent, a record low. Of course, Big Law firms typically hire associates well in advance, so these numbers partly reflect the hiring environment that existed a year or more earlier. And, in fairness, NALP reports that hiring at big firms did recover a bit for the class of 2012 after a terrible 2011, even if it was still well below the 2009 level. Still, the fact that the market for lawyers was historically weak more than three years after the recession is pretty alarming. NALP refers ominously to a “new normal” in law-firm hiring.

Update from a reader:

Here’s the main problem with Scheiber’s thesis: Where the heck is all the business going to go when 90% of big law firms collapse?

I’ve been a big law associate for a number of years, and I think I would have noticed if 9 out of 10 of my colleagues had been wandering the halls with nothing to do.  So, when the firm-pocalypse comes and wipes out 180 big firms, how are the remaining 20 (which will likely be the busiest 20) absorb all of the abandoned legal work without massive expansion?  Even if they could expand like that, with only 20 law firms, how could you ever find one that wasn’t already representing your adversary or negotiating counter-party?

And it’s not like thousands of little firms will spring up to replace all the fallen giants.  Small-firms are just not capable or cost efficient enough at handling the kinds of matters that the big boys do. You can’t run a giant, months-long document review out of a five-person law firm unless you aren’t doing anything else, and if you aren’t doing anything else, how does your firm survive when the case suddenly settles and you haven’t booked anything else because your whole firm was working on that one case which could have lasted months?

A reader writes:

As a progressive liberal parent, parenting in progressive liberal Seattle, I’m finding the lopsided caricature of liberal parenting presented recently on the blog to be rather unfair. In the specific case of fluoridation, it is by no means proven that fluoride is harmless –  some studies have linked fluoride to disruption of the endocrine system, leading to metabolic disorders and thyroid problems.  Could America’s obesity rates be somehow linked to its obsession with fluoridating its water?  The case against fluoridation is given here.

But in general, I would consider being against fluoridation to be a somewhat conservative stance. To me the idea of adding medicines to drinking water seems to be the nanny state operating at its finest (there is no other reason for adding fluoride to water beyond the prevention of tooth decay).  If I want to use fluoride, then it’s super simple for me to just buy a fluoridated toothpaste, giving me a degree of choice and control over what I put into my body that federally-mandated fluoridation just doesn’t give me.

On a more general note, I’m a firm believer in “you are what you eat”. I don’t think it’s an accident that my daughter is very rarely sick.

It’s because she generally gets her five fruits and vegetables a day.  But I have to be vigilant over what my eight-year-old daughter puts in her body because no one else is doing it for me.  Added sugars, salt, high fructose corn syrup, and hydrogenated fats are routinely added to processed foods, often when you would least expect them. Why do juice boxes require added sugar? Wherever she goes – camps, after school activities, birthday parties – she is presented with an overwhelming abundance of boxed pizza, boxed mac ‘n cheese and processed sugary treats. Try finding a vegetable, or even fruit,  on any kids menu in America. And that’s before we get to the barrage of propaganda on behalf of (government subsidized) Big Ag that she’s subjected to every time she turns on the TV.

It seems to me that “conservatism” is all about preserving the status quo of Big Ag and Big Pharma, whereas it is we progressive liberals who are seeking to return to and conserve an earlier simpler world where we can all have access to nutritious food grown in proper soil by local farmers. If we occasionally seem paranoid and over-zealous – and we are sometimes – it’s because that simple goal is nowadays really difficult to achieve.

Update from a conservative reader:

It warmed my heart to see this self-described “progressive liberal” parent from Seattle rail against government-mandated fluoridation and government-subsidized Big Ag – it certainly isn’t the libertarians pushing this stuff. I only wish that more of my friends on the left would see the virtues of smaller government.

Read the Dish’s coverage of the bloodshed from Saturday here. More violence could be imminent:

Supporters of Egypt’s deposed president Mohamed Morsi have called for a “million-person march” against his ouster after authorities warned of “decisive” action if protesters are considered a threat. Organisers of protests against the military’s overthrow of Morsi urged demonstrators to march on security buildings on Monday night and called a march for Tuesday. In a statement, the Anti-Coup Alliance of Islamist groups urged Egyptians “to go out into the streets and squares, to regain their freedom and dignity – that are being usurped by the bloody coup – and for the rights of the martyrs assassinated by its bullets.” The protest calls, which raises the possibility of fresh confrontations, comes after at least 72 people were killed at a sit-in in support of Morsi on Saturday morning.

Meanwhile, as seen above, pro-Morsi supporters have fortified their Rabaa encampment in Nasr City near where Saturday’s massacre occurred. Elsewhere, the Egyptian military continues to arrest Islamists and attempt to justify their violent crackdown:

But in a new report, Human Rights Watch emphasizes how nothing the protesters did could have possibly justified the level of the response by security forces:

“The use of deadly fire on such a scale so soon after the interim president announced the need to impose order by force suggests a shocking willingness by the police and by certain politicians to ratchet up violence against pro-Morsy protesters,” said Nadim Houry, deputy Middle East and North Africa director at Human Rights Watch. “It is almost impossible to imagine that so many killings would take place without an intention to kill, or at least a criminal disregard for people’s lives.” …

According to a doctor who was at the scene, the police began to fire teargas when the protesters were approximately 200 meters away. A skirmish ensued between the protesters and the police and men in civilian clothes, lasting for about two hours: protesters set cars on fire and threw rocks, while police fired birdshot and more teargas from their position near the bridge. The doctor told Human Rights Watch that after approximately two hours, live bullets were fired at the protesters from what appeared to be an elevated position, possibly from a nearby building. The timing was corroborated by two other witnesses. Fouad, another doctor working in the Rabaa field hospital, said, “The pattern of injuries we saw here was completely the opposite of the Republican Guard. In the Republican Guard incident [on July 8, 2013] it was mostly random live fire, it only looked like 10 percent [of those killed] were shot by snipers. This time it was like 80 percent were shot by snipers targeted from above.”