31/07/2026
Why I Continue to Ask Questions
Throughout my professional life, I have believed that medicine advances not only through evidence, but also through the courage to question accepted dogma. Working in diabetes and cardiometabolic medicine for over three decades, I have often challenged prevailing concepts long before they became subjects of mainstream discussion.
Years ago, through social media, the RSSDI e-magazine, and my own book, I wrote that there is no such thing as a "special diabetes diet"; that a 100-gram serving of mango can safely fit into the diet of most diabetics; that the ADA's 1995 recommendation of 60–65% calories from carbohydrates was a major error; and that maintaining some background insulin is essential for the safe use of SGLT2 inhibitors. Some of these ideas were later echoed by others who had greater academic visibility and resources, often without acknowledgment. Such experiences only strengthened my resolve to continue thinking independently.
My intellectual journey took a fascinating turn. R.Unger's glucagon-centric theory, followed by DeFronzo's Ominous Octet, fundamentally changed the way I looked at diabetes. The impressive clinical outcomes with GLP-1 receptor agonists, SGLT2 inhibitors, and more recently tirzepatide, survodutide, and retatrutide, convinced me that metabolic syndrome and diabetes are unlikely to represent deficiencies of isolated hormones. Instead, they appear to reflect disturbances within an integrated hormonal network that regulates the body's entire metabolic milieu.
Hours of reading, reflection, and discussions, with most notably inspiring EASD lectures by Timo Müller, Jens Holst, and Jonathan Campbell, eventually culminated in two original hypotheses.
This time, however, I decided to secure the academic priority of my work. I developed both concepts into publication-ready manuscripts, published them on Preprints.org, and obtained DOIs, thereby creating a permanent scholarly record of my authorship before wider dissemination.
Science progresses through questioning, debate, and rigorous testing-not through consensus alone. At a time when commercial interests and well-funded academic ecosystems (including APC-based publications, asking for thousands of USD or Institutional affiliations) often shape (and compel) research priorities, it is more important than ever that new ideas are judged by the quality of their evidence rather than the influence or resources behind those who propose them.
Whether these hypotheses are ultimately validated, modified, or disproved, they will have served their purpose if they stimulate fresh thinking and contribute to a deeper understanding of metabolic disease.
Here are the links to both articles:
Article 1: DOI: https://lnkd.in/gRyiKkqT
Link: https://lnkd.in/gcgC7kBJ
Article 2: DOI: https://lnkd.in/gvvZZm6D
Link: https://lnkd.in/gJrvCGsd
Which of these hypotheses do you believe deserves experimental testing first?
