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Steven LEVITT: I was at an in-person conference a few years back, the old days when people used to meet face to face. And a few minutes before we all sat down to dinner, the conference organizer pulled me aside and asked if I would be willing to facilitate the conversation at my table. Now, that is roughly my least favorite thing to do. And it only got worse when I was handed a list of suggested topics, not one of which was remotely interesting to me. So I decided to try something different, something I had never tried before. I tore up that list of topics and instead, I proposed that to start the conversation, each person should take five minutes to tell his or her life story. But with one twist. I told them I wanted no self-deprecation and no modesty, that I was giving them permission to be braggy and arrogant. I turned to the woman sitting on my left. Her name badge said Marina Nitze. She was younger than the other people at the table, small in stature, clearly an introvert. I said, “Marina, how about you start?” And it was immediately obvious that braggy arrogance was far out of her comfort zone. She spoke slowly, repeatedly apologizing after she noted an accomplishment. Each time I interrupted, telling her I gave her 100 percent permission, indeed that I insisted, that she tell us about every amazing thing she had done. And what unfolded was one of the most fascinating life histories I’ve ever heard.

Welcome to People I (Mostly) Admire with Steve Levitt.

LEVITT: More than a year had passed since that dinner when I decided to start this podcast. I began by writing a list of possible guests to have on the show. And the first name on that list was Marina Nitze. And I hope that you’ll find her story as enthralling as I did. Now, in this podcast, I can’t recreate the intimacy of a dinner table, and I can’t promise her that if she brags and gloats, you listeners won’t walk away thinking she’s a self-centered, self-promoting jerk. So I’m really worried that the version of her life she gives today won’t be nearly as interesting as the uncensored version she offered that night. I do, however, have one thing working to my advantage. I’ve heard the full arrogant version of her story, so if she leaves the best stuff out. I know what questions to ask her.

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Steve LEVITT: Thank you so much for making time for me, Marina.

Marina NITZE: Thanks so much for having me.

LEVITT: I’m guessing, from what I know about you, that you were a pretty unusual child. Is that true?

NITZE: I was not good at being a child. I started my first business when I was three-years-old. I sold curated magazine subscription cards to my neighbors. I presume they only purchased them from me because I was three. But, I had customers.

LEVITT: I don’t think that was your last business you ever started either.

NITZE: No. When I was in fifth grade, I became obsessed with the soap opera General Hospital. And I made an A.O.L. homepage for my favorite couple and learned HTML, and then I made hangman, bingo, and other soap opera-related games for this website when I was 11 or so. And actually, it was really popular and a number of actors and actresses hired me to make their official websites. They definitely did not know that I was 12.

LEVITT: You were literally 12-years-old and you’re the agent to the stars. So what did you tell them?

NITZE: I just kinda left the details out. There was no video conferencing at that time, and they could mail a check so it just worked out.

LEVITT: So what kind of money were you making when you were 12 years old? It was good money?

NITZE: Very serious money, actually. Because again, they didn’t know I was 12, so that was not factored into the pricing. And being able to hire someone to make a webpage at that time was a fairly rare skill. That business continued until I was well into my twenties.

LEVITT: And then, you started your bureaucracy-hacking when you were in high school, right? Cause you tried to figure out a way to get out of high school as fast as possible.

NITZE: I did. I loved high school. I actually met my husband there as well, so it really worked out for me. But I couldn’t maintain the pace of keeping my own business and going to school, plus all their extracurriculars and all the demands. So I read the rule book, and it said that the one thing that kept you senior year was that you had to have four years of English, but they would give you credit if you took the A.P. English exams. And there are two, at least there was at the time.

And so I snuck to a different school. I took the other A.P. exam for senior year. I passed it, flying colors. And then I made a case back to my headmaster that I should be able to graduate from high school. And he said, “I think you’re right.” He handed me my diploma the first week of August before senior year started. And then I found a college that would take all my existing A.P. credits. So I actually went from being a junior in high school to a junior in college in one week.

LEVITT: And did you graduate from college?

NITZE: I didn’t. I really loved my business. I stayed for a year and I thought, “I’ll go back next year,” and it still hasn’t happened yet.

LEVITT: After high school, you kept on doing your, I don’t know, call it your A.O.L. business. And that was what you were doing for a big chunk of your early life?

NITZE: Yeah, so I made websites, and I was a self-taught programmer, but I started funneling that into more of what I think I’ve always intrinsically loved doing, which is business process re-engineering. So instead of just making celebrity fan websites, I worked with auto dealerships, other sorts of companies and said, “How can you use technology to make your processes work faster and be friendlier for your customers?” And at the time, if you Googled ‘business efficiency consultant,’ I was the only search result, which led to me being offered to write Business Efficiency for Dummies.

LEVITT: So you were doing this efficiency consulting, and then somehow you made your way to Washington. How did that all happen?

NITZE: I was involved in the early Seattle tech-startup scene. And I heard from a local blog that the city of Seattle was offering a $20,000 prize to the company that could make the best web app that used open city data. And I thought this was stupid because $20,000 is not enough to make a real app that would really be in production. All you’re getting is a prototype that won’t ever see the light of day. I investigated the source of this $20,000 prize and it was coming from a mayor’s advisory board on technology. So I applied to join the board. I was accepted. Then I volunteered to run the committee overseeing the prize. And then I canceled the prize and we put that money instead on building relationship and community between the city I.T. team and the Seattle tech startup community.

Meanwhile, I see Chief Technology Officer of the United States, Todd Park, on TechCrunch Disrupt. And he says, “I’m looking for a bunch of tech savvy entrepreneurs to come into government and disrupt it.” And when I heard this my first, second, and third thought was, “I am totally not qualified. I am self-employed. I didn’t finish college. I’m a libertarian.” But it said if you sent in your resumé, you’d be added to their mailing list. And I thought that could be useful in my committee.

So I bought a $3 bright blue resume template online that said, “I’m Marina,” at the top. And I sent it in expecting to hear nothing and actually cried in my apartment that night. And I’m not an emotional person but I felt like I was a failure. Like I had made so many life decisions that meant I would never be qualified for this really cool-sounding opportunity. And I felt really down on myself.

A few months later I get a call from Richard Culatta at the Department of Education asking if I wanted to be his presidential innovation fellow. And my first reaction was: “I didn’t apply to the Department of Education.” And luckily, he didn’t let me hang up the phone. And by the end of it, he said, “Your blue resume really stood out in the pile.” And so I got on an airplane. I crashed on a friend’s couch in Washington, D.C. And then I joined the first class of presidential innovation fellows. It was a new branch of the White House fellows program. I worked on open data at the Department of Education and a year to the date I became the chief technology officer of the U.S. Department of Veterans Affairs.

LEVITT: Now, did you apply to that job or did they find you? Did you have an interest in Veterans Affairs?

NITZE: So at that time, the V.A. disability claims backlog was on the front page of the newspapers. There were literally offices buckling under the weight of unprocessed disability claims. President Obama called an emergency all-hands meeting at the White House to help the V.A. solve it. And he invited Todd Park, who was the C.T.O. of the United States.

Todd had a conflict and asked if I would go and take notes for him. And I immediately fell in love with the problem of solving V.A. disability claims because it wasn’t a technology problem so much as a business process engineering problem. So I flew around the country for a few months. I mapped out the process end to end. And then the White House appointed me to be the C.T.O. of the V.A.

LEVITT: I’ve lost track of how old you are, but you don’t seem very old at this point, from what you’ve told me.

NITZE: I was 27. I think I still am the youngest appointed C-suite executive in the federal government. I think it really speaks to the, I don’t mean to be self-deprecating, but to the dearth of technical talent around at the time. It is slightly crazy looking back that they put a 27-year-old in it, but I also think I did a good job, so I don’t know.

LEVITT: So a few years earlier, you were working as an independent consultant and now you’re the Chief Technology Officer at the V.A. You must have a huge team and a huge budget. How do you deal with that change?

NITZE: So the V.A. is the largest civilian agency. It has 330,000 full-time employees and I.T. alone has a $4.6 billion budget and 16,000 staff members. However, I was the Chief Technology Officer, not the Chief Information Officer. So when I started, they told me my job description was to redefine the art of the possible for how America honors and serves its veterans. And to do that, I had a $0 budget and zero staff members.

LEVITT: That doesn’t really sound like a recipe for success to me.

NITZE: I was sitting in my office one of the first days and nobody would let me into their meetings because they were really afraid of the impact that the new person who had just been auditing the V.A. from the White House was going to have on their projects. So I was fairly lonely that first week. But I really thought actively about this documentary I had seen about this guy that trades his red paperclip through a succession of barters for a house. And I’m literally thinking about this and I’m sitting in my office and a member of the executive secretary team pops her head in and says, “Hey Marina, have you seen green pack 82?” And I said, “I don’t know what a green pack is, but I have nothing else to do. Let me help you find green pack 82.”

And it turns out when members of Congress write letters to the V.A., they actually get hand delivered and then put in a green folder. And then anybody that may have feedback on the response would have to get their hands on this green folder and hand write their edits into it. And so, the executive secretary team was going all around this building all the time saying, “Who has this green folder?” And I said, “What if we printed barcodes on the front of the folder? And then you could keep track of who had last checked it in?” And I had unknowingly unlocked this unbelievably powerful source of political capital because now I was best friends with the executive secretary team that controls everybody’s meetings.

I thought V.A. could be a veteran-centered organization where a veteran could actually get all the services and benefits that they were entitled to in one cohesive place. As part of traveling around the country, I had spent some time sitting at V.A. hospitals. And I remember meeting this woman who really changed my life. Her husband had been hospitalized at the V.A. for the last nine months. He had not been in the V.A. for decades because his private-sector doctor told him he would never be able to get through the application process. And one day his doctor was out sick and a different doctor came in and said, “Hey, why don’t you apply for V.A. healthcare?”

So he gets into V.A. And as a woman’s telling me her life story, I’m asking her, “What other V.A. benefits and services do you take advantage of?” because they were eligible for home loan, their kids could go to college on the G.I. bill. And she looks at me and says, “What other benefits and services?” So it struck me, you could live at the V.A. for nine months and not have any idea of all of the things that you were eligible for. We were really falling down on that.

I laid this vision out for what a 21st century V.A. would look like and partnered with a colleague who had beautiful visual design skills, Molly. And I spent an entire paycheck printing this vision document book out at Kinko’s. I later discovered that the V.A. also has a printing press on the sixth floor, but I hadn’t found that corner yet. I leveraged my relationships with the executive secretaries to get meetings with all of my senior leader peers at the V.A. And I gave them copies of this vision book.

LEVITT: So right now you are working as the Chief Technology Officer, but essentially nobody knows anything about you. You deliver this thing and what happens next?

NITZE: I start seeing it peeking out of every senior leaders briefing book, they’re carrying it around with them. My next meeting, I get called into the Public Affairs Office who was angry with me because this vision book had been faxed to an investigative reporter who had follow up questions. And I knew I was onto something then. And the senior leaders helped me give it to the Secretary and when he came back, he said, “Hey Marina, I believe in this vision, I will give you a head count of two people,” which was much larger than my zero. 

You’re listening to People I (Mostly) Admire with Steve Levitt and his conversation with Marina Nitze. After this short break, they’ll return to talk about how Marina’s working to fix foster care and her personal experience with Type 1 Diabetes.

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LEVITT: Did you notice how reserved Marina was initially? She said, “Oh, I was not good at being a child. I started a business, but they only bought stuff because I was three-years-old.” And she described the things she did, but she usually left the most impressive part out, until I prodded her, and then she revealed it. But as the conversation went on, I think she realized I was going to force her to reveal her accomplishments so she started to volunteer them much more freely. For the rest of the interview, I want to ask about her latest work-related endeavors, but also about something much more personal that came up at the dinner table that night a few years back. Her lifelong battle with Type 1 or juvenile diabetes. I have to admit, I knew nothing about Type 1 diabetes before that conversation. And what I learned from her that night was stunning to me. She’s never talked publicly about her diabetes before, but I asked her in advance of this interview whether she’d be comfortable sharing her story, and she said, “Yes.” 

LEVITT: So eventually, you left the V.A. Did you do what you wanted to do at the V.A.?

NITZE: My vision booklet had 48 ideas in it. Each one was a couple of sentences. What if V.A. could attract and hire some of the top technologists in the nation for tours of duty? What if V.A. could have one website where a veteran or their family members could apply for all their benefits ? And when I left the V.A., we had accomplished 46 of those 48 things, which my team had to remind me of, because it was five years later. I was on to a whole new list of seemingly impossible tasks.

But it was a really nice moment before I left my office for the last time to go back through that booklet and feel good about what we had accomplished. And even now I can go to va.gov and see the real-time scorecard and see that a million veterans have enrolled in healthcare because of something that we built. 700,000 people have applied for disability claims and that feels pretty good.

LEVITT: What did you do next?

NITZE: I thought I was going to take some time off, but I also knew that I really wanted to work in foster care. I had been in something called a court-appointed special advocate since I was about 21. It’s like Big Brothers, Big Sisters, but you are legally assigned to a foster child’s case. I describe it as being like their tile grout, probably not the sexiest of descriptions. But my job is to help keep them from falling through the cracks.

And I saw these kids falling through crack after crack. And before I ever went to government, it was a space I was interested in bringing my business process re-engineering to, but I didn’t quite know how. And it turns out that Richard Culatta, who had called me to join the government for the first time, had then gone on to be the Chief Innovation Officer for the state of Rhode Island.

And he said, “Hey, why don’t you come here and see if there’s anything that we could do in the foster care space?” When I talked with families that had dropped out of becoming foster parents, they said, “The process is so complicated to get through, and so lengthy. And I call, and nobody has any idea who I am or if you’ve gotten my medical records or how many training classes I have left. If this is how you’re treating me when you’re recruiting me, how are you going to treat me when I have a child in my home that’s in crisis? And so I don’t want in.” And so, I worked with Rhode Island on redesigning their licensing process.

LEVITT: And the problem is that this licensing process is long and complicated and discouraging, and those incentives get in the way of people signing up to be foster parents.

NITZE: Absolutely. In foster care licensing is the process that a family will go through to get approved to take a child into their home. In foster care, we have two goals. We want to safely keep kids out of foster care in the first place. And then if you are in foster care, we want your first placement to be your last placement, and it to be with someone that you know, that’s in your community. And either you stay with them forever, or you go back home. But when you dig into that in practice, so many family placements can’t get through the licensing process that we put kids with strangers. We move kids 160 times. And then the easiest path tends to be putting them in a group home.

I run a 16-state working group now that helps redesign and re-engineer licensing processes where I actually want to make deep systemic reform. And some things we’ve found in our research, for example, are that the very first question that’s asked in most states is a very intimidating one where you have to list everything on your criminal record.

And I’ve met a 69-year-old grandmother, who is crying and telling me she is so embarrassed that she can’t even fill out that form because she knows that she’ll be rejected for a shoplifting conviction from 40 years ago. And I’m telling her, “That’s definitely not disqualifying. Please fill out that form.” But because that’s the first barrier that she faces, she assumes she can’t get through it.

LEVITT: So tell me you’re re-imagining. How would the process look if you had your way?

NITZE: It would be very brief. It would be a background check and a sinkhole check, as I describe it, where I make sure that your home is structurally sound. And as needed for individual children, there could be more of a safety plan there, but the licensing standards have gone crazy. You won’t get licensed if you don’t use recycling, you won’t get licensed if your dog who’s pregnant doesn’t have rabies vaccinations. The stories are just crushing. Because the people designing them are thinking from a liability perspective, but they’re not seeing that it means that these kids are not living with their family members.

LEVITT: I totally understand because when I adopted a daughter from China, I was going alone to pick her up in China. It meant that for 24 hours I was going to be a foster parent because my ex-wife wasn’t going to have met and signed the papers for my daughter. And as a consequence, we had to go through all of the licensing to be foster parents for one day. And it was intimidating. For instance, they came to the house and made sure we had appropriate fire extinguishers and other things, which I suppose is a sensible thing in general. But if I was allowed to raise my own children and no one thinks I need a fire extinguisher, it’s strange that I need one to raise a foster child.

NITZE: The strangest is many states will allow you to be placed with your grandmother based on just a background check and a sinkhole check, but they won’t give them any financial resources until they go through all the other requirements. And to me that is the worst of all, because it’s really putting up so many insurmountable obstacles to give family members the financial resources that they need. Whereas, if we put them with a stranger, we will suddenly materialize daycare funds and funds for fire extinguishers and all this sort of thing. And we really need to focus more on how we make licensing and resourcing family members as easy and frictionless as possible.

LEVITT: Do you think we’re too quick to remove children from the home or too slow?

NITZE: We are generally too, well — it’s not so much that we’re too quick. It’s that we remove them for lots of unacceptable reasons. Even the federal government estimates that 60 percent of kids are in foster care because they’re poor. Poor children are disproportionately exposed to mandated reporters.

So every time their parent takes them out of school to go get a housing voucher that they have to wait all day for in the office, that housing voucher representative is mandated to report that child is truant from school. Even though the parent had no other mechanism to safely get their child home from school and get the voucher. We will regularly remove children from homes because parents are leaving them home alone because they can’t afford daycare. And then we placed them in stranger foster care with a full daycare stipend. And those are the sorts of incentives that we really need to look at.

LEVITT: Do you have advice for kids in foster care? Are there things they can do to better navigate the system?

NITZE: So some of the most impressive, most accomplished people I’ve ever met in my life are former foster youth. And to the best of your ability, you have to hold on and look at this as time where you will build your resilience and you will build your grit. It is not your fault. To the extent that you can reach out and build a supportive network of adults that can help you through, I encourage you to do that, but you gotta make it to the other side because you will be so much more powerful than your peers based on your strength and your experience then you can even imagine right now.

LEVITT: Would you describe yourself as an organized person?

NITZE: Yes. I would describe myself as a Type-A person. I have a lot of lists. So I, being a business-process reengineering nerd, made my own task app about 10 years ago that runs most of my life. It’s called Task Tackler. I’m really obsessed with the idea that at different times of day, you may be optimized to do different types of tasks. I designed it for every task; it captures the mood that is most optimal that I should be in to do that task.

And this came out of a problem I noticed where I would be super caffeinated, raring to go in the morning, and I would immediately do the laundry or make a grocery list. That’s a terrible thing to do when you’re sharp and caffeinated. That’s when you should be working on big writing or research projects.

LEVITT: And how detailed are your lists? Do you plan out your entire day?

NITZE: So interestingly, I don’t plan out my entire day, but I do have enough metadata in my tasks to fill in my day accordingly. So I will, when I wake up say, “I’m feeling sharp or normal,” I’ll tell Task Tackler that, and I will say where I am, which in a pandemic is less relevant, but in my last nine years of life, I have lived on airplanes. And then it will tell me the next best thing I can do with my time.

I also love randomness, which may sound like the opposite of what I just said. The random button is on every page of Task Tackler, and I want it to randomly tell me something from this list to do next. And I find that that significantly removes some of that dread, when you have to look at a list of seven things to do, and you’re like, “Oh, I really don’t want to do number three.”

LEVITT: This metadata, as you described it, must include every single thing you do in your life, so do you tell it, “I should clean the oven once every three months?” How does it know what to tell you to do?

NITZE: So I have routines that are optimized for letting me do the task the least number of times to still achieve my goal. An easy example there is house cleaning. Clean your kitchen counter, track how many days it takes for your counter to feel dirty to you, whatever that measure is, and then clean it n-minus one days. So if every three days your kitchen counter looks gross and upsets you, clean it every two days, and then you’re never cleaning it more often than you need to, and you’re always enjoying the level of cleanliness that you want.

And I have really optimized that routine for lots of parts of my life. I work very hard a lot and then I’d have an afternoon where I’m just burnt out and I want to do something that’s not work. And I would lay on the couch and watch television. And instead now, I have a leisure mode that says, “Hey, remember you wanted to learn how to make cheese. You wanted to watch this movie. You wanted to listen to this podcast.” And so it will deliver up leisure tasks in that way.

To me, being a good friend and a good family member and a good wife are my top tier tasks in Task Tackler. And I assigned tasks to them because if I’m structuring my work contracts and prioritizing that I should be giving the same attention to my personal relationships.

LEVITT: How many tasks do you have total embedded in this software?

NITZE: My last task was number 16,782. So I don’t know if that sounds like a lot or a little, I have been using this for a long time.

LEVITT: You’ve told me that you have Type 1 diabetes and that you’re willing to talk about it today, but I also know it’s something that’s very personal and not something that you usually talk about publicly. So how about we give it a shot? And if at any time it starts to feel uncomfortable, we just move on to something else? How’s that sound?

NITZE: That sounds good. Yeah. You’ve seen me talk about it a hundred percent of the times that I’ve talked about it. All twice.

LEVITT: Can you explain in really simple terms what diabetes is and the difference between Type 1 and Type 2 diabetes?

NITZE: Type 1 diabetes is when your immune system attacks the cells in your pancreas. So you can’t make insulin anymore. And insulin is necessary to move sugar from your bloodstream, into your cells for energy and without it, your body will effectively eat itself and die. Type 2 diabetes is a disease of insulin resistance, where you are making some insulin, but not enough to get the sugar out of your blood. I have Type 1.

LEVITT: How old were you when you were diagnosed?

NITZE: I was nine. So in 1994.

LEVITT: As I understand it, the key to managing diabetes is keeping your blood sugar level stable. And I’m guessing, given your prowess at organization and managing things, you were probably really good at keeping your blood sugar stable.

NITZE: So there’s this measure of how stable your blood sugar is, it’s called your A.1.C. and it reflects an average of your blood sugar for the last three months. So a non-diabetic like you, yours is probably 4.4 to 5.2. 6.5 is where you’re diagnosed. That’s the diagnostic criteria. But interestingly, once you have diabetes, then that also becomes the goal.

And for decades, my doctor said, “If you keep an A.1.C. at 6.5 you will be safe from complications.” And yes, I was all over that. I would pre-bolus the exact amount of insulin before my bowl of whole grain pasta. I made sure I had every macronutrient tracked on a checklist. I weighed my food. I was hitting that 6.5 target as I had been told; it was absolutely in spreadsheets, and I would very carefully analyze it.

LEVITT: So that sounds a real success story. You were the perfect patient. Is there a problem with being diabetic if you manage it perfectly?

NITZE: I think it’s about what perfectly means. So I believed this until I was 32 and I went for my annual eye doctor appointment, which I expected to be routine and normal. And he very nonchalantly told me that I was starting to go blind. This happens to all of his diabetic patients. He was surprised it took so long at the old age of 32.

LEVITT: Why were you going blind? You were doing what you’re supposed to do. You were managing it, right?

NITZE: That was my question. So after that diagnosis, I also developed something called diabetic frozen shoulder, which is basically you move your arm in a very limited range of motion and it’s extremely painful. Here I was having followed every rule that I was given by the medical establishment. And I have two serious life-altering complications.

LEVITT: So what did you do after the diagnosis?

NITZE: So I went outside. I threw up in the parking lot. And then I did what probably everybody would do. I Googled and I said, “How do I fix this? I have done everything I was told.” And Google had this community called TypeOneGrit, and they followed a Type 1 diabetic doctor called Dr. Bernstein.

And they were reversing nephropathy, which is kidney disease; they were reversing neuropathy, which is when you lose sensation in your feet. And they were doing it by lowering their carbohydrates. So they were achieving normal non-diabetic blood sugars and A.1.C.’s. And what really struck me when I learned this was, this is the most obvious thing. I am a smart, organized person. How has nobody told me this for 25 years?

LEVITT: I’m just shocked that these were the realities that many people, maybe everybody who has Type 1 diabetes, ends up being debilitated in various ways and no one tells you. I mean is that not malpractice on the part of the medical profession?

NITZE: I think it comes down to — there’s a tremendous fear in diabetes management of a low blood sugar because one low blood sugar in the middle of night can kill you. But there’s nobody suing their doctor because they need their feet amputated and they can’t see anymore and they can’t move their left shoulder. So the incentives for the medical community are, we must avoid that low blood sugar at all cost. And these downstream consequences are just inevitable and unavoidable.

LEVITT: You’re saying really the doctor’s incentive is to avoid this acute incident with low blood sugar that leads to some awful short-run outcome, as opposed to the chronic debilitating thing, which ruins your life. And so, they emphasize the acute over the chronic.

NITZE: Absolutely. There are studies that I have now read that Type 1 diabetics on average have 19 fewer years of lifespan, which I would consider significant.

LEVITT: So you discover this organization and what behavior changes does the organization think you need to make to overcome the debilitating effects of diabetes?

NITZE: It’s very few carbs and very few carbs in one sitting, because carbohydrates are the main factor that drives your blood sugar up. Type 1 diabetics do always need a little bit of insulin for routine background body tasks. But once I switched to a low-carb diet, I needed one-tenth of the amount of insulin. And I had normal, non-diabetic blood sugars.

LEVITT: How long did it take for your blood sugar levels to fall?

NITZE: It was almost immediate. There was definitely some tweaking but within that first 90 days, my A.1.C. had dropped to 5.2, seemingly impossible for someone with diabetes. I also felt so much better in a way that I never realized I felt badly before. So I have had diabetes my entire adult life. So I don’t really remember a time before. My quality of sleep went up. My energy went through the roof.

LEVITT: Now I’ve heard Peter Attia, who’s a friend of mine, he had a guy named Jake Kushner come on his show and they were talking about this exact issue. So I just want to emphasize: you’re not a doctor, but everything you’re saying exactly jibes with what I’ve heard. But it leaves me so puzzled. Like you made a simple change in your diet — it’s completely transformed your life. Yet, the American Diabetes Association doesn’t espouse this approach. Is that true? And how do you explain why this approach is not mainstream?

NITZE: I spent a lot of time thinking about this because I am angry that nobody talked to me about it and I am angry that this is not the first course of treatment for everybody. The medical approach is more and more drugs. Medicine does not treat with food. And the American Diabetes Association I don’t think has any incentive to reduce the scope of its scale.

LEVITT: Let me make a counter argument. You’re trying to fix foster care. That’s like you saying, “Oh God, if I fixed foster care, there’s not going to be a problem for me to solve. So I shouldn’t fix foster care.” Don’t you think the American Diabetes Association would have the same view? If they could get rid of diabetes, it would be a good thing?

NITZE: I would like to believe that. I have not seen their behavior aligned with that. Here’s an interesting thing. Tracey Brown, who is the C.E.O. of the American Diabetes Association recently met with Dr. Bernstein and she tried his method and she is almost completely in remission herself, but when she talks about it publicly she is roundly criticized, but by all accounts, she seems to have discovered that there is a way to reverse her disease and she is not able to get her organization to embrace that too.

LEVITT: Thinking like a rational person, I’m just left thinking: there must be another side to this story. For instance, is it the case that if you’re on this low-carb diet and then you deviate, then you run a real risk of some tragic outcome?

NITZE: No. That does not apply. And I agree with you that this sounds overly simplistic. I think part of it is there’s no, low carb lobby. I also think this is a complicated issue to address. So in my case, I was fully ready and willing to jump into a low carb lifestyle and track it and feel good about the success. But this can be hard for a lot of people. A lot of people have a lot of attachment to food and their grandmother’s casserole and whatever else it may be.

And if you are told, “Hey, you could take these few drugs and continue living your life exactly as it is, or you have to swap out your wheat flour with almond flour and swap out your Pop-Tarts with Legendary pop tarts.” Not everybody’s willing to make that change. I recognize that there are complicating factors in terms of food availability and food deserts; in terms of what you can spend your food stamps on; in terms of hospital cafeterias; in terms of school lunch menus.

LEVITT: So I’m sure there are doctors listening to this, and I’m sure they’re screaming, saying, “You’re not a doctor and this is heresy. If people follow this advice, it’s going to kill them.” But, what you’re telling me as a non-doctor is that’s totally false.

NITZE: What I’m telling you as a non-doctor is that last week I went back to the eye doctor and three years after adopting this low-carb diet, my progressive incurable disease is almost gone with no treatment.

LEVITT: Let’s say someone listening to this podcast is struck by what you’ve said, Marina, and they believe in you because you’ve been so effective at so many things and they have resources and they said, “Marina, come work with us and let’s fix diabetes.” Is that a phone call you’d like to receive?

NITZE: Yes. I would love it if my experiences and my life can help make a meaningful difference for that for our world. And if nobody calls me, I may have to call myself in a few years on it.

LEVITT: I look at your life in awe and I just think, “Wow, you have done so many amazing things in such a remarkable way.” What kind of advice would you offer to someone when you think about the secret to living a good life, a life worth living?

NITZE: I really live my life by this Lily Tomlin quote. And the quote is, “I always wondered why somebody didn’t do something about that. And then I realized: I’m somebody.” To me, joy in life is making the world a better place and concretely making progress every day. And I hope that for everybody.

LEVITT: The American Diabetes Association has somewhat amended its thoughts on a low-carb diet. While they’re not promoting it to the extent Marina is, they do acknowledge that there can be health benefits for diabetics and people should make the right diet choices for themselves. Nonetheless, I was so motivated and disturbed by Marina’s diabetes story that I’ve made diabetes a key focus of the research center that I run at the University of Chicago. It seems like such an opportunity to do some good. And separately, at the top of the podcast, I mentioned that little social experiment around the dinner table where people were given permission to tell their story full of arrogance. It’s worth noting how that experiment played out. After everyone told their story, we began to talk about the experience. And what was strange and unexpected is that without any prompting, we all began to reveal our deepest failures and our greatest fears. I think every single person at that table shed a tear that night. I left that table with a feeling I had made seven close friends. Then Covid hit, so I’ve never been able to replicate the experience. But if anyone listening finds himself in a position to try to carry out that social experiment, I would love to know how it works out. Send me an email, whether it succeeds or fails.

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People I (Mostly) Admire is part of the Freakonomics Radio Network, which also includes Freakonomics Radio, No Stupid Questions, and coming soon Sudhir Breaks the Internet. This show is produced by Freakonomics Radio and Stitcher. Morgan Levey is our producer and Dan Dzula is the engineer; our staff also includes Alison Craiglow, Mark McClusky, Greg Rippin, and Emma Tyrrell. All of the music you heard on this show was composed by Luis Guerra. To listen ad-free, subscribe to Stitcher Premium. We can be reached at pima@freakonomics.com. That’s P-I-M-A at Freakonomics.com. Thanks for listening.

NITZE: I suspect the American Diabetes Association won’t be calling, though.

LEVITT: Probably not.

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