Before addressing the political opportunity in front of the vice-president, let us first confront the sacred cow in the room.
Contrary to recent claims by Donald Trump, JD Vance and Ted Cruz, Kamala Harris loves a good cheeseburger; she positively does not want to take our red meat away. She has cited sugars and sodas as major culprits in our poor health. Moreover, the Biden-Harris administration has demonstrated that it is unafraid to challenge the stranglehold the pharmaceutical industry has over insulin prices, and the cost that industry charges Medicare patients for drugs.
Next, let’s dispense with the false narrative that Trump and his acolyte Robert F Kennedy Jr, have the capacity to “make America healthy again.” As part of RFK Jr’s recent endorsement, Trump vowed to appoint “a panel of top experts, working with Bobby, to investigate what is causing the decades-long increase in chronic health problems …” Kennedy, whose anti-vaccine work is more likely to make America have measles again, has recently become the darling of many metabolic health advocates for his series of half-truths about America’s obesity epidemic.
Let’s not be fooled. To paraphrase Harris, these are not serious people, and the consequences of putting America’s healthcare in their hands would be deadly.
I happen to live with type 2 diabetes, and have spent the past year chronicling the ways one of the country’s most lethal, expensive and ubiquitous diseases is actually reversible through a diet low in carbohydrates – the macronutrient that diabetics like me cannot safely metabolize without the help of drug therapies. Nutrition in America has become quite politically polarizing, as shaky science often collides with ideology, leaving us at a loss to know why we get fat, why we get sick, and even whether red meat causes diabetes (it doesn’t). Our healthcare budget is $4tn a year, yet our life expectancy is only 48th in the world, and we seem to be getting heavier and sicker. Something is terribly wrong.
In this abyss lies a golden opportunity for presidential candidate Harris to present a healthcare agenda that would save thousands of lives, billions of dollars, as well as her appeal to voters in conservative states. She can do what no president has ever had the courage to do before: launch a national campaign to reverse America’s diabetes epidemic and, in the process, improve our metabolic health. She might even declare the destructive disease a national emergency.
This initiative would be both good policy and good politics, and it is not as quixotic as it might first sound. Type 2 diabetes is a condition where the hormone insulin does not naturally function properly, leading to high blood sugars, and leaving its victims at risk of cardiovascular, kidney, eye and other disease. Currently, 38 million American adults have diabetes, while another nearly 100 million more have pre-diabetes – or more than a third of adult Americans. At $420bn per year, it is one of America’s costliest diseases, accounting for over 10% of the country’s $4tn annual healthcare budget. It kills over 100,000 Americans annually, more than die of opiate overdoses.
And while it is true that people of color are more likely to get diabetes than white people, it is also the case that, like the opiate crisis, diabetes is a color-blind disease that has disproportionately ravaged red state America. In fact, 14 of the 15 states with the highest diabetes mortality rates voted Republican in 2020. And 14 of the 15 states with the lowest mortality rates voted Democratic in 2020.
What form should a Harris initiative take? Here are my personal recommendations, based on my own experience with the disease, and a year’s worth of interviewing well over 100 researchers, clinicians, advocates and patients. Frankly, it is baffling that this disease – which is killing us widely, breaking our budget and reversible through diet – is not yet a matter of national urgency.
1. First, she should announce her intention to appoint a diabetes czar whose job, among other things, would be to solve this puzzle – over the past quarter-century, America’s pharmaceutical and medical technology industry have made extraordinary strides developing various forms of insulin and other drugs, continuous glucose monitors and test strips. So why have seven times more Americans been diagnosed with diabetes than in 1980? Eventually commonsense solutions would emerge, such as restricting cereal companies’ ability to market their sugary treats to children.
Not only would the czar be empowered to confront things like the scandalous $1bn-plus in sugar subsidies provided by US taxpayers, she would explore common-sense treatments for treating diabetes that are diet and lifestyle-focused. (A good place to start would be the excellent 2024 book Turn Around Diabetes, written by endocrinologist Roshani Sanghani.)
2. We must defund, disqualify and otherwise delegitimize the American Diabetes Association (ADA). As I have written, the ADA has become a virtual branch of big pharma and big food. Yet it sets standards of care for clinicians and de-emphasizes mountains of evidence that the low-carbohydrate diet is a powerful tool in reversing the disease. Frankly, it is mind-boggling that the world’s most powerful diabetes-fighting organization (2023 revenue: $145m) has so utterly failed to stem the disease, but still sets standards of care, controls research dollars and dictates the diabetes narrative in this country.
Late last year, the ADA was sued by its former director of nutrition. She claimed she was fired for refusing to include the artificial sweetener Splenda, whose parent company donated $1m to the ADA, in the ADA’s list of approved recipes. It is one of American healthcare’s great tragedies that the ADA and the plaintiff, Elizabeth Hanna, settled before the facts of the inner workings of the ADA were brought to light in a trial. In any case, the complaint is a stinging indictment of the organization and should be read by every clinician interested in learning how corporate donations have corrupted the organization’s nutrition guidance.
3. Perhaps most urgently, the federal government, including the National Institutes of Health, should expand its research budget to include researchers treating patients with low-carbohydrate and ketogenic diets. Over the past two decades, there has been an explosion of courageous clinicians who prescribe the low-carbohydrate diet to their patients, as well as at least two startups – Virta Health and OwnaHealth – with promising results treating diabetes and obesity with low-carbohydrate diets.
But because their research does not include the search for the next blockbuster drug, researchers often cannot access ADA, NIH and big pharma research dollars. They don’t get prominent spots in pharma-funded conferences. This is an enormous impediment to the low-carbohydrate diet becoming part of the medical mainstream and in my opinion is responsible for the persistence of the diabetes plague.
4. We should give platforms to people who actually have diabetes, especially those who have reversed their condition by taking control of their diet. Of all the misconceptions I uncovered in my reporting on diabetes, the most common was that the low-carb diet was too difficult for patients, particularly low-income patients, to maintain. Of course, resisting bread, sweets, rice and starches is not easy, but it is made far more difficult by the utter lack of a national consensus that these are the foods responsible for diabetes and obesity. Stopping smoking is hard too, but once it became a national imperative, usage plummeted. In my experience, when patients are told the truth (“Stop eating carbs or your disease will progress and you may die”), they can change their behavior. And they feel empowered.
Take the case of Jemia Keshwani, a 40-year-old LaGrange, Georgia, woman who has had diabetes for 25 years, and who narrowly escaped amputation of her right foot after her doctor prescribed a low-carbohydrate diet. She has lost 120lb (54kg) and no longer shoots insulin into her belly four times a day. “I didn’t understand you could change things around if you eat the right foods,” she said. “You know how sometimes you feel helpless? Now I don’t feel that way.”
Or the case of Ajala Efem, a 47-year old Bronx woman, who, according to a recent article in Medscape, lost nearly 30lbs and got off 15 medications after her Bronx-based healthcare provider, OwnaHealth, prescribed a low-carb diet.
“I went from being sick to feeling so great,” she told her endocrinologist. “My feet aren’t hurting; I’m not in pain; I’m eating as much as I want, and I really enjoy my food so much.”
This past March, Harris asked an audience in Las Vegas how many people had family members living with diabetes. “A sea of hands went up,” she wrote on her Facebook page.
Harris clearly understands the diabetes scourge and needs only a gentle push to make it a priority. So here is one final word of affectionate advice. The next time she attends a state fair, she might consider having one of those cheeseburgers she loves. It’s delicious, nutritious and will make a great photo op.
Just lose the ketchup and bun.
Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project
