A funny thing happened when Dr Robert Califf, the Food and Drug Administration commissioner, delivered the keynote address to the American Diabetes Association’s annual scientific session last month – he told the truth about our country’s colossal failure to treat the raging health crisis.
“For the larger epidemic of type 2 diabetes, we’re failing right now,” Califf said. “I don’t say that lightly.”
Califf did not praise his hosts, the ADA – the powerful body that sets the standard for diabetes care, while accepting tens of millions of dollars annually from the drug and medical device industry.
He also did not the laude the ADA’s funders, the drug and medical device companies that earn billions of dollars selling the insulin, pumps, needles, continuous glucose monitors and other paraphernalia Califf’s agency regulates. And he did not shrink from pointing out that, according to some accounts, diabetes has surpassed cancer as the leading economic cost to our health care system, adding up to over $400bn annually.
Instead, Califf cited America’s ruinously high consumption of sugar and the food industry’s poor labeling policies. He pointed out that affluent Americans invariably receive greater access to the latest technology than poor Americans. And he pointed out, according to an account in MedPage Today, that even the vast majority of digital tools routinely prescribed for people with diabetes fail to help people manage the disease.
“A big part of this [the solution] is going to have to be digital health tools,” he said. “We’re living in a world now where new digital health tools are coming out on a daily basis, but analyses that have been done are not showing that they’re delivering on the promises.”
Now if only Califf had connected the dots!
As I have written, a safe, effective and cheap solution to the type 2 diabetes epidemic already exists. To put it simply, type 2 diabetes, the condition of insulin resistance which afflicts 95% of people with diabetes, is reversible with a low-carb diet. The American Diabetes Association has even quietly acknowledged this. Numerous clinicians practice this and have published their results. Yet, as over 100,000 Americans still die from the condition annually, the American Diabetes Association and medical establishment steadfastly refuse to advocate for it.
It is one of the greatest disconnects in all of American healthcare – even as fatalities and costs of the disease continue to soar, why does the ADA and medical establishment refuse to advocate for, and educate patients about, the dietary solution that could spare lives and save billions? Moreover, at what point will the medical establishment and public servants such as Califf recognize the forces benefitting from the diabetes epidemic such as big pharma, big medtech, big food and – yes – the American Diabetes Association, are the actual sources of our diabetes problem?
Califf’s address to the ADA is a great example both of what is promising and depressing about diabetes care nowadays. Califf is a respected cardiologist who spent most of his career in academia. He is vocal advocate for healthcare as a right and understands how unbalanced access to healthcare is in our country, based on income, region and race.
And yet, his speech virtually ignored critical research that screams for greater adoption of the low-carb diet for people with diabetes. For example, Califf’s citation of a study that concluded that the majority of digital tools prescribed for people with diabetes are not effective. That claim came from a March study this year by the independent Peterson Health Technology Institute which analyzed eight companies that sold digital technology tools to people with diabetes. And it is correct that Peterson concluded that “the evidence shows that the technologies do not deliver meaningful clinical benefits, and result in increased healthcare spending”.
But now take a little closer at the Peterson study. According to Peterson, there were “two potential bright spots” in the diabetic treatment area, one of which was Virta Health, a medical care company which treats people with diabetes with a low-carb diet. “Initial data showed that Virta users are much more likely to achieve clinically meaningful benefits in glycemic control, including diabetes remission and the ability to reduce or eliminate their diabetes medications, if they can maintain the rigorous dietary requirements of the intervention.” In layperson’s terms, in other words, Virta’s low-carb diet helped people with diabetes reverse their disease!
Califf is unequivocally correct that we are “failing” people with type 2 diabetes. The question is, can the medical establishment and federal agencies wean themselves off the carbohydrates that spike blood sugars, and the drugs that often only make matters worse?
As someone with type 2 diabetes who reversed his condition with a low-carbohydrate diet, I understand this is an uphill battle, but one worth fighting. And I am far from alone; in fact there is a growing ecosystem of extraordinary writers, clinicians, researchers and patients who advocate for healthy low-carb eating. Writers Gary Taubes and Nina Teicholz have produced extraordinary “follow the science” journalism that should be essential reading for every diabetes practitioner in the country. Their science-based work has literally revolutionized the thinking of thousands of diabetes sufferers such as myself, yet they remain a decided minority in the area of nutrition journalism.
And on the grass roots level, a number of promising new David v Goliath organizations are sprouting up that are attempting to challenge the American Diabetes Association’s stranglehold on how we treat the disease.
Leon Rock, a community activist who was diagnosed with type 2 diabetes in 2005, created the African American Diabetes Association in the wake of the Covid epidemic, after being struck by how the American Diabetes Association fails to fund research or provide support for the unique needs of African-Americans with diabetes. “When I was first diagnosed with type 2 diabetes, I went to the ADA to learn if there were any programs that addressed the needs of the Black community and they blew me off,” he said. “I would say nine out of 10 Black men do not trust their doctor.”
One of Rock’s main concerns with the ADA’s approach to treating the disease is that in addition to “having Black faces on their website”, it needs to meet people with diabetes “where they live”. The African American Diabetes Association, Rock adds, has been focusing on the Boston, Washington DC and Baltimore communities offering pop-up educational sessions in local barbershops and hair salons. His group next plans to begin work in the Mississippi Delta. “We want to take our message to the diabetes belt,” he says.
And this year, a group of physicians who advocate a low-carb diet for people with diabetes and obesity, created a new non-profit, the American Diabetes Society that is meant to offer an alternative to the ADA’s big pharma approach to treatment. “There’s been more research about low-carb than any other therapy and it’s shown the benefits,” said Dr Ken Berry, a family doctor, author and leading low-carb advocate. “But the ADA just had its huge conference, and they barely mentioned the existence of the low-carb diet.”
Berry has enlisted the support of other low-carb clinicians and is actively fundraising for the new non-profit. “What’s wrong with the ADA is they are so intertwined with big food and big pharma and the people who make insulin and diabetic medications,” he said. “Low carb will improve your health and lessen your complication, but just like in every other walk of life, money talks.”
In the meantime, the ADA remains in control of diabetes policy in this country, and dissenting voices have a difficult time being heard. In fact, if you want to hear or read Califf’s keynote address, best of luck. Not a word about his speech on the ADA website – the ADA did, however, cover 2023’s less-controversial keynote about genomics, however!).
But that doesn’t mean Califf isn’t on to something. Yes, we are failing the 38 million people with diabetes in this country, not to mention the over 100,000 Americans who die from the condition annually. And yes, the $400bn in diabetes-related annual expenditures is breaking the back of our healthcare system. But the overwhelming evidence points to an effective, safe and cheaper solution – the low-carbohydrate diet. The first step is to tell the truth.
Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of The Marshall Project
