Low-carb diets work. Why does the American Diabetes Association push insulin instead? | Diabetes

For insight into the influence of big business over America’s estimated $4 trillion healthcare system, look no further than the world’s most powerful diabetes advocacy and research nonprofit , the American Diabetes Association (ADA).

Diabetes affects 38 million Americans, and another 90 million are considered pre-diabetic. Each year, the disease claims the lives of more than 100,000 Americans and disproportionately affects people of color. It’s also extremely expensive, as doctor visits, hospital stays, insulin, blood test strips, leg amputations, continuous glucose monitors, and many glucose-lowering medications total about $400 billion. per year. Quite frankly, we are losing the war against diabetes.

And unlike many other diseases – such as certain cancers, Alzheimer’s disease, kidney disease or Crohn’s disease – type 2 diabetes is reversible.

This bears repeating and elaboration. Numerous nutritional studies have shown that diabetes can be reversed through a strict diet low in carbohydrates, the macronutrient that people with diabetes cannot metabolize without the help of medication. The ADA concedes this — but you won’t necessarily know it from drug therapies or the foods and recipes the organization recommends for people suffering from this condition.

In 2020, Tracey D Brown, then president of the ADA, shook the diabetes world when she revealed that she had type 2 diabetes and had stopped taking insulin and other medications by joining on a low-carbohydrate diet.

“Here’s what I do. And it’s pretty simple,” she said in an interview that might have driven the ADA’s pharmaceutical benefactors crazy. “High blood sugar happens when you have sugars in your body and you don’t have insulin to handle the sugars in your body. Carbohydrates turn into sugar. So I’m just trying to make people aware of how much carbs you’re actually putting into your body.

The next day, the low-carb website published a “breaking news” article about the “very encouraging news” that “the influential CEO of the American Diabetes Association ( ADA) is officially considered low-carb.” “carbohydrate eater”. The following year, Brown resigned from his position at the ADA to take a management position at Walgreens.

Evidence that low-carbohydrate diets can effectively treat diabetes existed at least before the discovery of insulin in 1921, when doctors often prescribed low-carbohydrate (i.e., low sugar) diets to their patients. ) and high in fat. In the late 18th century, as recounted in Gary Taubes’ book Rethinking Diabetes: What Science Reveals About Diet, Insulin and Successful Treatments, a Scottish doctor named John Rollo helped two patients with diabetes (a rarer disease in the ‘time) to regain health. by limiting their carbohydrate intake.

“The ingenious author of the work presented to us”, 1797 article in the Edinburgh Review. According to the Annals of Medicine, “recommends a mode of treatment which, in some cases, has been found decidedly productive and has yielded remarkable benefits.”

In 2019, the ADA quietly and reluctantly acknowledged the effectiveness of the low-carb diet. In a review article on dietary guidelines in its medical journal Diabetes Care, the ADA gave the low-carb diet its due:

“Low-carb eating habits, especially very low-carbohydrate eating habits, have been shown to reduce A1C” – the metric that measures blood sugar levels over a period of time – “and the need antihyperglycemic medications. These eating habits are among the most studied eating habits in people with type 2 diabetes.”

Unfortunately, the ADA still views diabetes as a progressive disease that gets worse over time. It still allows insulin therapy for people with type 2 diabetes, a remedy that many doctors say will harm patients in the long term.

“Type 2 diabetes is a condition of high blood sugar and insulin in which the body resists the effects of insulin and signals that it has stored enough,” Mariela Glandt, a Harvard-trained endocrinologist who prescribes a low insulin level. carbohydrate diet to his patients in the Bronx, told me. “Giving insulin to a diabetic is like giving more alcohol to an alcoholic when he is shaking. This will treat the symptom – that is, the sugar level will go down – but ultimately we are making the disease worse and increasing the risk of long-term complications.

As I previously wrote in the Guardian, I was diagnosed with type 2 diabetes three years ago and prescribed insulin and metformin injections, but was able to stop taking all medications by adhering to a strict low-carb diet.

The experience left me perplexed. I couldn’t understand why only a tiny minority of clinicians seemed to recommend a dietary approach to diabetes treatment, rather than the high-insulin diet I was initially prescribed. Or why the ADA’s massive educational campaigns relaxed the diet and let millions of people with type 2 diabetes take many medications or inject themselves with insulin instead.

This is not a minor issue; If people with diabetes were told clearly and unambiguously that if they stopped eating high-carb foods, they could probably stop or reverse their diabetes, could thousands of lives and billions of dollars be saved?

“The reality is that if you want to effectively treat type 2 diabetes, the first thing you have to do is reject the ADA dietary guidelines,” Sami Inkinen told me. Inkinen founded Virta Health, a healthcare startup that treats people with diabetes by prescribing a very low-carb diet. “The ADA has been slow to accept the change. Very slow.”

The ADA’s message seems almost calculated to add to the confusion – as if, after 80 years of existence and billions of dollars spent on medical research, the ADA is just a helpless observer in the debates over low-carb diets.

“From no-carb to low-carb to whole and empty carbs, it’s hard to know what it all means,” the ADA website reads. “’Carbs’ or ‘carbohydrates’ are getting a lot of attention these days and it’s no secret that carbs can affect your blood sugar (blood sugar). You may be wondering if you should eat less of it, or even eat it at all. You’re not alone!”

ADA Scientific and Medical Director Dr Robert A Gabbay said the ADA dietary guidelines were the result of a rigorous scientific process undertaken each year by a team of medical experts who review the latest studies about the best way to treat type 2 diabetes. “There is no one-size-fits-all solution,” he told me. “There are several ways to effectively manage your diabetes. »

He added that corporate funders have no say in the organization’s guidelines: “The standards of care process receives no funding from industry, (and) our guidelines and recommendations are based on science. »

The ADA has a major role to play in how diabetes is managed globally. Its medical practice committees issue medical guidelines on standards of care to U.S. physicians and physicians around the world. The organization has an annual budget of $100 million, 600,000 volunteers and 20,000 members of the healthcare community. It organizes bike marathons and walking marathons, and publishes dietary guidelines and recipes that are downloaded by the millions each year. It publishes academic journals and organizes medical conferences at which the latest research is presented. It funds medical research. It hosts summer camps for diabetic children.

“Their professional practice committee writes all the guidelines that we follow,” Kasia Lipska, an endocrinologist at the Yale School of Medicine, told me. “Clinicians have a lot of respect for this organization. Their guidelines are the bible of diabetes medical practice.

The ADA is far from the only obstacle to widespread adoption of a low-carb diet. In the absence of a national health education initiative linking carbohydrates to the diabetes epidemic, clinicians specializing in low-carb diets will be making their voices heard in the wilderness. It can be difficult for many people with diabetes to give up the breads, sweets, pastas and starchy foods that form the basis of many diets. And given the lack of healthy food options on the shelves of many U.S. supermarkets, some clinicians I spoke with, each dedicated to their patients’ well-being, said it was more effective to simply prescribe products pharmaceuticals to their patients.

“The low-carb diet can resonate,” a retired endocrinologist told me. “But among all my patients who adopted a low-carb diet, very few were from lower socioeconomic classes.”

Diabetes has been hijacked as a business opportunity almost from the moment insulin – the hormone that people with type 1 diabetes cannot produce – was first discovered by a team of researchers from the University of Toronto. In 1923, the board of governors of the University of Toronto sold the insulin patent to Eli Lilly and Company for $1, because Lilly was better able to manufacture and distribute the synthetic hormone. “I don’t own insulin,” said the drug’s co-inventor, Sir Frederick G Banting. “It belongs to the world.”

Eventually, two international pharmaceutical companies – now known as Novo Nordisk and Novartis – also fought over the patents.

“The reason the insulin story is so scandalous is because the inventors of insulin wanted insulin to be available to everyone,” David Mitchell, founder of the nonprofit organization, told me lucrative Patients For Affordable Drugs. “Somehow these three pharmaceutical companies came together to create a global oligopoly. This is a remarkable thing considering the birth of insulin.

ADA corporate contributions are not precisely traceable. Based on the financial documents, here’s what we know: Between 2017 and 2024, more than 50 pharmaceutical and device manufacturers contributed on…

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