debtOr if you want a glimpse into how big corporations influence America’s $4 trillion healthcare system, you need only look to the American Diabetes Association (ADA), the world’s most powerful diabetes advocacy and research nonprofit.
Diabetes affects 38 million Americans, with another 90 million considered prediabetic. The disease kills more than 100,000 Americans each year, disproportionately affecting people of color, and is prohibitively expensive: doctor's visits, hospital stays, insulin, blood test strips, amputations, continuous glucose monitors, and an array of glucose-lowering medications. Add up That amounts to about $400 billion a year. Quite frankly, we are losing the war on diabetes.
And unlike many other illnesses, such as certain cancers, Alzheimer’s, kidney disease and Crohn’s disease, type 2 diabetes is curable.
This bears repeating and elaborating: Numerous nutrition studies have shown that diabetes can be reversed by a strict diet that limits carbohydrates, a macronutrient that diabetics cannot metabolize without the aid of medication. The ADA acknowledges this, but you wouldn't necessarily know it from the medications, foods, and recipes it recommends for people with the disease.
In 2020, then-ADA President Tracy D. Brown shocked the diabetes community by revealing that she had type 2 diabetes and that adhering to a low-carb diet had helped her stop taking insulin and other medications.
“This is what I do. It's very simple,” she said. Said In an interview that may have infuriated the ADA's pharmaceutical industry backers, he said: “Blood sugar rises when you have sugar in your body and you don't have insulin to control it. Carbohydrates turn into sugar. So I want people to know how many carbs they're actually putting in their body.”
The next day, I went to the low-carb website DietDoctor.com Published A “breaking news” article about the “very encouraging news” that “the influential CEO of the American Diabetes Association (ADA) is openly committed to following a low-carb diet.” The following year, Brown left his position with the ADA to take a senior position at Walgreens.
Evidence that a low-carb diet can effectively treat diabetes has existed at least since before the discovery of insulin in 1921. At the time, doctors often prescribed very low-carb (i.e. low-sugar) and high-fat diets for their patients. As detailed in Gary Taubes' book Rethinking Diabetes: What the Science Reveals About Diet, Insulin, and Successful Treatments, in the late 18th century, a Scottish doctor named John Rollo helped two people with diabetes (a rare disease at the time) recover from cancer by restricting their carbohydrate intake.
“The original author of the work now before us,” an article in the Edinburgh Review, 1797 “The authors recommend a treatment that has, in some cases, clearly produced remarkable results,” the Annals of Medicine said.
In 2019, the ADA quietly and reluctantly endorsed the benefits of low-carb diets. article The ADA gave high praise to low-carb diets in its dietary guidelines in the medical journal Diabetes Care.
“Low-carb diets, especially very low-carb diets, have been shown to lower A1C, a measure of blood sugar levels over a period of time, and reduce the need for antihyperglycemic medications. These diets are some of the most studied in people with type 2 diabetes.”
Unfortunately, the ADA still considers diabetes a progressive disease that worsens over time, and while the ADA still approves insulin therapy for people with type 2 diabetes, many doctors say it harms patients in the long run.
“Type 2 diabetes is when blood sugar and insulin levels are too high, and the body resists the effects of insulin by signaling that it has enough stores,” Mariella Grant, a Harvard-trained endocrinologist who prescribes low-carb diets to patients in the Bronx, told me. “Giving a diabetic insulin is like giving more alcohol to a shaking alcoholic: It cures the symptoms — the high blood sugar goes down — but it ultimately makes the disease worse and increases the likelihood of long-term complications.”
As I previously wrote in the Guardian, I was diagnosed with type 2 diabetes three years ago and prescribed insulin injections and metformin, but adhering to a strict low-carb diet has helped me get off all my medication.
This experience left me perplexed. I couldn't understand why only a minority of clinicians recommended diet as a treatment for diabetes rather than the insulin-heavy therapy originally prescribed, and why the ADA's massive education campaign had downplayed diet in favor of forcing millions of people with type 2 diabetes to take a variety of medications or inject insulin.
This is not a trivial issue: imagine how many thousands of lives and billions of dollars could be saved if people with diabetes were clearly told that they could potentially halt or reverse the progression of their diabetes by eliminating foods high in carbohydrates.
“The reality is, if you want to effectively treat type 2 diabetes, you have to start by throwing out the ADA dietary guidelines,” Sami Inkinen told me. Inkinen founded Virta Health, a healthcare startup that treats people with diabetes by prescribing them a very low-carb diet. “The ADA is slow to embrace change. Very slow.”
The ADA's messaging seems calculated to increase confusion, as if the ADA, which has been in existence for 80 years and has spent billions of dollars on medical research, is merely a powerless bystander in the low-carb diet debate.
“From no carb to low carb to full carb to empty carb, it can be hard to know what it all means,” the ADA website says. read“There's been a lot of attention recently on 'carbs' and 'carbohydrates' and we all know that carbs affect blood sugar levels. You might be wondering whether you should eat less carbs or even avoid them altogether. You're not alone!”
Dr. Robert A. Gabbay, the ADA's chief scientific and medical officer, said the ADA's dietary guidelines are the result of a rigorous scientific process conducted each year by a team of medical experts who review the latest research on how to best treat type 2 diabetes. “There is no 'one size fits all,'” he told me. “There is no one way to successfully manage diabetes.”
He added that corporate funders have no say in the organisation's guidelines: “The standards of care process is not industry funded. [and] Our guidelines and recommendations are based on science.”
The ADA has a major say in how diabetes is managed globally. The ADA's Medical Affairs Committee issues medical guideline standards to U.S. physicians and physicians around the world. The ADA has an annual budget of $100 million, 600,000 volunteers, and 20,000 medical personnel. The ADA organizes bike and walk marathons and publishes dietary guidelines and recipes that are downloaded millions of times each year. The ADA publishes academic journals and holds medical conferences that present the latest research. The ADA funds medical research. The ADA hosts summer camps for children with diabetes.
“All of the guidelines we follow are written by their specialty practice committees,” 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 care.”
The ADA isn't the only obstacle preventing widespread adoption of low-carb diets. Without a national health education effort linking carbohydrates to the diabetes epidemic, low-carb clinicians will be a voice in the wilderness. For many people with diabetes, it can be difficult to abstain from breads, sweets, pastas and starches that are the basis of many meals. And given the lack of healthy food options on the shelves of many American supermarkets, some clinicians I spoke with who are committed to their patients' health said they would be more effective if they simply prescribed medications for their patients.
“Low-carb diets can resonate,” a retired endocrinologist told me, “but very few of my patients who have gone on low-carb diets come from lower socioeconomic classes.”
From the moment insulin (a hormone that type 1 diabetics cannot produce) was first discovered by a research team at the University of Toronto, diabetes has been exploited as a business opportunity. In 1923, the University of Toronto Board of Regents sold the insulin patent to Eli Lilly and Company for $1, because Lilly had a better grasp of manufacturing and distributing the synthetic hormone. “Insulin is not mine,” said Sir Frederick G. Banting, co-inventor of the insulin drug. “Insulin belongs to the world.”
Eventually, two international pharmaceutical companies, now known as Novo Nordisk and Novartis, also contested the patent.
“The insulin story is crazy because the inventors of insulin wanted it to be for everyone,” David Mitchell, founder of the nonprofit Patients for Affordable Medicines, told me. “Somehow these three pharmaceutical companies got together and created a global monopoly, which is amazing when you think about the creation of insulin.”
Corporate ADA donations cannot be accurately tracked. Financial ReportingWhat is known is that more than 50 pharmaceutical and medical device manufacturers have donated more than $134 million to the organization, or about 20% of its total funding, between 2017 and 2024. No breakdown of food industry contributions was provided.
It's easy to see how ADA contributors get more for their money: ADA's social media feeds are a virtual supermarket of goods for sale by its funders.
Need a diabetes test? Come to CVS! (3-year, $10 million partnership in 2021) Want to learn more about kidney care? Make it happen with DaVita! ($1.5 million in 2024Want to donate to the ADA? Just go to your local GNC store and drop some money in the can. ($100,000 in 2024) Not to mention, low-carb products that lower blood sugar also reduce the need for the pharmaceutical and ancillary products that make diabetes a huge boon for the medical industry.
Patients seeking affordable medicines in 2021 Published The groundbreaking report looked at 15 patient advocacy groups and their ties to the pharmaceutical industry. The ADA received the lowest score, the report said, because it “receives funding from the pharmaceutical industry,” “has board members with financial ties to the pharmaceutical industry,” and “shares lobbyists and lobbying firms with the pharmaceutical industry.”
To read the ADA’s publications, you get the impression it’s a privately run, grassroots organization. “Your support counts twice!” a banner on its website proclaims. Every few seconds, a pop-up appears announcing a new small donation: “Patrick F. donated $100,” “L Robert H. donated $12,” “Al S donated $20.” These small donors may not know that a 2021 Patients for Affordable Drugs report found that “one-third of ADA board members have financial ties to the pharmaceutical industry.”
Diabetes is a national scandal in the public eye. Despite countless medical innovations, including hypoglycemic drugs, fast-acting insulin, slow-acting insulin, A1C testing, continuous glucose monitors, and insulin pumps, more than 100,000 Americans die from diabetes each year. In the 1980s, before many of these medical innovations were available, number It was 35,000.
The biggest winners from the ADA's close deal with industry are, of course, it was fun of Estimation With annual sales of $58 billion in 2017, medical device and food companies make donations to the ADA in exchange for recipe approval.
The losers are the millions of people who suffer amputations, blindness, and neuropathy from diabetes, who take daily insulin injections, and eat carbohydrate-heavy foods, because they are simply not informed about healthy options. It is not too late for the ADA to speak out loud and clear and tell people with diabetes the truth. We may lose funders, but we may also save lives.
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Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project.
