Low-carb diets work. Why does the American Diabetes Association push insulin instead?
For a glimpse into how big business influences the $4tn US healthcare system, look no further than the world’s most powerful diabetes advocacy and research non-profit, the American Diabetes Association (ADA).
Diabetes afflicts 38 million Americans, with another 90 million considered pre-diabetic. Every year the disease claims the lives of over 100,000 Americans and disproportionately affects people of color. It is also ruinously expensive, as doctors visits, hospital stays, insulin, blood test strips, leg amputations, continuous glucose monitors and numerous glucose-lowering drugs add up to about $400bn a year. To put it bluntly, we are losing the war on diabetes.
And unlike many other diseases – such as certain cancers, Alzheimer’s, kidney disease, or Crohn’s – 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 drugs. The ADA concedes this – but you wouldn’t necessarily know it from the drug therapies or the foods and recipes that the organization recommends to people suffering from the condition.
In 2020, the then ADA president, Tracey D Brown, rocked the diabetes world when she disclosed that she had type 2 diabetes and had gotten off insulin and other medications by adhering to a low-carbohydrate diet.
“Here is what I do. And it is pretty simple,” she said in an interview that might have made the ADA’s pharmaceutical benefactors crazy. “Elevated blood sugars happen when you have sugars in your body and you don’t have insulin to manage the sugars in your body. Carbohydrates turn into sugar. So I just try to get people to be aware of how many carbohydrates you are actually putting in your body.”
The very next day, the low-carbfocused website DietDoctor.com published a “breaking news” story about the “highly encouraging news” that “the influential CEO of the American Diabetes Association (ADA) is on the record as a low-carb eater”. The following year, Brown resigned her position at the ADA to take a senior role at Walgreens.
The evidence that low-carb diets can effectively treat diabetes has been around at least since before insulin’s discovery in 1921, when doctors often prescribed very low-carb (ie low-sugar), fat-rich diets to their patients. In the late 18th century, as recounted in Gary Taubes’s book Rethinking Diabetes: What Science Reveals About Diet, Insulin and Successful Treatments, a
Scottish doctor by the name of John Rollo helped two patients with diabetes (a rarer condition those days) return to health by restricting their carbohydrate intake.
“The ingenious author of the work now before us,” a 1797 article in the Edinburgh reviewAnnals of Medicine said, “recommends a mode of treatment, which in some cases, has been decidedly productive of remarkable benefit.”
In 2019, the ADA quietly and grudgingly acknowledged the low-carb diet’s effectiveness. In a journal article on dietary guidelines in its medical journal Diabetes Care, the ADA gave the low-carb diet its due:
“Low carbohydrate eating patterns, especially very low-carbohydrate eating patterns, have been shown to reduce A1C” – the metric that measures one’s blood sugar levels over a period of time – “and the need for antihyperglycemic medications. These eating patterns are among the most studied eating patterns for people with type 2 diabetes.”
Unfortunately, the ADA still sees diabetes as a progressive disease that gets worse over time. It still sanctions insulin therapy for people with type 2 diabetes, a remedy many doctors say will harm patients in the long run.
“Type 2 diabetes is a condition of too-high blood sugar and too-high insulin where the body is resisting the effects of insulin, and signaling that it has stored enough,” Mariela Glandt, a Harvard-trained endocrinologist who prescribes a low-carbohydrate diet to her patients in the Bronx, told me. “Giving insulin to someone with diabetes is like giving more alcohol to an alcoholic when they are shaking. It will treat the symptom – ie, the high sugar will come down – but in the end we make the disease worse and increase the chances of long-term complications.”
As I previously wrote about in the
Guardian, I was diagnosed with type 2 diabetes three years ago and prescribed insulin shots and metformin, but was able to get off all medication by adhering to a strict low-carbohydrate diet.
The experience left me baffled. I couldn’t understand why only a tiny minority of clinicians seem to recommend a diet-based approach to diabetes treatment, rather than the insulin-heavy regimen I was initially prescribed. Or why the ADA’s huge educational campaigns soft-pedaled the diet, and preferred to let millions of people with type 2 diabetes take numerous medications or shoot themselves up with insulin instead.
This is not a minor matter; if people with diabetes were told clearly and unambiguously that if they stopped eating carbohydrate-rich foods they could probably arrest or reverse their diabetes, could thousands of lives and billions of dollars be saved?
“The reality is that if you want to treat type 2 diabetes effectively, the first thing you have to do is throw out the ADA’s dietary guidelines,” Sami Inkinen told me. Inkinen founded Virta Health, a healthcare startup that treats people with diabetes by prescribing a very lowcarb diet. “The ADA has been slow to accept change. Very slow.”
The ADA’s messaging 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 merely a helpless observer in the low-carb diet debates.
“From carb-free to low-carb, to whole and empty carbs, it’s hard to know what it all means,” the ADA website reads. “‘Carbohydrates’ or ‘carbs’ get a lot of attention these days and it’s no secret that carbs can affect your blood glucose (blood sugar). You might be wondering if you should eat less of them, or even eat them at all. You’re not