FDA Chief Is Right: We’re Failing People With Diabetes | Neil Barsky

a A funny thing happened when Dr. Robert Califf, commissioner of the Food and Drug Administration, gave the keynote address at the American Diabetes Association’s annual scientific meeting last month. He told the truth about our country’s colossal failure to address the raging health crisis.

“For the larger epidemic of type 2 diabetes, we are 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 he tens of millions of dollars a year from the pharmaceutical and medical device industry.

Nor did he praise the ADA’s funders, the pharmaceutical and medical device companies that make billions of dollars selling the insulin, pumps, needles, continuous glucose monitors and other paraphernalia that California’s agency regulates. And he was quick to point out that, by some accounts, diabetes has surpassed cancer as the largest economic cost to our health care system, worth more than $400 billion annually.

Instead, Califf cited America’s disastrously high sugar consumption and the food industry’s poor labeling practices. He pointed out that wealthy Americans consistently have more access to the latest technology than poor Americans. And he pointed out, according to according to a report in MedPage Today that even the vast majority of digital tools routinely prescribed to people with diabetes are failing 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 live in a world now where new digital health tools are coming out every day, but the analyses that have been done don’t show that they are delivering on the promise.”

If only Califf had dotted the i’s and crossed the t’s!

As I’ve written, there is already a safe, effective, and inexpensive solution to the type 2 diabetes epidemic. Simply put, type 2 diabetes, the insulin resistance condition that affects 95% of people with diabetes, is reversible with a low-carb diet. The American Diabetes Association has even this quietly acknowledged. Numerous clinicians practice this and have published their resultsYet the American Diabetes Association and the medical community stubbornly refuse to take action on this condition, as more than 100,000 Americans still die from the condition each year.

It’s one of the greatest disconnects in the entire American health care system—even as the death toll and cost of the disease continue to rise, why do the ADA and the medical community refuse to advocate for and educate patients about the dietary solution that could save lives and billions? Furthermore, at what point will the medical community and government officials like Califf acknowledge that the forces profiting from the diabetes epidemic, like big pharma, big medtech, big food, and—yes—the American Diabetes Association, are the real sources of our diabetes problem?

Califf’s speech to the ADA is a great example of what is both promising and depressing about diabetes care today. Califf is a respected cardiologist who has spent most of his career in academia. He is an outspoken advocate for health care as a right and understands the imbalances in access to health care in our country based on income, region, and race.

And yet his speech virtually ignored critical research that shout for greater acceptance of the low-carb diet for people with diabetes. For example, Califf cites a study that concluded that most digital aids prescribed to people with diabetes are ineffective. That claim came from a March study by the independent Peterson Health Technology Institute, which analyzed eight companies that marketed digital technology aids to people with diabetes. And Peterson is correct in concluding that “the evidence shows that the technologies do not provide meaningful clinical benefits and lead to higher health care spending.”

But now take a closer look at the Peterson study. According to Peterson, there were “two potential bright spots” in the field of diabetes treatment, one of which was Virta Health, a medical care company that treats people with diabetes with a low-carb diet. “Initial data showed that Virta users were significantly 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 could maintain the strict dietary requirements of the intervention.” In layman’s terms, Virta’s low-carb diet helped people with diabetes reverse their disease!

Califf is absolutely right that we are “failing” people with type 2 diabetes. The question is: Can the medical community and federal agencies wean themselves off the carbohydrates that raise blood sugar levels and the drugs that often make matters worse?

As someone with type 2 diabetes who reversed his condition with a low-carb diet, I understand that this is an uphill battle, but one worth fighting. And I’m far from alone; in fact, there’s a growing ecosystem of extraordinary writers, clinicians, researchers, and patients advocating for healthy low-carb eating. Authors Gary Taubes and Nina Teicholz have produced extraordinary “follow the science” books 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 patients like myself, yet they remain a decided minority in the field of nutrition journalism.

And at the local level, a number of promising new David versus Goliath organizations are emerging that are trying to break the American Diabetes Association’s stranglehold on the way 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 is not funding research or providing 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 ask if there were any programs that were addressing the needs of the Black community and they ignored me,” he said. “I would say nine out of 10 Black men don’t trust their doctor.”

One of Rock’s biggest concerns about the ADA’s approach to treating the disease is that in addition to “putting black faces on their website,” they also need to meet people with diabetes “where they live.” The African American Diabetes Association, Rock adds, is targeting the communities of Boston, Washington, D.C., and Baltimore by offering pop-up educational sessions at local barbershops and salons. His group plans to next work in the Mississippi Delta. “We want to get our message out to the diabetes belt,” he says.

And this year, a group of doctors who advocate low-carb diets for people with diabetes and obesity launched a new nonprofit, the American Diabetes Society, to offer an alternative to the ADA’s big-pharma approach. “There’s more research on low-carb than any other therapy, and it’s shown the benefits,” said Dr. Ken Berry, a family physician, author and leading low-carb advocate. “But the ADA just had a big convention, and they barely mentioned the existence of the low-carb diet.”

Berry has enlisted the support of other low-carb clinicians and is actively raising funds for the new nonprofit. “What’s wrong with the ADA is that they’re so entwined with big food and big pharmaceuticals and the people who make insulin and diabetes drugs,” he said. “Low carb improves your health and reduces your complications, but like every other aspect of life, money talks.”

Meanwhile, the ADA continues to control diabetes policy in this country, and dissenting voices are having a hard time being heard. If you want to hear or read Califf’s keynote, good luck. Not a word about his speech is on the ADA website – the ADA did cover the less controversial 2023 keynote on genomics, though!).

But that doesn’t mean Califf isn’t on the right track. Yes, we’re failing the 38 million people in this country with diabetes, not to mention the more than 100,000 Americans who die from the disease each year. And yes, the $400 billion spent annually on diabetes is a drain on our health care system. But the overwhelming evidence points to an effective, safe, and less expensive solution: the low-carb 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