Monday, January 09, 2006

Diabetics Must Demand Accountability from the ADA

Earlier today, the New York Times ran the heartbreaking story, Diabetes and Its Awful Toll Quietly Emerge as a Crisis, about the “epidemic” of diabetes in New York City and its progressive, deadly destruction in those afflicted. This isn’t just a New York story, but a snapshot of the future in American that deserves our efforts to ensure we are doing all we can, as a nation, to end what is truly a devastating epidemic. (If the NYT link requires registration, try the reprint of the article at the Amherst Times)

The author paints the bleak reality of diabetes:

Diabetics are two to four times more likely than others to develop heart disease or have a stroke, and three times more likely to die of complications from flu or pneumonia, according to the Centers for Disease Control. Most diabetics suffer nervous-system damage and poor circulation, which can lead to amputations of toes, feet and entire legs; even a tiny cut on the foot can lead to gangrene because it will not be seen or felt.

Women with diabetes are at higher risk for complications in pregnancy, including miscarriages and birth defects. Men run a higher risk of impotence. Young adults have twice the chance of getting gum disease and losing teeth.

And people with Type 2 are often hounded by parallel problems - high blood pressure and high cholesterol, among others - brought on not by the diabetes, but by the behavior that led to it, or by genetics.

Dr. Monica Sweeney, medical director of the Bedford-Stuyvesant Family Health Center, offered an analogy: "It's like bad kids. If you have one bad kid, not so bad. Two bad kids, it's worse. Put five bad kids together and it's unmanageable. Diabetes is like five bad kids together. You want to scream."

The outlook, at best, is bleak:

Diabetes has no cure. It is progressive and often fatal, and while the patient lives, the welter of medical complications it sets off can attack every major organ.


The health care system is good at dispensing pills and opening up bodies, and with diabetes it had better be, because it has proved ineffectual at stopping the disease. People typically have it for 7 to 10 years before it is even diagnosed, and by that time it will often have begun to set off grievous consequences. Thus, most treatment is simply triage, doctors coping with the poisonous complications of patients who return again and again.

No cure and treatment that is, at best, basic triage to cope with the complications as they happen and a management plan that leads only down the path to progressive degeneration.

Is this the best we can do?

Of course not – but it is the best the American Diabetes Association (ADA) wants you to believe we have.

Interestingly, when this story broke this morning, I was working on a piece about the latest ADA position statement, Standards of Medical Care in Diabetes–2006, since this year’s publication had extensive revision to the section Medical Nutrition Therapy (MNT). I was following the reference trail to understand how they decided that:

Low-carbohydrate diets (restricting total carbohydrate to <130 g/day) are not recommended in the management of diabetes. (E) The “E” noted after the statement indicates this recommendation is based on “expert opinion.” A cleaver double-speak for “there is no research evidence available for us to present that proves low-carb diets are bad for those with diabetes.” For decades, the ADA has maintained that diabetics need carbohydrate in their diet – the very macronutrient that aggravates and complicates their condition – and recommends 45-65% of their total calories each day come from carbohydrate. What boggles my mind is how we as a nation continue to put up with such a counter-intuitive, illogical, obviously flawed recommendation!

Let me be clear here – excessive carbohydrate is the very thing that destroys a T2 diabetic’s endocrine system and metabolism permanently – so there is no reversal and only progressive degeneration of the whole body from within if the diabetic continues to eat excessive carbohydrate each day. What is excessive carbohydrate? ANY level of carbohydrate beyond what your body can tolerate, effectively metabolize and use as energy!

Rather than acknowledge this fact, the ADA continues to promote the idea that “management” of the progressive degeneration is the only way to go and the only treatment that is “effective.”

Rather than disappoint the diabetic and tell them to face the facts and stop eating cakes, candy, cookies, pastries and such, the ADA tells those with diabetes that “sugar can be a part of your diet” and even publishes recipes for their convenience, while telling them to monitor blood sugars and keep popping pills or injecting insulin as directed.

Rather than tell a diabetic the TRUTH – that their own research shows that it doesn’t matter what type of carbohydrate is eaten, if the total non-fiber intake remains the same, regardless of source, they all stimulate high blood sugars – they lull the diabetic into thinking that somehow “complex” carbohydrates offer some magic protection against blood sugar rising too high.

Rather than tell the diabetic there is certainty they will progressively decline in health if they do not stop eating excessive amounts of foods that turn into glucose, they tell them to continue eating a high carbohydrate diet and progressively increase medications and then “manage” the other complications – high blood pressure, high cholesterol, high triglycerides, renal failure, etc. – with a multitude of more medical interventions.

Rather than providing uncomplicated recommendations for weight loss – the single most effective non-pharmacological option available - they continue to promote the idea no one is smart enough to plan their meals without a “professional registered dietitian” at the wheel, directing what to eat, when to eat and how to prepare foods. Their menus are too often nutritionally deficient, too low in calories and too difficult to follow for the long-term – is it any wonder the majority of type II diabetics are still obese?

Rather than admit their dietary recommendations are contributing to the progressive degeneration of those with diabetes, they remain staunch that this type of “treatment” is the best we have.

Can you tell I’m just a bit disgusted by this being considered the “standard” treatment for someone with diabetes?

I hope everyone reading this today is ANGRY! If you’re diabetic, pre-diabetic, have a family member or friend, co-worker or someone else you care about that is diabetic or pre-diabetic – you should be angry!

It is time we, as a nation, start to DEMAND accountability from the leading health organizations, trusted by the nation to provide timely, relevant, evidence-based recommendations for the treatment of diabetes!

The ADA survives because we, as a nation, are not demanding they be accountable to every diabetic out there who has followed their recommendations and still are declining each day. The ADA continuing to promote the idea of managing the disease symptoms and progressive complications is NOT good enough anymore.

Only an aggressive campaign that openly and honestly reviews every last piece of scientific data available and comprehensively details exactly what metabolic and/or endocrine improvement is seen with each option will be an acceptable start.

You see, the drugs and other medical interventions do not provide metabolic and/or endocrine system improvement – they just make you feel better while you’re body continues to degenerate and self-destruct inside.

Do you want treatment to just mask your slow death or do you want real improvement in how your body systems function each day? The ADA is giving you the former – scientific research data already holds the latter.

The ADA tells you this scientifically supported approach is unbalanced and will lead to kidney damage, heart attacks, high cholesterol and other health problems. The ADA just refuses to accept it works and continues to tell you to ignore it, dismiss it and forget trying it since it is unhealthy.

It’s called carbohydrate restriction – the fastest, most effective dietary treatment to reduce or eliminate your dependence on medications to control your blood sugars, reduce your weight and thus increase your insulin sensitivity. All of which are real, measurable improvements within your body and not just “medication induced” improvements that do nothing to stop the progressive complications you are facing in the long-term!

Type II Diabetics, ask yourself, do you want to have to take medication every day for the rest of your life and progressively add more and more as the years go by? No? Well...

Demand the ADA begin to tell you the truth about restricting carbohydrate in your diet!

Demand the ADA begin to give you actual IMPROVEMENT in, not just medical management of, your metabolism, endocrine system and thus, your diabetes!


  1. I was also angry when I read the article in the NYT. I'm a RN who's been out of direct care for several years. I just don't understand it!

    Maybe I went to a very progressive school, but 30 yrs ago when I was in school, we were told that Type 2 was nothing more than "wearing out" your pancreas....and the more carbohydrates you ate, the faster you would develop diabetes. I remember my teacher standing there and saying "if we live long enough, we'll all become diabetic. Some of us will develop it faster because we eat more carbohydrates than our pancreas can handle". As a new grad, I remember counseling people to watch their intake of starchy vegetables, bread, pasta, etc....and to NEVER have sugar, honey, etc.

    Since I had been out of direct patient care for several years working as a Case Manager, but not with diabetics, I was appalled a few years ago when I found out that sugar was no longer unacceptable, and that the ADA was pushing 45%+ of calories from carbs a day.

    Back when I went to school and first started out in nursing, we didn't "manage" diabetes, we treated it. We only saw the major complications of diabetes when patients didn't take their meds or follow thier diet!

    What really bothers me, besides the diet, is we no longer try to get people to get their blood sugars down to normal levels! An A1C of 7 is still too high! Why do we no longer shoot for non-diabetic levels?

    We are forcing people to mis-manage their disease! We feed them drugs that they don't need, and which make their disease worse, not better! And when they have complications we chop off limbs and put in stents, and feed them more drugs!

    And it not limited to diabetes! Heart disease is being "treated" by the very things that caused it in the first place! And the list goes on.

    Thank you for speaking out. We need more voices like yours!

  2. I've been diabetic for 8+ years and active on several diabetes lists. I was lucky enough at the beginning to find one which advocated a lower carb diet to help control diabetes. As I continued to post on these lists, I was appalled to discover how many were misled by the ADA line. Further investigation revealed how ubiquitous the ADA was -- promulgated by both hospitals and physicians as the "one way" to control diabetes. I've come to feel that the ADA does REAL HARM and needs to be stopped. But what can a few diabetics do?

  3. Anonymous10:17 PM

    It's not the amount of carbohydrates that you eat, it is the type. If all of these diabetics would be told to eat only whole grain carbohydrates, which should be the smaller amount of carbs they eat, and instead get their carbs from beans, the best carb out there, with water soluble fiber that controls the blood sugar, and get a healthy dose of vegetables of all kinds instead of refined carbs, juice, and sugar. The food that is best is the least messed with- stick with the healthy stuff- that goes for everyone. There would be many less obese people if we ate more fiber containing foods. Our modern diet is to blame. People's taste buds are completely out of whack, adjusted to high fat and salt, refined carbs and preserved in a mess of unpronounceable chemicals. It looks good, but is slowly turning the screws..