Reform Standard of Care for Obesity, Diabetes, Cardiovascular Disease

Headline: “Medicaid Cuts Snarl GOP Budget Plan.” But Medicaid costs can be dramatically reduced and care improved without cuts. Just reform Standard of Care: advise patients struggling with obesity, diabetes, and cardiovascular disease to reduce carbohydrates, especially starchy and highly-processed carbs. Recommend more eggs and less cereal. Each of us is biochemically unique, so we can discover how our bodies manage the foods we eat. Inexpensive Continuous Glucose Monitors (CGMs) show us which foods spike our blood glucose and insulin. We can adjust what and when we eat to normalize our blood glucose levels, reducing cravings.

Nutritionists are divided, with some saying to avoid seed (or vegetable oils), which are usually in packaged, processed foods. Seed oils are inflammatory and contribute to insulin resistance (see: RFK, Jr. May Be Right About Seed Oils, Goodman Institute, Feb. 15, 2025). Others claim seed (vegetable) oils are healthy. I review contrasting seed oil health blames and claims at link.

Current public health advice for anyone overweight or obese draws from the energy-balance theory of obesity. Consuming more calories than are burned each day leads to weight gain (the theory goes). But there is more to this story. How food is metabolized matters. High carbohydrate foods raise blood glucose levels too fast and too high which causes insulin release to push excess glucose into fat cells.

For decades federal health and nutrition policies have been misleading, adhering to the diet-heart hypothesis (that saturated fat causes heart disease), and the calories in/calories out theory of weight gain and obesity. This 2020 Harvard Health article Stop counting calories explains the problem with calorie counting. But later in the article, advice for “Healthy weight management” recommends: “choosing unprocessed foods, including lean meats, whole grains, and lots of fruits and vegetables…” is nearly the opposite of dietary advice from other doctors and nutrition researchers.

What’s going on? For debaters looking to reform federal health care policies, adopting a new science-based Standard of Care for metabolic health can reduce human suffering and health care costs worldwide.

According to the Center for Disease Conrol, about 98 million American adults (more than 1 in 3) have prediabetes—blood sugar levels that are higher than normal but not high enough yet to be classified as type 2 diabetes.

For an overview of science-based diabetes care and Standard of Care, see resources of the American Diabetes Society. In contrast to the better-known and better-funded American Diabetes Association, the society does not promote high carbohydrate foods to diabetics.

Economists emphasize that regulatory agencies and associations can be “captured” by the industries they regulate or draw income from. So critics note that the American Diabetes Association received funding from processed food and pharmaceutical companies and associations. In the slide below, conflicting advice is shown from competing U.S. and U.K. diabetes associations.

A model for federal Medicaid Standard of Care reform is the recently announced partnership between OwnaHealth and Bronx, NY Medicaid provider Essen Health Care: Essen Health Care Announces Strategic Partnership with OwnaHealth to Transform Diabetes and Obesity Care for Medicaid and Underserved Communities (PR Newswire, February 18, 2025).

This follows the success of an ongoing Essen Health/OwnaHealth pilot project, reported in Medscape by science journalist Nina Teicholz.

…Ajala Efem’s type 2 diabetes was so poorly controlled that her blood sugar often soared northward of 500 mg/dL despite insulin shots three to five times a day. She would experience dizziness, vomiting, severe headaches, and the neuropathy in her feet made walking painful…
Efem had to wait 8 months for an appointment with an endocrinologist, but that visit proved to be life-changing. She lost 28 lb and got off 15 medications in a single month. Efem did not join a gym or count calories; she simply changed the food she ate and adopted a low-carb diet.

• For Richer, for Poorer: Low-Carb Diets Work for All Incomes (Medscape, July 17, 2024)

• And discussed here: LowCarbMD Podcast: Episode 355: Dr. Mariela Glandt