Elizabeth Hanna had a simple job: help people with diabetes figure out what to eat. Anyone with common sense knows this should probably not entail foods that might increase people’s risk of getting diabetes. But that’s not necessarily the thinking at the American Diabetes Association (ADA), the world’s leading diabetes research and patient advocacy group, which also receives millions of dollars from sponsors in the pharmaceutical, food and agricultural industries.
According to a lawsuit Hanna recently filed against the ADA, the organization – which endorses recipes and food plans on its website and on the websites of “partner” food brands – tried to get her to greenlight recipes that she believed flew in the face of the ADA’s mission. These included recipes like a “cucumber and onion salad” made with a third of a cup of Splenda granulated artificial sweetener, “autumnal sheet-pan veggies” with a quarter cup of Splenda monk fruit sweetener and a “cranberry almond spinach salad” with a quarter cup of Splenda monk fruit sweetener.
Guess which company gave more than $1m to the ADA in 2022? Splenda.
Hanna, a registered dietitian nutritionist and certified diabetes care and education specialist with “16 years of experience in the field of medical nutrition therapy”, according to the lawsuit, says the ADA and in particular Nicole Johnson, the ADA’s vice-president of operations for the science and healthcare division – “a former Miss America who has traded upon the dreams and aspirations of people with diabetes to reach fame and fortune” – pressured her to endorse what she believed were unhealthy and unethical claims.
Hanna refused, according to the lawsuit, and complained internally; she was fired in October of last year, in what she believes was an act of retaliation and silencing. Her lawsuit also alleges that a higher-up, “apparently conscious that her prior statements would not support a poor performance finding for Hanna … fraudulently altered, modified and/or destroyed” a performance review. The ADA denies the allegations made in Hanna’s lawsuit.
The Hanna lawsuit should be read against the backdrop of the global diabetes and obesity epidemics. The United States has some of the best medical research institutions in the world, and other countries look to us for guidance on how to best treat diseases such as diabetes. But as someone who was diagnosed with type 2 diabetes three years ago, I can attest that the dietary and medicinal guidance one gets from doctors and the ADA can be worse than the condition. The result is what the former head of the World Health Organization has called “a slow-motion disaster”, that led to the deaths of 2 million people in 2019.
Hanna filed her lawsuit against the ADA in New Jersey in November. Her lawsuit paints a picture of an organization more beholden to its corporate benefactors than the 127 million Americans with diabetes or pre-diabetes – echoing the kinds of criticisms that you can read in online diabetes forums, where one person charges the ADA with existing “in service of physicians and sponsors, not patients. They are in the business of selling pharmaceutical and nutritional products. It’s in their best interest for people to remain sick.”
Another complains: “I truly believe that the entire medical establishment, including the ADA, wants to keep diabetics diabetic in order to continue to reap the [revenue] paid for prescriptions every year.”
That might sound harsh. Yet, according to Hanna’s lawsuit, the ADA went through “no less than four individuals in the director of nutrition position since 2019 and no less than three individuals in the associate director of nutrition position since 2020”, with previous ADA nutritionists allegedly fired or driven out after refusing to comply with what they believed were unethical and unscientific demands. The lawsuit goes on to suggest that companies such as Splenda had a direct line to the ADA’s highest authorities.
After Hanna declined to approve recipes she considered inappropriate, according to her lawsuit, an ADA colleague advised her that Splenda “would escalate the issue to the ADA’s chief executive officer, Charles Henderson, but instead it appears that Splenda raised the issue to Robert Gabbay MD (“Dr Bob”), chief scientific officer of the science and healthcare division”. Hanna later learned “that Splenda refused to make the suggested changes to bring [the recipes] into conformity with nutritional science and continued to demand approval”.
The Splenda arrangement, the lawsuit argues, was simply “a scheme to defraud the American people by approving and endorsing recipes submitted by Splenda … when the ADA knew that those recipes were contrary to … well-established and emerging scientific principles”.
In 1976, researchers discovered trichlorogalactosucrose, a highly sweet-tasting chemical compound that they dubbed “sucralose”. Splenda successfully marketed sucralose as a sugar substitute; since 1991, Splenda has sold “more than 100 billion yellow packets”, the brand’s website boasts, and become by far the most popular artificial sweetener in the US. (Splenda also sells sugar substitutes derived from natural sources such as monk fruit and stevia.)
Sucralose is far more concentrated than sucrose, the compound in table sugar; the human body cannot metabolize sucralose like sugar, so it passes through without the body absorbing its calories. Sucralose is mixed with fillers to create Splenda, which contains fewer calories than sugar and is allowed to be marketed as a calorie-less sugar substitute, though it does contain some calories.
A large share of Splenda’s consumers are people with diabetes; Splenda advertises its sweeteners as a tool for wellness generally and diabetes management specifically. In a press release this January celebrating Splenda’s 25th anniversary, Ted Gelov, the chair and CEO of the Heartland Food Products Group, Splenda’s parent company, said: “This anniversary is not just about our brand; it’s about the countless individuals who have trusted Splenda to be a part of their health and wellness journey.”
Yet research has suggested that Splenda may wreak havoc on gut biome health and lead to increased glucose intolerance in a way that is similar to regular sugar. In fact, just last summer, at the very same time Hanna was battling with her bosses, the ADA’s own journal Diabetes Care published a study, drawn from 13 years of data from 105,588 participants, that concluded that there were “positive associations between artificial sweetener intakes and increased [type-2 diabetes] risk” that “strengthen the evidence that these additives may not be safe sugar alternatives”.
The World Health Organization has said that non-sugar-sweeteners such as Splenda may contribute to “risk of type 2 diabetes, cardiovascular diseases and mortality in adults”. According to the CDC, as Hanna’s lawsuit cites, high blood-sugar levels can put a person with diabetes at risk of diabetic ketoacidosis, or DKA, which can cause coma or death.
Hanna’s lawsuit says that she told higher-ups at ADA that she was uncomfortable endorsing recipes “that promoted the use of non-nutritive sweeteners, like Splenda, sprinkled on whole foods like vegetables and beans”; that the ADA’s own guidelines banned “approval of recipes that used non-nutritive sweeteners on whole foods”; and that she and her team had only approved Splenda-based recipes in the past in situations in which “the non-nutritive sweeteners were being used to cut down on sugar and calories”.
There is “no reason, other than taking Splenda’s money, for the ADA to recommend that people with diabetes add massive amounts of Splenda to cucumber salad”, Hanna’s complaint argues. In response to questions about the Splenda lawsuit, the ADA said it cannot comment on ongoing litigation.
Heartland Food Products Group rejected the allegations made in Hanna’s lawsuit, and said it had notified her counsel to that effect.
“Any allegation that Heartland Food Products Group, the makers of Splenda Brand sweeteners, was involved in any improper scheme is false and offensive,” it said. “Like many other companies focused on helping people with diabetes and the impact diabetes has on health, Heartland will continue to support the ADA and honorably provide recipes and educational information to help people successfully reduce sugar levels and live happier and healthier lives.”
The Splenda affair is far from the first time the ADA was caught with its hand in the corporate cookie jar. In 2006, the New York Times published an investigation into the ADA’s entanglement with pharmaceutical and food companies. In the article, the ADA’s chief medical officer boasted that the organization had turned down millions of dollars in prospective fees from various food companies interested in forging partnerships. “We tightened things up quite a bit,” Richard Kahn, then the organization’s chief scientific and medical officer, said.
Well, not exactly. In fact, at the time, the ADA had just inked a $1.5m sponsorship deal with Cadbury Schweppes, the world’s largest confectioner. “Maybe the American Diabetes Association should rename itself the American Junk Food Association,” said one consumer advocate.
Kahn next offered one of the most startling comments about nutrition and diabetes one will ever read: “There is not a shred of evidence that sugar, per se, has anything to do with diabetes,” he told the Times.
Last year, the ADA signaled it still has not lost its appetite for carbohydrate-rich foods. In March of 2023, it announced a partnership with the Idaho Potato Commission that made Idaho potatoes the first vegetable to be included in the ADA’s Better Choices For Life program.
“With a mission to prevent and cure diabetes and improve the lives of all people affected by diabetes, the number one question the ADA receives is, what can I eat?” the Idaho Potato Commission press release read. “Many wrongly believe they cannot eat potatoes.” The release goes on to recommend that the potatoes should be prepared with the skins on, and should be baked or boiled, not fried.
Some clinicians say that it is terrible nutritional advice. “Potatoes are a starch and starches are simply chains of glucose, or sugars,” Mariela Glandt, a Harvard-trained endocrinologist who prescribes a low-carbohydrate diet to her patients in the Bronx, told me. “Since diabetes is an intolerance to sugar, potatoes tend to make the diabetes worse. For people with diabetes, a potato is a potato.”
The Idaho Potato Commission donated between $150,000 and $499,000 to the ADA. According to a recent annual report, the commission is the only one of the ADA’s top 35 donors that sells a vegetable.
One hopes that Elizabeth Hanna’s lawsuit helps put an end to the ADA’s practice of taking money from food companies that sell products that can harm people with diabetes. Thanks to the work of journalistic mavericks such as Gary Taubes and Nina Teicholz, there is already a vocal public that thinks the ADA is making reckless food recommendations.
In a recent post on Taubes and Teicholz’s Substack publication Unsettled Science, Teicholz poked fun at a recent ADA video featuring its current director of nutrition and wellness (Hanna’s successor, in other words), recommending that people with diabetes fill a full quarter of their plate with carbohydrate-rich foods. The ADA video, which had nearly 2m views, elicited a torrent of negative online reaction, Teicholz noted: “Quite a few [of the comments] wondered the obvious: why tell diabetics to eat starches (carbohydrates) when one could well define diabetes as simply a condition of carbohydrate intolerance? One commenter suggested adding a Coke to complete the meal.”
The United States is a country where cereal companies market their sugary products to children, local news shows promote 7-Eleven’s “Slurpee Day”, vegetables are scarce in many neighborhood stores and nearly 70% of American adults are considered overweight or obese. Type 2 diabetes is a serious and sometimes life-threatening condition that is directly tied to America’s dietary dysfunction. The ADA did not cause the problem. Elizabeth Hanna’s whistleblower lawsuit, however, suggests that the organization’s nutritional advice is actually making it worse.
Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of The Marshall Project