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Metformin is the first resort in diabetes treatment. If it proves to truly increase birth defects by 40% that may have to change. It was my doctor's first reso

Metformin is the first resort in diabetes treatment. If it proves to truly increase birth defects by 40% that may have to change. It was my doctor's first resort for me, but the side effects were too severe and I stopped it. He vaguely mentioned that it would help if I lost weight, but made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort. Apparently around here it's not even in the standard toolkit.

somenameforme 5y ago
IMO relative percents should really not be used when trying to consider the impact of things because it gives you no clue about it. If the rate of something is 1 in 1 million then a 40% increase means your odds of having an issue go from negligible to negligible, but a 40% increase makes it sound much scarier. I think the reason for that is that a 40% increase subconsciously tickles our "40% of" intuition, even when we consciously understand that's not what it means. That said in this case the 40% is genuinely scary, because it's a jump from 3.3% with birth defects to 5.2%, or in other words nearly 1 in 50 babies (1.9% of births) standing to be affected by this issue. Although just quickly skimming their numbers, the sample size is unclear to me. That jump was driven by only 13 birth defects among those taking the drug, based on what the article says is a sample of 1.1 million births.
bladley 5y ago
The Diabetes Code is a great book about reversing diabetes through dietary intervention. The author discusses exactly what you're saying here: surprisingly few doctors know how effective a low-carb diet is at treating and curing type 2 diabetes.
- hirundo 5y ago
  Agree. If you have diabetes I highly recommend making Jason Fung your doctor by reading his books, watching his videos, and taking his advice.
Zircom 5y ago
Unfortunately the vast vast majority of people won't commit to a big lifestyle change like that in the first place, and a big majority of the people that due end up not following through. So most doctors won't bother suggesting it as a legitimate option because for most people it kind of isn't.
- lm28469 5y ago
  > So most doctors won't bother suggesting it If you put it as: - exercise to live longer and healthier, to have a better life in literally every aspect vs - take X and Y pills until you die, it'll cost you up to xxx thousand dollars over your lifespan, will cause serious side effects and will not solve the root cause I bet people would be at least consider the first option. The problem is that the pharma industry works the same way as the food industry, their business model is to sell you things you need on a regular schedule and the for as long as possible.
- 0des 5y ago
  At some point in every doctor's career, there is a point where they decide to let us eat cake.
  - giantg2 5y ago
    Doctors aren't supposed to decide much of anything for us, especially lifestyle choices. But they should at least present the appropriate options once.
- giantg2 5y ago
  "So most doctors won't bother suggesting it as a legitimate option because for most people it kind of isn't." This is just flat wrong and borders on malpractice for deceptive counseling. Even if a patient is unlikely to accept an option, they still need to be presented with the best/standard options. This is also the lowest risk and highest gain option with a proven track record. I would stop seeing a doctor who is not presenting all the standard options and would rather just have me pop pills.
  - 5y ago
passivate 5y ago
Are you able to go back to a regular diet or is this more about managing diabetes and keep doing it long term?
- nradov 5y ago
  If by "regular diet" you mean a typical American diet including large portions of foods with high glycemic index then no. If you want to keep the disease in remission then it has to be a permanent lifestyle change.
giantg2 5y ago
Wow, if they aren't suggesting dietary and exercise based solutions first, that's a huge red flag. Find a new doctor.
- SpodGaju 5y ago
  You will be hard pressed to find a doctor that talks nutrition. It took me four years to force my doctor to test my serum zinc levels. When she did they found I was deficient. She did not know what to do, nor did it even seem to impact or shock her. Zinc sulphate gave my life back to me. (Lupus, mood disorder) You would think that my doctor would share this with everyone. But no.
  - giantg2 5y ago
    Interesting. A family member was having memory issues and the doctors were very supportive of our idea to look at the possibility of testing blood levels and taking supplements or changing diet based on the findings.
    - SpodGaju 5y ago
      Medical care is not distributed evenly in the U.S. I think my issue was I was already disabled and on Medicare diagnosed with Bipolar disorder which is caused by my immune disregulation, probably Lupus. https://apm.amegroups.com/article/view/60122/html https://apm.amegroups.com/article/view/60122/html Anyway, it is difficult for the doctors to get medicare to cover these tests. I also insisted she perform a serum amino acid test which revealed several high amino acids including all of the branched chain amino acids. She had to make up reasons to get them to cover the tests even though I have all these issues, including poor kidney function. There is defiantly a stigma with how they treat people with mood disorders. Any physical complaint was always treated as it it were something I was imagining. I was only luckyy that my mother and brother has Ankylosing Spondylitis because even though I still had to fight to get an MRI for my lower back pain and they found I was in the early stages of the disease as well. She said now that she had the nutritional results she did not know what to do with them and she could not even send me to a specialist.
nradov 5y ago
Virta Research has peer reviewed research supporting this approach. They have been successful with getting many type-2 diabetes patients into remission primarily using low carb diets. If you're insulin resistant then the first step has to be eliminating basically all sugar. https://www.virtahealth.com/resource-type/research https://www.virtahealth.com/resource-type/research
Trasmatta 5y ago
> Metformin is the first resort in diabetes treatment First resort for T2 diabetes. T1 diabetics have to go on insulin immediately, there's no other option.
- SpodGaju 5y ago
  They have yet to see the other option for type 1 dates, but they are getting close. https://www.aacc.org/science-and-research/scientific-shorts/2012/zinc-what-is-its-relevance-to-type-1-diabetes https://www.aacc.org/science-and-research/scientific-shorts/... https://link.springer.com/article/10.1186/s40199-015-0127-4 https://link.springer.com/article/10.1186/s40199-015-0127-4 https://www.cambridge.org/core/journals/nutrition-research-reviews/article/zinc-pancreatic-islet-cell-function-and-diabetes-new-insights-into-an-old-story/CAC3F0A9EBAAA2FD1FB5D01D822B990B https://www.cambridge.org/core/journals/nutrition-research-r... https://www.e-cep.org/journal/view.php?number=20125555368 https://www.e-cep.org/journal/view.php?number=20125555368 I believe that Type 1, being classified and "autoimmune disease", can be reversed.
dkarl 5y ago
> made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort Doctors know that if they compared "taking Metformin" to "eating a low-carb diet," the low-carb diet would win hands down. But that's not the comparison that's relevant for them, because it's not a choice they get to make. They have to choose between "advising someone to take Metformin" and "advising someone to eat a low-carb diet." The results of the latter are negligible on average.
- TylerE 5y ago
  It isn't a choice. It's quite practical to do both.
  - dkarl 5y ago
    You're right in a limited way, but the way it was put to me, doctors don't see it as possible to effectively pitch both approaches in the same session with a patient. You probably won't see them a second time, so you have to lead with the pills and concentrate on the pills. It's your one shot to get them on a medication that will extend and improve their life if there is one for their condition, like metformin or a statin, so even though you mention dietary changes, you're not making a realistic effort at convincing them to try it, because that would involve a lot more time and discussion and coaching about what a healthy diet is. You focus on the medication because getting them to take medication daily is a realistic goal that will succeed with a decent percentage of patients. Also, if you stress the dietary approach too much, a lot of patients will eventually ask, "If I make the dietary changes, is it possible I can avoid taking medication?" and you have to say "yes" and now the odds are you'll never see them again and they won't get either. So you mention the dietary changes, just so they know it's effective if they're inclined to go that route, but you focus on getting them to take medication. It's definitely a sad compromise aimed at the average patient, and doctors hate it.

somenameforme 5y ago

IMO relative percents should really not be used when trying to consider the impact of things because it gives you no clue about it. If the rate of something is 1 in 1 million then a 40% increase means your odds of having an issue go from negligible to negligible, but a 40% increase makes it sound much scarier. I think the reason for that is that a 40% increase subconsciously tickles our "40% of" intuition, even when we consciously understand that's not what it means. That said in this case the 40% is genuinely scary, because it's a jump from 3.3% with birth defects to 5.2%, or in other words nearly 1 in 50 babies (1.9% of births) standing to be affected by this issue. Although just quickly skimming their numbers, the sample size is unclear to me. That jump was driven by only 13 birth defects among those taking the drug, based on what the article says is a sample of 1.1 million births.

bladley 5y ago

The Diabetes Code is a great book about reversing diabetes through dietary intervention. The author discusses exactly what you're saying here: surprisingly few doctors know how effective a low-carb diet is at treating and curing type 2 diabetes.

hirundo 5y ago
Agree. If you have diabetes I highly recommend making Jason Fung your doctor by reading his books, watching his videos, and taking his advice.

Zircom 5y ago

Unfortunately the vast vast majority of people won't commit to a big lifestyle change like that in the first place, and a big majority of the people that due end up not following through. So most doctors won't bother suggesting it as a legitimate option because for most people it kind of isn't.

lm28469 5y ago
> So most doctors won't bother suggesting it If you put it as: - exercise to live longer and healthier, to have a better life in literally every aspect vs - take X and Y pills until you die, it'll cost you up to xxx thousand dollars over your lifespan, will cause serious side effects and will not solve the root cause I bet people would be at least consider the first option. The problem is that the pharma industry works the same way as the food industry, their business model is to sell you things you need on a regular schedule and the for as long as possible.
0des 5y ago
At some point in every doctor's career, there is a point where they decide to let us eat cake.
- giantg2 5y ago
  Doctors aren't supposed to decide much of anything for us, especially lifestyle choices. But they should at least present the appropriate options once.
giantg2 5y ago
"So most doctors won't bother suggesting it as a legitimate option because for most people it kind of isn't." This is just flat wrong and borders on malpractice for deceptive counseling. Even if a patient is unlikely to accept an option, they still need to be presented with the best/standard options. This is also the lowest risk and highest gain option with a proven track record. I would stop seeing a doctor who is not presenting all the standard options and would rather just have me pop pills.
- 5y ago

passivate 5y ago

Are you able to go back to a regular diet or is this more about managing diabetes and keep doing it long term?

nradov 5y ago
If by "regular diet" you mean a typical American diet including large portions of foods with high glycemic index then no. If you want to keep the disease in remission then it has to be a permanent lifestyle change.

giantg2 5y ago

Wow, if they aren't suggesting dietary and exercise based solutions first, that's a huge red flag. Find a new doctor.

SpodGaju 5y ago
You will be hard pressed to find a doctor that talks nutrition. It took me four years to force my doctor to test my serum zinc levels. When she did they found I was deficient. She did not know what to do, nor did it even seem to impact or shock her. Zinc sulphate gave my life back to me. (Lupus, mood disorder) You would think that my doctor would share this with everyone. But no.
- giantg2 5y ago
  Interesting. A family member was having memory issues and the doctors were very supportive of our idea to look at the possibility of testing blood levels and taking supplements or changing diet based on the findings.
  - SpodGaju 5y ago
    Medical care is not distributed evenly in the U.S. I think my issue was I was already disabled and on Medicare diagnosed with Bipolar disorder which is caused by my immune disregulation, probably Lupus. https://apm.amegroups.com/article/view/60122/html https://apm.amegroups.com/article/view/60122/html Anyway, it is difficult for the doctors to get medicare to cover these tests. I also insisted she perform a serum amino acid test which revealed several high amino acids including all of the branched chain amino acids. She had to make up reasons to get them to cover the tests even though I have all these issues, including poor kidney function. There is defiantly a stigma with how they treat people with mood disorders. Any physical complaint was always treated as it it were something I was imagining. I was only luckyy that my mother and brother has Ankylosing Spondylitis because even though I still had to fight to get an MRI for my lower back pain and they found I was in the early stages of the disease as well. She said now that she had the nutritional results she did not know what to do with them and she could not even send me to a specialist.

nradov 5y ago

Virta Research has peer reviewed research supporting this approach. They have been successful with getting many type-2 diabetes patients into remission primarily using low carb diets. If you're insulin resistant then the first step has to be eliminating basically all sugar. https://www.virtahealth.com/resource-type/research https://www.virtahealth.com/resource-type/research

Trasmatta 5y ago

> Metformin is the first resort in diabetes treatment First resort for T2 diabetes. T1 diabetics have to go on insulin immediately, there's no other option.

SpodGaju 5y ago
They have yet to see the other option for type 1 dates, but they are getting close. https://www.aacc.org/science-and-research/scientific-shorts/2012/zinc-what-is-its-relevance-to-type-1-diabetes https://www.aacc.org/science-and-research/scientific-shorts/... https://link.springer.com/article/10.1186/s40199-015-0127-4 https://link.springer.com/article/10.1186/s40199-015-0127-4 https://www.cambridge.org/core/journals/nutrition-research-reviews/article/zinc-pancreatic-islet-cell-function-and-diabetes-new-insights-into-an-old-story/CAC3F0A9EBAAA2FD1FB5D01D822B990B https://www.cambridge.org/core/journals/nutrition-research-r... https://www.e-cep.org/journal/view.php?number=20125555368 https://www.e-cep.org/journal/view.php?number=20125555368 I believe that Type 1, being classified and "autoimmune disease", can be reversed.

dkarl 5y ago

> made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort Doctors know that if they compared "taking Metformin" to "eating a low-carb diet," the low-carb diet would win hands down. But that's not the comparison that's relevant for them, because it's not a choice they get to make. They have to choose between "advising someone to take Metformin" and "advising someone to eat a low-carb diet." The results of the latter are negligible on average.

TylerE 5y ago
It isn't a choice. It's quite practical to do both.
- dkarl 5y ago
  You're right in a limited way, but the way it was put to me, doctors don't see it as possible to effectively pitch both approaches in the same session with a patient. You probably won't see them a second time, so you have to lead with the pills and concentrate on the pills. It's your one shot to get them on a medication that will extend and improve their life if there is one for their condition, like metformin or a statin, so even though you mention dietary changes, you're not making a realistic effort at convincing them to try it, because that would involve a lot more time and discussion and coaching about what a healthy diet is. You focus on the medication because getting them to take medication daily is a realistic goal that will succeed with a decent percentage of patients. Also, if you stress the dietary approach too much, a lot of patients will eventually ask, "If I make the dietary changes, is it possible I can avoid taking medication?" and you have to say "yes" and now the odds are you'll never see them again and they won't get either. So you mention the dietary changes, just so they know it's effective if they're inclined to go that route, but you focus on getting them to take medication. It's definitely a sad compromise aimed at the average patient, and doctors hate it.