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> 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 Metfo

by 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.

by dkarl 5y ago

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.