I am pretty interested in weight loss (but I am not a professional), I will try to explain.
First, the stance of medical profession is to treat diseases. There is not much effort on preventing diseases. They will wait until you get sick and then when you pass a magic threshold will assault you with a battery of treatments. We know that diabetes takes decades to develop, yet our description of a person who is halfway to developing diabetes is still "healthy". You need to wait until your body gets so devastated by your bad diet and habits that it gets completely disregulated and you put on a lot of fat before suddenly being considered a subject for treatment.
Second, the dissemination of knowledge in medical profession is glacially slow. Even if the research progresses quite fast, it takes a generation of medical professionals to die out and newly trained people to replace them to actually update the knowledge as it is being practiced. We are still in the "fat is bad" times even though we know and have known for a long time that it is actually carbs, processed food and bad fats that are major contributing factors to the obesity epidemic (that plus sedentary lifestyle, stress and bad sleep).
Third, people in the medical profession are heavily penalised for having a different view on things to the point that most are scared to speak up. For the most part, practicing anything that is not in line with mainline view will get you expelled from the profession and barred from practicing medicine ever again.
Fourth, the dieting, while sounding nice as a solution, does not tend to work well. Most people are unable to stick to a diet long term. Managing early diabetes with a diet would require sticking to it religiously and permanently. Medical professionals are not stupid and know that that's something that very few people can actually do.
> the stance of medical profession is to treat diseases. There is not much effort on preventing diseases.
This is totally incorrect. The problem is many people only go to the doctor once symptomatic. Your doctor should be testing for pre-diabetic risk factors at your annual physical.
> dieting, while sounding nice as a solution, does not tend to work
It's the same as all diets, no? We know that if you eat less, you will lose weight. You just need to do that for the rest of your life, forever, or you will most likely put the weight back on. I am pretty sure there is research that shows "diets don't work" because of that.
The same probably applies to diabetes. Yes, if you eat a low carb diet you can improve your A1C, but you would have to do that for the rest of your life (or however long). Sure, part of it is probably _capitalism_, but I'm fairly sure that for a large part of the population, prescribing them diet instead of insulin would result in worse outcomes.
It's not so much "low carb" as it is avoiding the sugar junkie culture that pervades the Standard American Diet.
Keto can be an effective acute intervention against type 2 diabetes, but then one might add carbs back in to a reasonable level, but not the poisonous level of the Standard American Diet.
Exactly. If you have a 100% effective treatment for a disease, but only 10% are able to maintain the regimen, you have a 10% effective treatment. The distinction is obviously critical at the individual level, but at the policy level you need to know what the actual result of a recommended treatment will be.
It’s like how condoms are 87% effective because the rate includes people who don’t use them consistently. Knowing that they’re 98% effective when used properly is important knowledge to the individual, but the effective rate is more important to anyone advising policy of what advice to give.
> We know that if you eat less, you will lose weight.
not really no, there are several very weird processes that add up to something entirely different.
You don't mean weight but body fat. If you just restrict calories you will lose both fat and muscle. You will get more hungry the longer you keep it up until you eventually replace the lost kg with fat alone. Less energy, less muscle mass to burn energy - brilliant plan!
To lose fat you need to stop eating long enough to trigger fat burning or the reserves won't be addressed. Might take a few attempts to get used to it. Then you need to do strength training.
The ratio carbs and starch is how some people stay skinny while eating a lot while others stay fat eating next to nothing.
It also gets hard to move if your heavy. You will adapt your life to avoid moving.
It involves dozens of other fascinating processes. Metabolic syndrome lowering testosterone making it hard to grow muscle which lowers testosterone again, nutrition shortages, poor sleep from lack of exercise/activity and lack of activity from poor sleep, not getting any sunlight etc etc
No, I literally mean weight, I am aware you will lose both muscle and fat. Yes, there are biological processes that can affect that process, but the gist is the same. If you don't eat, you will lose weight.
> We know that if you eat less, you will lose weight.
No one is looking to lose weight that generally. (or they shouldn't be)
> You just need to do that for the rest of your life, forever, or you will most likely put the weight back on.
Not at all. There are several mechanisms by which being fat contributes to getting more fat.
> I am pretty sure there is research that shows "diets don't work" because of that.
Simply eating less doesn't work. Other diets work.
> The same probably applies to diabetes. Yes, if you eat a low carb diet you can improve your A1C, but you would have to do that for the rest of your life (or however long).
Excess fat causes insulin resistance and insulin resistance makes you fat. If you have and use more muscles you can (and will) eat more. Your metabolism will also speed up if you are more active.
When overweight it is much harder to jump on a bicycle, skate, take a long walk or sign up for a sport.
> I'm fairly sure that for a large part of the population, prescribing them diet instead of insulin would result in worse outcomes.
Fasting can fix insulin resistance. If you eat plenty of fat and protein between the fasts you will adapt to burn that.
The system is quite good, if you don't eat for 12 hours the reserves are addressed. May take a bit of getting used to since the mechanism is quite rusty. You become much more focused and active naturally. It is time to hunt or otherwise find food. When the belly is stuffed there is no need for physical activity.
Just ran into this. Apparently arthritis is caused by overweight and eating to much carbs. It is also a major reason why overweight people avoid exercise.
because America is a massive money-hungry machine and run by for-profit corporatjons, and if your business is treating chronically ill people, where's the money in preventing illness through proper nutrition and awareness?
jason fung and many other modern doctors have proven time and time again, demonstrably, that type two diabetes is absolutely reversible purely through better nutrition and dietary practices.
I don’t where the author got the idea that clinicians aren’t advocating low carb diets for diabetes patients. Every clinician I have ever had has recommended a low carb diet to help with diabetes.
This is written by someone who has never had to convince people to do what they know they should be doing.
Diet and exercise (i.e., what to do) are solved problems. The hard part is convincing people to change their behavior (i.e., how to get people to do it). The medical profession is constantly searching for better ways of doing this (e.g., motivational interviewing).
And while you work on changing their habits, the disease process is still causing them harm and if there exists a medication that can mitigate that harm that a patient is more likely to take, the risk:reward ratio often leads to a clear recommendation.
15 comments
[ 3.2 ms ] story [ 43.1 ms ] threadFirst, the stance of medical profession is to treat diseases. There is not much effort on preventing diseases. They will wait until you get sick and then when you pass a magic threshold will assault you with a battery of treatments. We know that diabetes takes decades to develop, yet our description of a person who is halfway to developing diabetes is still "healthy". You need to wait until your body gets so devastated by your bad diet and habits that it gets completely disregulated and you put on a lot of fat before suddenly being considered a subject for treatment.
Second, the dissemination of knowledge in medical profession is glacially slow. Even if the research progresses quite fast, it takes a generation of medical professionals to die out and newly trained people to replace them to actually update the knowledge as it is being practiced. We are still in the "fat is bad" times even though we know and have known for a long time that it is actually carbs, processed food and bad fats that are major contributing factors to the obesity epidemic (that plus sedentary lifestyle, stress and bad sleep).
Third, people in the medical profession are heavily penalised for having a different view on things to the point that most are scared to speak up. For the most part, practicing anything that is not in line with mainline view will get you expelled from the profession and barred from practicing medicine ever again.
Fourth, the dieting, while sounding nice as a solution, does not tend to work well. Most people are unable to stick to a diet long term. Managing early diabetes with a diet would require sticking to it religiously and permanently. Medical professionals are not stupid and know that that's something that very few people can actually do.
This is totally incorrect. The problem is many people only go to the doctor once symptomatic. Your doctor should be testing for pre-diabetic risk factors at your annual physical.
> dieting, while sounding nice as a solution, does not tend to work
This is the entire answer.
The same probably applies to diabetes. Yes, if you eat a low carb diet you can improve your A1C, but you would have to do that for the rest of your life (or however long). Sure, part of it is probably _capitalism_, but I'm fairly sure that for a large part of the population, prescribing them diet instead of insulin would result in worse outcomes.
Keto can be an effective acute intervention against type 2 diabetes, but then one might add carbs back in to a reasonable level, but not the poisonous level of the Standard American Diet.
It’s like how condoms are 87% effective because the rate includes people who don’t use them consistently. Knowing that they’re 98% effective when used properly is important knowledge to the individual, but the effective rate is more important to anyone advising policy of what advice to give.
not really no, there are several very weird processes that add up to something entirely different.
You don't mean weight but body fat. If you just restrict calories you will lose both fat and muscle. You will get more hungry the longer you keep it up until you eventually replace the lost kg with fat alone. Less energy, less muscle mass to burn energy - brilliant plan!
To lose fat you need to stop eating long enough to trigger fat burning or the reserves won't be addressed. Might take a few attempts to get used to it. Then you need to do strength training.
The ratio carbs and starch is how some people stay skinny while eating a lot while others stay fat eating next to nothing.
It also gets hard to move if your heavy. You will adapt your life to avoid moving.
It involves dozens of other fascinating processes. Metabolic syndrome lowering testosterone making it hard to grow muscle which lowers testosterone again, nutrition shortages, poor sleep from lack of exercise/activity and lack of activity from poor sleep, not getting any sunlight etc etc
There is a big difference between them.
> We know that if you eat less, you will lose weight.
No one is looking to lose weight that generally. (or they shouldn't be)
> You just need to do that for the rest of your life, forever, or you will most likely put the weight back on.
Not at all. There are several mechanisms by which being fat contributes to getting more fat.
> I am pretty sure there is research that shows "diets don't work" because of that.
Simply eating less doesn't work. Other diets work. > The same probably applies to diabetes. Yes, if you eat a low carb diet you can improve your A1C, but you would have to do that for the rest of your life (or however long).
Excess fat causes insulin resistance and insulin resistance makes you fat. If you have and use more muscles you can (and will) eat more. Your metabolism will also speed up if you are more active.
When overweight it is much harder to jump on a bicycle, skate, take a long walk or sign up for a sport.
> I'm fairly sure that for a large part of the population, prescribing them diet instead of insulin would result in worse outcomes.
Fasting can fix insulin resistance. If you eat plenty of fat and protein between the fasts you will adapt to burn that.
The system is quite good, if you don't eat for 12 hours the reserves are addressed. May take a bit of getting used to since the mechanism is quite rusty. You become much more focused and active naturally. It is time to hunt or otherwise find food. When the belly is stuffed there is no need for physical activity.
https://www.youtube.com/watch?v=UYj3IROfvV4
jason fung and many other modern doctors have proven time and time again, demonstrably, that type two diabetes is absolutely reversible purely through better nutrition and dietary practices.
and it doesn't even have to be low-carb.
At a macroeconomic level - disease yields substantially higher profits than health in our current model.
Diet and exercise (i.e., what to do) are solved problems. The hard part is convincing people to change their behavior (i.e., how to get people to do it). The medical profession is constantly searching for better ways of doing this (e.g., motivational interviewing).
And while you work on changing their habits, the disease process is still causing them harm and if there exists a medication that can mitigate that harm that a patient is more likely to take, the risk:reward ratio often leads to a clear recommendation.