[el_oni]

> reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease.

My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). And that most people that the doctor sees in your BILs situation wouldn't stick to a ketogenic diet, and would need to go onto meds at some point in the future anyway.

Aside from that, im glad that it worked out for him. My anecdote about T2, is that a guy who works with my SO was told to control his diabetes with diet and is now insulin dependant, he hasnt been doing his insulin properly and has developed a swathe of health problems because of it.

[jonfw]

You've also got to look at how doctors are being incentivized. Medicine funnels more money into the medical system- and kickbacks or 'rewards' programs from pharmaceutical companies are common.

Outside of that- people like their doctors to do things. Everybody knows that they could use a better diet and more exercise- a doctor who says that and nothing else may not make people feel like they're getting their money's worth.

[bosie]

I am not even sure the incentives matter, compliance rates from patients are horrendous in medicine.

Incentives or not, suggesting a lifestyle change (go from SAD to extreme low carb) might be the best course of action but how many patients will follow through? does medicine even know how to handle this transition? Of course they don't. Advising this lifestyle change might work for 1% but what about the other 99%?

[49para]

Dr's are also incredibly uninformed about Keto, Carnivore, low carb in general.

The response I've received from my Dr friends regarding nutritional intervention vs drugs, is that "diets don't work".

They have no clue as to recent research being done. Changes to medical "best" practice are generational and take a long time.

[el_oni]

I wouldn't say that they are uninformed, just that they are informed by the literature. And unfortunately the literature surrounding diet is awash with special interest groups, small sample sizes and dodgy statistics. While clinical trials involving pharmaceuticals are often more rigorous. It's near impossible to do randomised double blind controls for diet, and energy levels and feeling great aren't as easy to measure empirically

[AnonC]

Of course “diets” don’t work. People consider diets as something you get on for some results or changes and then abandon them or give up later. So what actually works is making it a lifestyle change, which isn’t easy either, but is at least honest in what it means to people when they hear the word. Lifestyle changes are hard. Diets are what people usually see celebrities doing before an awards ceremony.

[thomascgalvin]

> My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet).

This is probably true, but I'd like to see statistics. Compliance with med schedules is pretty terrible, too; that's why all of your antibiotics have a label telling you to actually finish your course.

[el_oni]

According to the highlights of this 2011 study[0], compliance is around 50% for drugs. I don't know if this is higher or lower than i was expecting to be honest...

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/