Comment by atria | Hacker News Reader

Comment by atria | Hacker News Reader

Parent Full thread

^ This times 1000000. There is so much chicanery and malfeasance in the nutrition and fitness industry.

I was diagnosed with T2 diabetes a few years ago. I went to dietitian who prescribed a diet with 60% carbs (I believe its roughly the same as the ADA dietary guidelines). The standard treatment is medication, followed by more medication, then insulin shots.

Frustrated, I read everything I could get my hands on, and found two books that I'd highly recommend: 1) Dr. Bernstein's Diabetes Solution, and 2) Think Like a Pancreas by Gary Scheiner. Dr. Bernstein is notable because he was diagnosed with T1 when it was a fatal condition. He survived, became an electrical engineer and ultimately went on to become an MD. He lobbied the AMA to allow patients to have blood glucose meters, when the AMA wanted them to be restricted to doctors offices.

I stopped listening to medical practitioners and starting experimenting with the foods I ate, using pairs testing with a glucose monitor. There is no question that a low carb diet is the way to go.

> I stopped listening to medical practitioners and starting experimenting with the foods I ate, using pairs testing with a glucose monitor.

I sometimes wonder if the state of medical ethics is killing us. We've made it so expensive to do a medical study that nobody is going to do it unless the end result is something they can sell, so the only "solutions" we get are drugs because there is no money to be made in prescribing diabetics a diet of fish and vegetables.

It's a sad state if an individual can learn more by experimenting on themselves than their doctor knows because the doctor isn't allowed to participate in or publish the result of the same experiment without a multi-million dollar budget.

Generally I would say the responsibility of doing something that is beneficial to society but not economical rests on government. Vote for politicians that will increase research funding

That is a very low standard of morality. Historically private institutions had greater trust and expectations from society. They may have abused that trust - but the solution is not to absolve them of what was their historic responsibility.

> "...no money to be made..."

That's the ethics of business. We have no healthcare; there's a healthcare industry and we are how it extracts its profits.

This inevitably corrupts the goals of an "ideal world" healthcare system which would exist to provide efficient and affordable healthcare.

Aren't there tons of studies on whether some particular food is good for the heart, good for the brain, etc.? It's not that nobody does them, it's just really hard to get a conclusive result that applies to everyone. There are lots of foods that are both good and bad for you, depending on the study.

I think the problem might be more that there aren't very many universal results, and the fish and vegetables diet that works for one person won't work for others.

> Aren't there tons of studies on whether some particular food is good for the heart, good for the brain, etc.?

Not really. There's tons of studies on whether some particular food is connected to some very narrow positive or negative outcome for the heart, brain, etc., on which popular ideas about the food being generally good for the heart, brain, etc. are built. (And, from those, even flimsier popular ideas about the food being generally healthy or not.)

> It's not that nobody does them, it's just really hard to get a conclusive result that applies to everyone.

Exactly. The research is starting to show that individual reactions vary dramatically.

I went to an interesting talk the other week about the potential for personalized medicine to and how what seemed like just throwing data at medical issues can eliminate this problem.

ie, you gather medical data from thousands of people and find someone similar on a micro level to the current patient and see what has helped them.

We don't need more research to answer most questions on what to eat - eating real food, namely plants, prevents diabetes, atherosclerosis, etc. When doctors do tell people to eat plants people usually don't listen.

I think Doctors need to be better trained, Americans need to completely rethink nutrition and health (I can't speak for other countries), government needs to help inform people, and laws about marketing food may need to be changed.

In addition further research could help, but in my opinion nutrition is a solved problem, eat real food and avoid meat and processed junk.

My opinion is based on how little my friends in the medical profession and/or training know about nutrition and the book How Not to Die which focuses on how diet affects deadly diseases.

potatoes and corn are plants, both of which cause enough of an insulin spike to be worrisome. Just eat plants isn't a good enough answer.

So are seeds and carrots. In reality, all root vegetables store a great deal of carbohydrates that us diabetics must watch out for.

I've been 'gotten' by carrots in a crock-pot beef. I miscounted and got waylaid by them.

While doctors don't always know the most about a diet there is also the aspect of actually following the diet. People suck at following diets so giving one that is as little adjustment from a normal diet as possible might increase compliance and will result in predictable insulin levels.

If you pick a very strict diet then people drop the diet completely or cheat all the time, resulting in uneven insulin levels.

It is like inflammatory bowel disease. Many doctors rarely prescribe rectal medication for long term use even if it might be more effective than alternatives just because it is difficult enough to get people to take their pills.

But I do think diet suggestions will change more in the future when it comes to diabetes.

Yes, this is sadly correct. In the pharma industry, we call it pleasing "the stakeholders." Many times more expensive tests/treatments/etc are developed over cheaper ones, as the risk seemingly (if the MBA stakeholders are to be believed) necessitates chasing medical innovations that will have the largest ROI.

I've heard the theory that establishing these high standards was actually in the best interest of the pharmacy industry. A great way to keep competition at bay, because only huge companies can afford to comply with the regulations.

The limiting factor on medical research isn't ethics: it's samples large and diverse enough to have a meaningful ability to distinguish between null and alternative hypotheses.

We produce shit studies with small sample sizes and dodgy methodologies all the time. They just don't add to the pool of human knowledge.

> We produce shit studies with small sample sizes and dodgy methodologies all the time. They just don't add to the pool of human knowledge.

They actually do. A crappy study with p=.70 isn't enough to justify changing the standard treatment for a disease but it is enough to justify doing the more comprehensive study to see if the result still holds.

We have a choice between doing ten comprehensive studies only to prove that nine of the things didn't work, or using the same resources to do a hundred crappy studies and then repeat the five with the most promising results using the more robust methodology and discover that three of them still hold.

You confuse p-value with methodology. P-value is entirely a product of sample size and effect size. For a given effect size, the cheaper I want the study to be, the smaller I make the sample, and the less likely I am to reach a significant p-value.

The problem is when the methodology itself is broken. For instance, using case-control methodologies on things with small-to-moderate effect sizes. Past studies comparing such studies with eventual RCTs showed that the case control studies gave absolutely no indication of what the RCTs would show as a consensus: it was entirely random.

There is no amount of money, small or large, worth throwing at studies that shift our prior probability to posterior by 0 units.

This paper is nice:

http://www.sciencedirect.com/science/article/pii/S0899900714...

Reply on news.ycombinator.com