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Comment by feralimal | Hacker News Reader

Don't worry about not being a doctor - that's a good thing!

Doctors would NOT advise anyone to cut calories by 80% even if, as in your case, it improves your health. Nor would they advise a diabetic to abstain from carbs, and so take away the trigger for their condition. (Ie - you don't have diabetes if you don't eat carbs.) 99.9% of doctors will only prescribe drugs.

The medical industry is not about well - its about maximising illness for profit. And improving diet and eating behaviour is the last thing they will do - there's no money in that!

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> Nor would they advise a diabetic to abstain from carbs, and so take away the trigger for their condition. (Ie - you don't have diabetes if you don't eat carbs.) 99.9% of doctors will only prescribe drugs

They don't right now, because the evidence around the long-term effects isn't sufficient. They're clearly coming round to it though. See the section "Dietary advice" in NICE guidance.

https://www.nice.org.uk/guidance/ng17/resources/2019-surveil...

Anyone at risk of diabetes or dealing with diabetes should also look at research into the relationship between diabetes and inflammation, which suggests that there may be other factors to consider beyond just diet for how to best prevent and mitigate the condition.

There is also interesting research into how protein (muscle health) impacts insulin resistance:

https://news.ycombinator.com/item?id=8748147

Thank you for posting your thoughts on the business centric approach of our modern medical system. It makes me feel less crazy sìnce nobody I talk to face to face about even want to hear it. "Our doctors are working hard towards our own good"

No problem. The reality is that the medical industry is a sickness industry. Not a wellness industry. There is no incentive for them to make people well, but every incentive to keep people unwell for a prolonged period.

By that token, there cannot be a "wellness industry". If you pay people to make you well, their incentive is to keep you sick.

I don't think this is true. This incentive is eliminated by the fact that you can always gauge an industry's success rate. In this case, we gauge how efficient they are at making us well, compared to not following their advice. You can also outsource this gauging to an external entity, which should not have this particular perverse incentive.

This solution does not work if we fall down into the trap of having a few gigantic corporations handle everything for us, which unfortunately seems to be the recent trend.

That solution changes the incentive to them just performing slightly better than doing nothing, instead of the best they could.

My issue is with the GP implying that there are other fields that do have an incentive to make you maximally well, when I contend is impossible when you're paying someone for cures.

> That solution changes the incentive to them just performing slightly better than doing nothing, instead of the best they could.

Does it? You don't simply gauge whether someone is performing better than the baseline, but how much better. This allows you to select the best performer.

Many doctors are good people and entered medicine to help others. But after about 5 min in practice realize you have no idea how to actually help most people, let alone cure them. New drugs get advertised to you even more heavily than to your patients, and so you prescribe.

Systemic approaches to helping your patients are hard and those doctors that try it often don’t take insurance because most insurance companies won’t pay for their trouble. They want to fall back on the hard numbers of a limited set of narrow interventions.

Perhaps if there was more upstream incentive to keep patients healthy things would be different. But at the end of the day, many patients are not compliant and are very resistant to lifestyle changes, and as a doctor, despite knowing more today about the human body than ever in history, deep down you know you’re little better than a charlatan.

I'm alive in part because I was friends for some years with a physician and I was friends for some years with a former Registered Nurse who also studied a variety of other health approaches. Since we were friends, they heard a lot about my situation over a long period of time and this led to them giving me very useful feedback that changed the course of my life.

Our current medical system has some serious problems in the way things get done that interfere with medical personnel being effective. I hope we can find real solutions for that in coming years.

Only if you are so inclined and it's not in the TMI realm or otherwise inadvisable, I'd be interested to hear the tl;dr of what you learned to do or not do.

It's really too much information for a single comment. I do try to blog about it and I do have a reddit called r/HealthWorks where I keep hoping -- someday! -- people will join and talk with me and yadda.

But in a nutshell (and this is very quick and dirty -- I have been doing this nearly twenty years):

1. A comment by my physician friend -- who minored in parasitology -- convinced me that I was correct that my husband had brought a parasitic infection back from Saudi and infected me with it sexually. So that same day, I said to my husband "You are never touching me again without a condom." My condition stabilized about two weeks later (after another round of antibiotics was prescribed) and I began slowly getting better thereafter.

2. He and I later divorced and I have been celibate for more than fifteen years while working on my health. Sex is germy and it was too much of a health risk for me for a long time. This is also part of a more general principle I have followed: If you have a chronic or recurring infection, figure out what the damn source is and resolve that piece. You don't pick up infections randomly from the ether or some nonsense.

3. I took about $300 worth of supplements for a few years to redress a huge backlog of nutritional deficiencies.

4. I got really picky about my diet. Among other things, I looked into fat chemistry and I avoid or limit long chain triglycerides and favor medium chain triglycerides. (Medium chain triglycerides have long been medically prescribed as beneficially for my condition and for other serious gut issues, but limiting long chain triglycerides is not anything I have ever seen recommended and it makes a really huge difference for me.)

5. The standard medical recommendation for my condition is a high fat, high salt, high calorie diet. The result is that the standard advice is to pursue a junk food diet. I do not count calories and I make an effort to get more salt than most people consume, but I got super picky about dietary quality and focused on nutritional density instead of calories per se.

6. "An ounce of prevention is worth a pound of cure." Or several pounds if you have a compromised immune system. I work hard at avoiding exposure to germs, etc. and I currently work from home to help me have control over my environment and limit my exposure to germs, chemicals, etc.

There's no doubt more, but that's what occurs to me off the top of my head.

> Sex is germy

There's an understatement.

(TMI as a euphemism for stuff that readers might not want to be reading on a mostly tech community site)

Your clarification is several hours too late. My edit window long since expired. And this is not a "mostly tech forum."

Sorry. It's medical information. If it bothers you to know that disease can be transmitted sexually and likely was in this specific instance, I don't know what to tell you.

Type I diabetes does not go away when you eliminate carbs. (There’s some evidence type II does). These are different diseases, and though they have some similarities - lumping then together as “diabetes” like you did here is mostly harmful.

While doctors do distinguish between different types of diabetes, my anecdotal experience is that they do not in practise distinguish between the two types. They do not tell type II patients that they will not have the condition if they don't eat carbs.

So which is worse or more harmful? Me, some clown on the internet, bringing this to people's attention? Or 1000s of doctors failing to provide full information to their patients, thereby dooming them to a degenerative life experience, taking ever greater drugs?

You. Because despite knowing the difference, you help perpetuate the “no difference” ignorance.

I know people who were scoffed by teachers in school (and by others) “well, you shouldn’t have eaten so much sweets then” for having type 1.

Doctors do differentiate. They do not prescribe metformin for type 1, and approach insulin very differently (if at all) for type 2. They don’t recommed eliminating carb for type 2 because they don’t know it works (for no direct fault of their own... the system is biased against it)

I think ignorance is worse than feigning ignorance when you know better. But maybe that’s just me.

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