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Comment by happytiger | Hacker News Reader

That’s some sage advice.

People are often surprised when I tell them about the insane levels of pre-diabetes in the US:

> The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.

It’s honestly insane to continue a way of life that’s doing this to the majority of the population.

https://www.uspharmacist.com/article/prediabetes-trends-amon....

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The other insane thing is studies have shown that type 2 diabetes can be reversed by fasting. Fasting is problematic to the medical industry because it is zero cost.

"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."

https://clindiabetesendo.biomedcentral.com/articles/10.1186/...

> Fasting is problematic to the medical industry because it is zero cost.

No, fasting is problematic because people don't like it.

Health conscious people don't understand how much resistance the average patient has to advice about lifestyle modifications, or how difficult it is to get patients to adhere to recommended lifestyle changes.

A good example is sleep apnea and CPAP machines: In theory, a CPAP machine should provide life-changing improvements in sleep quality and daytime energy for someone with sleep apnea, yet patient adherence rates are shockingly low (even when covered by insurance). Many patients are simply annoyed by the machines and give up on it.

That's not to mention the fact that weight loss is extremely effective in many (though not all) sleep apnea situations, but it's rare that patients will actually follow through with that.

It's also rare for a doctor to tell a person they are too fat and to lose weight. The assumption (and most cost effective solution) is that patients just want a prescription for something and be sent on their way.

US healthcare is crisis focused, not health focused.

> It's also rare for a doctor to tell a person they are too fat and to lose weight.

Genuinely curious... have you ever been an obese person? Every fat person I've known have told me they're constantly shamed about being fat in medical settings, some to the point where they actively avoid going to a doctor anymore because they've given up on anything beyond being told they're fat.

It its a complicating factor in almost every ailment known to humankind. A doctor would be negligent not to address it. There is no healthy level of obesity.

So... you get my confusion and skepticism at this claim that it is "rare" for doctors to bring up obesity to an obese patient!

I'd say I'm obese, and never heard a word about it. Even through covid. I have a friend who is a doctor who has been brutally honest with me (it's appreciated), but even though I've gone to many paid doctors in the northeast US, not a peep.

I don't want to confuse my experience with actual data. Also, I don't think it's shaming if it's a health issue and obesity should be recognized as such.

> It's also rare for a doctor to tell a person they are too fat and to lose weight.

I don't think this is true. Doctors do tell patients if they are overweight, and they do encourage them to make lifestyle changes including losing weight.

Okay, that's fair, I didn't provide data so you responded in kind. So I went to find a study:

"Fewer than one of five overweight patients and slightly over half of obese patients reported being told they were overweight by their provider."

So "rare" is the wrong word.

https://www.commonwealthfund.org/publications/journal-articl...

Disordered eating is more dangerous then obesity.

Both are worse than eating right. It's not a binary.

I doubt that's true unless the degree is extreme. Humans evolved with "disordered eating" and fasting is well-researched.

Humans evolved with a lot of behaviors that is or was not healthy. Evolution requires you to have offspring and have them alive until having own offsprings.

Speaking as someone who has spent several months trying to adjust to a CPAP machine before finally giving up, it's not because it's annoying, it's because I literally can't sleep with the damn thing strapped onto my face. I'm well aware of the benefits, and I would love it if I could have them... but between sleep apnea and no sleep at all, the choice is obvious.

Everyone has a unique situation, but wanted to share my experience because improving apnea can have such a huge impact. I have a relatively mild case, so CPAP was borderline but I tried it. Like you spent 4 months and never got past 3 hours in one night, even trying several masks. Gave up for a year, worked on sleep hygiene in general and tried again. After about 2 weeks of a new mask and adjusting settings slept through the night. 5 years on I still wish I didn’t need it, but the improved quality of life means I basically never go to sleep without it. Can’t imagine how big a deal it is to someone with severe apnea.

You don’t need to completely throw in the towel if you don’t want to. Take breaks, try different masks as much as you can, get your dr to help adjust pressures. At least for some of us it does eventually click.

Good luck!

I have a friend who got a CPAP and was happily sleeping with it on the first day, 5 minutes in. I'm very envious, but... I've already tried several different masks, went to the supplier to have them adjust that stuff to fit me etc.

At the end of the day, we are all different, and the threshold for what physical sensations a person can tolerate is highly variable. Everyone understands that about pain (I hope!), but this goes just as much for all these other things that are not necessarily painful as such, but are still physical.

>Fasting is problematic to the medical industry because it is zero cost.

Is this just an American thing? Every GP I've ever seen has asked me about my diet and exercise despite me being in the healthy BMI range.

I don't think that fasting is problematic to the medical industry in the US. And if it is, it's not because it's zero cost. Doctors love zero cost interventions. The real challenge is just the standard medical challenge: 1) educating doctors as new evidence comes in, 2) doctors educating patients, and 3) patients complying with the intervention.

It's a pessimism thing.

I've had doctors (in America) tell me to not worry about medical issues and others recommend a battery of tests to look for correlated but uncommon issues. My current GP recommends basic, palatable approaches to diet and exercise that have nothing to do with giving them money (and, presumably, reduce my medical costs with them down the road.)

I've also had doctors suggest that I get an issue reclassified so they could do surgery. That could be viewed as them wanting money, but I view it as them seeing a problem that can be fixed by surgery because, as a surgeon, that's how they approach problems.

Are you asking if your anecdotal evidence is sufficient to make an inference for all of Europe and the US?

Other studies have shown that type-2 diabetes can also be put into remission for many patients with nutritional ketosis. So, there are potentially multiple approaches to try.

https://www.virtahealth.com/research

to be clear this isn't reversing T2 diabetes. Rather, it allows you to manage it. But the physical damage causing T2 diabetes generally remains

The American diabetes association admitted last year that T2 can be "reversed" with the caveat that you mentioned about existing damage. However, to actually damage things to a level where they are noticeable takes years and years. If you catch it early, T2 is entirely "reversible".

Ah, very neat, thank you!

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