Are doctors too quick to prescribe meds over supporting lifestyle change?

[smcc]

Heard it from more than several doctors themselves! (Re the three hours or so of nutrition.) They may have been under-exaggerating?

I hope you are right re doctors slowly catching up with the effect of low-carb diets, and with the power of eat and metering. The pharmaceutical companies don't make any money from us low carbing though! And they may see themselves as losing money from it. And doctors and big pharma are very close buddies. But I hope you are right.

In my experience as a now retired GP the first line of attack on type 2 diabetes has always been a reduction in CHO intake. Indeed, before the discovery of insulin, this was also the only form of treatment for type 1.
Unfortunately, as I said in an earlier post, a large number of type 2s make no effort to change their dietary habits and I often felt that I was banging my head against a brick wall!

 

[Totto]

In my experience as a now retired GP the first line of attack on type 2 diabetes has always been a reduction in CHO intake. Indeed, before the discovery of insulin, this was also the only form of treatment for type 1.
Unfortunately, as I said in an earlier post, a large number of type 2s make no effort to change their dietary habits and I often felt that I was banging my head against a brick wall!

I and other diabetics in my family have been told to eat lots of healthy carbs and avoid fat. Mum followed the advice and had to go on insulin. I ignored it and am medication free.

 

[Pinkorchid]

We sometimes forget that those here who are controlling their diabetes with LCHF are in the minority among the thousands of diabetics that there are not just in the UK but worldwide and the majority will never even have heard of controlling T2 diabetes with diet and exercise only
Some diabetics may not ever need medication if they are determined to control their T2 diabetes with lifestyle changes but most I think will unfortunately never change their lifestyle or diets so doctors will prescribe medication because they know that most will need it. I think someone said it is better to start on medication and come off in the future if lifestyle changes means we no longer need it and hopefully many will be able to do that

 

[SunnyExpat]

We sometimes forget that those here who are controlling their diabetes with LCHF are in the minority among the thousands of diabetics that there are not just in the UK but worldwide and the majority will never even have heard of controlling T2 diabetes with diet and exercise only
Some diabetics may not ever need medication if they are determined to control their T2 diabetes with lifestyle changes but most I think will unfortunately never change their lifestyle or diets so doctors will prescribe medication because they know that most will need it. I think someone said it is better to start on medication and come off in the future if lifestyle changes means we no longer need it and hopefully many will be able to do that

Speaking personally, I support most doctors have seen patients like me normally.

After years of being told to lose weight, and adopt a lifestyle change, I developed type 2 diabetes.
So what doctor in their right mind wouldn't prescribe the correct treatment for someone they already know from experience can't make any changes?
Admittedly, I then became the exception, made the changes, and came off the drugs, but that surprised them

 

[seadragon]

I would say my doctor was definitely too quick to prescribe pills. I had been told I was pre-diabetic two years ago but only just in the range after a GTT test. I only saw the nurse who wasn't a diabetic specialist I don't think. She just advised me to eat starchy carbs with every meal and eat low GI if possible and come back in a year. No mention of exercise or losing weight (not that I was overweight as was in the healthy BMI range).
At second test I was asked to go and see the doctor and she immediately said I was still in pre-diabetic range but she'd prescribe metformin and statins. I asked about diet and exercise and she just said that it wouldn't work and I didn't really have any weight to lose anyway. She could see I was resistant to the idea of medication (especially statins) so told me if I was determined not to take them then i should go away and look into it myself and come back in two weeks. Her own opinion was that statins should be put in the water ( she actually said that ) which horrified me and made me lose confidence in her as a GP especially since I'd heard about the side affects.
Two weeks later I went back and having read everything I could and discovered this forum which was a huge help I felt able to say no to medication but I felt I had to fight her on it which shouldn't be the case. On statins I said I didn't think the decrease in risk was worth the side effects. She tried to say that it halved my risk but that's misleading when the actual figures are that it may save an extra 4 out of 100. She'd never heard of the Jupiter study, completely dismissed side effects, said co Q10 wasn't given as there was 'no evidence' it helped and didn't mention the fact statins have been proven to contribute to development of diabetes. She then refused to discuss them any more.
As for metformin I can see the value in it for some people but did not feel it would be right for me. I asked about meters and she was very dismissive. To be fair she did offer the local course but as I understand it that was still pedalling the standard NHS Eat Well plate. There was certainly no mention of low carbs at any time.
I believe the doctors get money for every patient they put on statins and for every diabetic they have on their books which seems to be perversely offering incentives to keep people unwell and over-medicated.

 

[ButtterflyLady]

I would say my doctor was definitely too quick to prescribe pills. I had been told I was pre-diabetic two years ago but only just in the range after a GTT test. I only saw the nurse who wasn't a diabetic specialist I don't think. She just advised me to eat starchy carbs with every meal and eat low GI if possible and come back in a year. No mention of exercise or losing weight (not that I was overweight as was in the healthy BMI range).
At second test I was asked to go and see the doctor and she immediately said I was still in pre-diabetic range but she'd prescribe metformin and statins. I asked about diet and exercise and she just said that it wouldn't work and I didn't really have any weight to lose anyway. She could see I was resistant to the idea of medication (especially statins) so told me if I was determined not to take them then i should go away and look into it myself and come back in two weeks. Her own opinion was that statins should be put in the water ( she actually said that ) which horrified me and made me lose confidence in her as a GP especially since I'd heard about the side affects.
Two weeks later I went back and having read everything I could and discovered this forum which was a huge help I felt able to say no to medication but I felt I had to fight her on it which shouldn't be the case. On statins I said I didn't think the decrease in risk was worth the side effects. She tried to say that it halved my risk but that's misleading when the actual figures are that it may save an extra 4 out of 100. She'd never heard of the Jupiter study, completely dismissed side effects, said co Q10 wasn't given as there was 'no evidence' it helped and didn't mention the fact statins have been proven to contribute to development of diabetes. She then refused to discuss them any more.
As for metformin I can see the value in it for some people but did not feel it would be right for me. I asked about meters and she was very dismissive. To be fair she did offer the local course but as I understand it that was still pedalling the standard NHS Eat Well plate. There was certainly no mention of low carbs at any time.
I believe the doctors get money for every patient they put on statins and for every diabetic they have on their books which seems to be perversely offering incentives to keep people unwell and over-medicated.

I would change doctors if I were you. Her attitude is too rigid, she is not up to date with research, and she is rude to patients. I don't believe doctors get paid for putting patients on statins but they have been persuaded that statins are good because they save lives. To me, they don't save enough lives to make the side effects and risk of diabetes worth it. They get paid for testing for and monitoring diabetes, as I understand it, but not for having diabetics on their books. Health planners have estimated the number of people likely to develop T2 diabetes, but they didn't take into account that some of them would find out how to prevent it or go into remission. We are still a minority though.

 

[AloeSvea]

I don't think doctors are sitting back and thinking "I know low carbing will make this person healthier but my big pharma buddies will make more money if we get them to stay sick". I think it's more a case of them not knowing that it's possible to send diabetes into remission through dietary changes and also them not thinking many of their patients will have the commitment level to see it through and stick with it. The people we read about at this forum are the minority of patients who understand that remission is possible and how to do it. I would say a majority of people with T2 diabetes have no idea it's possible and a good proportion of them are not motivated enough to do it long term. We see the tip of the iceberg here and it gives us a skewed view.

I was not saying, suggesting or implying that doctors were thinking like that or motivated by the desire to make or keep their patients sick. (What a horrendous idea!)

 

[AloeSvea]

I suppose you can make the leap of faith, and believe that every doctor is part of a global conspiracy, who has sold out his profession, and disregarded the oath they made, and now choose to actively conspire with 'big pharma' to harm and eventually kill the patients they care for, but even so, I'd like to believe there would possibly still be one or two the would be whistle blowers and would expose the vast amount of bribery 'big pharma' must be paying to those doctors who have sold their souls.

Either that, or maybe believe not all patients have the commitment to change, and the doctor is simply doing the best they can, with someone who is probably resisting the changes to even start down the road?

I personally do not believe that every doctor is part of a global conspiracy, sold out their profession, and disregard their hippocratic oath. (I would be loathe for anyone to interpret my previous comments in that way, based on the above quote.)

But there is in fact a 'big pharma', whether or not you put it in inverted commas does not stop it from actually existing - alas! If it is desired I can research some very good articles and post them. If desired.

 

[AloeSvea]

No-one is saying doctors get PAID for prescribing statins or any drug, as in metformin etc. But consider how much money Big Pharma puts into lobbying doctors. They put an enormous amount of money into informing doctors of the benefits of medication. There are no lobbyists for dietary changes and the benefits of physical activity. Just us!

 

[Celeriac]

I believe that all doctors want to do the right thing by their patients, at heart. I don't believe that there's a conspiracy between Big Pharma and the medical profession. I do believe that Big Pharma researchs potential big profit areas primarily and aggressively markets drugs, which sometimes haven't had much testing.

In the past, doctors were seen by nurses and patients as being omnipotent and consequently some have the mind set that they, having done the training, know everything and patients know nothing.

Pre-Internet this would have been true but these days, doctors have to contend with patients worrying about articles in the Daily Mail, self-diagnosing, taking all sorts of remedies that can be harmful (coumarin in cassia cinnamon for example) and questioning their GPS and consultants about everything, having read studies.

If you've spent ten years training and all day your patients are effectively doubting you, I'm sure that gets old real fast. It could also be awkward if you have been too busy to even open the BMJ or Lancet and they've not only heard of the study, they've read it. I can't blame doctors for becoming defensive in some instances.

In a speech last month, Health Secretary Jeremy Hunt said that the NHS needs to be more human-centred and he doesn't think patients Googling is a bad thing and neither do I. When patients Google and read up, it shows that they are invested in their own health. Some doctors don't see this.

What needs to change, during medical training, is that doctors have to learn to engage with these patients not rebuff them. Instead of seeing it as an attack on their knowledge they need to see it from the angle of Worried-Patient-Invested-In-Own-Health.

My GP makes me feel lucky. He doesn't tell me that I should be eating a load of starchy carbs and he does listen and discuss my experiments. He does insist however, that if I try something, I keep him informed, test BG and don't try anything that doesn't have medical research to back it up - that doesn't limit me to the UK however as there are studies on all sorts of things.

 

[ButtterflyLady]

I think it's good advice to only try things that have medical research to back them up. There is strong medical evidence and weak medical evidence though. Meta reviews and systematic analyses are stronger than single studies, especially if the studies are small scale, have design flaws, or are published in "low impact journals" (lesser-known journals that are easy to get papers accepted in - some will even publish your research for a small fee!). Also, I am loathe to accept a treatment proposed in in vitro (lab bench) or animal studies, as successful human trials are necessary before a treatment can be regarded as safe and effective.

On top of all this, I believe that people trained in the relevant field of medicine or related science are better placed to read these studies in context and fully understand their implications than laypeople are. If I find a good quality meta review supporting a treatment, I bring it to my doctor and get her take on it. We work together to improve my health. Her expertise is valuable, and necessary, but I have total commitment and time available to look for information and ask questions. I don't think she minds fielding my questions, because I think seeing patient after patient who is not interested in the details may get boring.

We should think of ourselves as a breath of fresh air in an otherwise tedious existence, lol.

 

[Nyxks]

Think it depends, my mom was a t2 n only ever diet controlled her Endo never tried to put her on pills or insulin not even in the days leading to her death.
Me from within a few weeks was on insulin because I'm t1 so it's necessary, but lifestyle changes where never discussed with my mom or I as our Endo never saw the need to do so I guess.

 

[ConradJ]

Celeriac, you are absolutely right. In my experience as a now retired GP most type 2s are extremely unwilling to change the dietary habits of a lifetime even when the most severe of possible complications is pointed out to them. It is well known that the huge increase in the incidence of type 2 diabetes in recent times is largely due to overeating and lack of exercise. The only real answer to the epidemic is prevention.

Well said.

If they won't change then should their driving licences, etc. be rescinded to enforce a change?

 

[Celeriac]

Your environment matters when it comes to food.

In a country village these days you may not have a pub, let alone a post office or village shop. The bus to the nearest town, ten miles away, may only run on an hourly service and cost £6 return. If you're younger you can use delivery services but not all older people are on the Internet.

In a town, there are takeaways, supermarkets, cafes, markets, fast food outlets, delis, convenience stores, vending machines, Polish shops, pubs - maybe even butchers, greengrocers and bakeries. It's never a problem to find food, but much of it can be poor quality processed stuff.

Older people often grow veg in their gardens or on allotments but younger people tend not to. I've had an allotment in three places and every time I've been the youngest person there by a good thirty years.

The processed junk in the middle of the supermarket is easier to store and transport than fresh food and it's cheap because a little of the raw food goes a long way when it's so mucked about. It doesn't need cooking, maybe boiling water at most.

Cookery shows are really popular, but many people just watch them as entertainment, they don't cook any of the recipes. Some can be really expensive to make, too.

Partly thanks to Jamie Oliver, cookery became a compulsory subject in schools up to Year 9, last year, which has to be a good thing.

A person's socio-economic background does still determine where they live, what is available to them foodwise and whether it's seen as normal in their social groups to cook and eat healthy food.

 

[pixie1]

I only found out yesterday, that the little animal called Deglu, cannot produce insulin, they naturally avoid carbohydrates. These little animals are from Chile, kept as pets, dietary requirements have to be carefull, avoiding giving them carbs. Research is being done around this little animal. How interesting,

 

[SunnyExpat]

Your environment matters when it comes to food.

In a country village these days you may not have a pub, let alone a post office or village shop. The bus to the nearest town, ten miles away, may only run on an hourly service and cost £6 return. If you're younger you can use delivery services but not all older people are on the Internet.

In a town, there are takeaways, supermarkets, cafes, markets, fast food outlets, delis, convenience stores, vending machines, Polish shops, pubs - maybe even butchers, greengrocers and bakeries. It's never a problem to find food, but much of it can be poor quality processed stuff.

Older people often grow veg in their gardens or on allotments but younger people tend not to. I've had an allotment in three places and every time I've been the youngest person there by a good thirty years.

The processed junk in the middle of the supermarket is easier to store and transport than fresh food and it's cheap because a little of the raw food goes a long way when it's so mucked about. It doesn't need cooking, maybe boiling water at most.

Cookery shows are really popular, but many people just watch them as entertainment, they don't cook any of the recipes. Some can be really expensive to make, too.

Partly thanks to Jamie Oliver, cookery became a compulsory subject in schools up to Year 9, last year, which has to be a good thing.

A person's socio-economic background does still determine where they live, what is available to them foodwise and whether it's seen as normal in their social groups to cook and eat healthy food.

The cookery show comment is interesting.
My daughter likes to watch 'bake off'
She also quite often cooks many of the recipes on there.
When I visit her, I don't/can't eat any of them, as they are mainly sugar and flour.
How old is Mary now?