My Doctor, and the Low-Carb Route

Today was my regular diabetes follow-up appointment with my American GP. I thought forum members would be interested to hear what he had to say, and have decided to reproduce the relevant parts of the conversation without any additional comment from me. (I have redacted some specific stuff relating to me, mostly nothing to do with diabetes.)

Obviously I want to keep this anonymous, but for context: I live in a large American city on the East Coast. It is the home of numerous hospitals, clinics and research establishments. My doctor, in addition to being my regular GP, is also an instructor at a world-famous medical school. I didn't do anything special to get "allocated" to him (I picked his name at random from a local list furnished by my insurance company). He has the demeanor of a friendly family doctor.

Me: "Dr. K, I just wanted to say that when you asked me to try the low-carb, no-drugs option on diagnosis nine months ago, I was really surprised. Frankly I did not expect it to work. I was even more surprised, shocked actually, when the A1C came back two months later and showed my diabetes was controlled."

Dr. K.: "That's because the low-carb diet works!"

Me: "Was my case unusual? Does it work for most of your patients?"

Dr. K.: "No, not usually."

Me: "Why is that?"

Dr. K.: "You're much more motivated than most of them. Most of them are overweight. They've been eating certain kinds of foods all their lives and have become addicted to them. They just don't seem to be able to change their habits."

Me: "I guess it can be a progressive disease. So I may end up needing the drugs eventually."

Dr. K.: "Drugs are great when you need them!"

Me: "Thank you very much for trusting your patients, Dr. K. I really appreciate that." (We shake hands.)

nomoredonuts said:

Wonder if Trump will let me emigrate...

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Hold on! He is already trying to take away my health insurance (or rather, to make it far too expensive for me to afford). Bye-bye, Dr. K.!

More context. When Dr. K. put me on the low-carb diet in February he did not provide any specific advice, apart from "not getting your sugar from Domino's [UK equivalent: Tate & Lyle]," avoiding pasta, potatos, that was about it. No more than a couple of sentences. No leaflet explaining this low-carb lark, nothing at all. He was smiling and extremely empathetic, but the amount of concrete info provided was zip.

I had to figure it all out of my own, and I did not know about this forum. I was incredibly lucky to find dietdoctor.com and took it from there.

Still, at least I had someone "batting in my corner," huh?

So I vowed not to "comment" at all, in my initial post in this thread.

But now I will say it. Dr. K.'s reference to "overweight" people being addicted to certain kinds of foods and unable to adjust their diet sufficiently plays straight into the stereotype. I did not call him out on it (far be it for me to be rude to my doctor) but it stuck out like a sore thumb.

We know, from this forum, that being overweight is not necessarily connected with lack of willpower. It may be that being overweight is an extra hurdle when trying to get BG under control using mainly diet. Or maybe not.

However, Dr. K. did make it clear that the low-carb, diet-only route is one that he tries out on everybody who might benefit, including people who are overweight. It is his experience that the overweight ones do more poorly on this treatment.

This is all so maddeningly anecdotal. I keep coming back to this.

It is also now abundantly clear to me that we on this forum are a self-selected group of highly motivated (most of the time) people who perhaps are just more concerned about our health than the Average Joes out there. This, too, will skew our attitudes into what is perhaps an unwarranted optimism about the great mass of people with diabetes.

If only all suitable patients could, at least, be handed a medically vetted book that would present the low-carb option, and the other options, in context. Or, be systematically steered to websites such as this one, or phone apps that are similar.

If only.

ringi said:

If the doctor thinks "low-carb" will fail due to people not having the will to do it, it is very lickly a message of hope is not given, and therefore his/her clients don't expect it to work, so are not motivated.

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I have told this story in other threads. At diagnosis the conversation was like this:

"Look, @Grateful, if your HbA1C had been 15% or something, I would have put you on drugs right now. But let's try something else. I'd like you to try a low-carbohydrate diet, plus some daily exercise, and come back in another couple of months to do another test and see how things are going."

The important thing is that this was said with a broad smile and looking me straight in the eyes. It came just after he had said a few things about "progress being made" in treating diabetes, and about how "we see fewer of those people who go blind or are losing limbs."

Yes it was a huge message of hope. So much so, that until I got the next A1C result two months later, I thought that my doctor was a real outlier (because of what I had read on the Internet) and probably just trying to jolly me along before dosing me up with drugs eventually. I could not have been more wrong.