Quote:
Originally posted by Lisa N
Is the ADA simply being pragmatic in their recommendation knowing that most people won't comply with cutting back on sugar (or cutting it out altogether) no matter how much they are told that it's going to hurt them and make them sicker and simply recommending that diabetics go ahead and eat it but increase their medications to compensate?
|
So many profound issues in this thread.
I've often speculated that many times our physicians, deep in their heart of hearts, know what the really effective treatement is, but are constantly weighing in their own minds the tradeoff between optimal treatment and the ability to
obtain compliance with their instructions. I think that sometimes they knowingly instruct patients suboptimally because they know that at least they can obtain a given level of compliance and thereby provide their patients
some treatment which is effective. If they attempt to provide truly optimal treatment they run the risk that they'll make matters worse if the patient doesn't fully comply.
For instance, if my doctor tells me to keep my carbohydrate count below 30 grams per day and consume as much fat as I wish, what are the risks? If I cheat and eat 100 or 200 grams CHO / day with the increased fat intake, they are considerable. The excess insulin produced will stimulate my liver to produce adipose tissue, raise my LDL cholesterol, lower my HDL and increas triglycerides. In short, make matters
worse.
The line of least resistance for them is to follow the ADA party line, and rest assured that they're not opening themselves up to a malpractice suit. The medical literature is replete with recommendations about the "proper" treatment and diet for diabetes. They can always cite it if anybody challenges their dietary recommdations.