"Flexibility often leads to failure!" Excerpts from a pretty good article targeted at physicians on how to guide patients:

"Encourage an optimal diet. Diet studies show that patients sometimes follow their doctors's orders and sometimes do not, but the more significant the changes their doctors recommend, the more changes patients actually accomplish. If a doctor recommends as close to an optimal diet as possible, the likelihood of patients making at least some healthful changes is higher than if the doctor recommends only minor changes."

"A contrary view is that, for many patients, recommended diet changes may be more effective if they are gradual, stepwise, and communicated with the understanding that perfection is not expected. This view is common among clinicians but is at odds with clinical experience with other types of lifestyle changes, such as smoking cessation or substance abuse treatment, where flexibility often leads to failure."

"A reasonable solution is to prescribe an optimal diet, while avoiding any semblance of moralizing when patients have lapses. It should be recognized that guilt and secrecy often characterize dietary behavior. A physician can coach patients through the routine difficulties of diet change, while helping patients set aside guilt and blame."

"Just like moderate changes in diet usually result in modest reductions in cholesterol, asking patients with diabetes to make moderate changes achieves equally moderate results! which is one possible reasoning they end up on drugs, injections or both. Everything in moderation is a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, moderate amputations, "maybe just a few toes!". Moderation in all things is not necessarily a good thing. The more we as physicians ask our patients, the more we are likely to get. The old adage, "shoot for the moon" seems to apply, and may be more effective than limiting patients to small steps that sound more manageable but are not sufficient to actually stop the disease."

"Just like moderate changes in diet usually result in only modest reductions in cholesterol, asking people with diabetes to make moderate changes often achieves equally moderate results, which is one possible reason why most end up on drugs, injections, or both. Everything in moderation may be a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, and moderate amputations. Moderation in all things is not necessarily a good thing."

"Sure, you could choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? I don't tell my smoking patients to cut down to half-a-pack a day. I tell them to quit. Sure, smoking a half pack is better than two packs, but we should try to put only healthy things into our mouths."

"When people with severe or advanced disease come to us there is very little room for error."

"The analogy I give is: if you just put a little bit of cyanide in your coffee every morning, okay, how far would you have to run to run it off? Cyanide is low in calories and low in carbs, by the way. The point is that it's poison! We have to understand that a little bit of chicken and a little bit of fish: the biochemistry of these foods — it's not the calories, not the fats and not those other things; it's the biochemistry of these foods — that's abnormal for our system. So that's why a small amount is too much because it's like putting a little bit of cyanide in your coffee every morning. It may not kill you right then and there but it's enough to make you sick because of the abnormal biochemistry of these substances.

"After all those years in this business I shall say that for the sick, dietary therapy is sometimes like a 4 digits code to open the safe. You will not get 75% of the safe content if you input only 3 digits. You need to put all 4 to get anything!"