Fellow physician here. Why does it have to be paired with exercise/certain diet? It doesn’t work on your metabolism without exercise?

That sounds to me like the old stigma is still going strong. Unless you mean the wink-wink kind of lifestyle mod we do for cholesterol or hypertension…it is certainly nice if folks exercise and eat plants, but the drug either works and is safe and we use it to treat a medical condition…or its doesn’t. Patients shouldn’t have to adhere to a certain program to be given necessary medication.

Good points! I really just mean the analogy to be about how people can do extraordinary things when they are trained over time to do them. Surgery very difficult to get into, training excruciating and those factors help weed out most. The few left in the subspecialty surgery groups really love it, really deserve to do what they do and are of a different breed. Even among doctors, who are all pretty good at working hard and focusing.

Exactly. Just because people can’t imagine doing something extraordinary, doesn’t mean it’s crazy or dangerous. People do ultramarathons that run 36 hours with no sleep as well. Adaptation is the operative word here.