TravelerEastWest

Sounds correct. Going to a chain the person doing the measurements is a non professional. You need at least a trained optometrist and better yet an ophthalmologist who can check if you have undiagnosed diseases.

You correct. Most of the time I will be able too make it back to America and for the time when I can't I will simply have to pay for the procedure here. I can't get insurance here due to age and pre existing conditions - so the choice is move back to America or self Insure... I choose to stay here. I think the odds are that an expensive illness such as cancer won't happen overnight- I am not worried about heart disease. An accident is certainly possible...!

I agree with you that with my discount the room rate with nursing fees will be around 5 or 6,000 per day. The rooms are very comfortable though - smiling... Actually I don't mind a shared room at all and it might be better at times. But Thai public hospitals from what I have seen are not very good - can be very crowded with very poor service - sure there are exceptions some special private/public clinics etc... Actually i got a COVId booster at a ;are public hospital with a private wing it was very good service. Thank you for the insurance examples! seems like there still are no ,local Thai options where I pay the "wholesale" insurer price for the deductible like I used to do in America. In three years at 65 I will qualify for Medicare so that might be the best way to go for any serious cancer/heart attack type problems. Meanwhile I will eat well and exercise a lot. Thanks again for your help!

Does anyone know how to get a very high deductible insurance plan where I pay my deductible at the insurance company's lower rate (than the normal public rate)? I am 62 and have pre existing conditions... Thank you! Note I spoke to a Thai insurance broker in the past but was told that type of insurance does not exist in Thailand. Currently I have a Bangkok hospital plan where with their hospitals I get a discounted rate on their platinum plan. So let say I pay 50% of the room rate half is discounted and half I pay out of pocket. So sort of a middle path plan...

Agreed 100% for an extra charge to get great service is worth it...

"I don't mean to come down on True North or Goldhammer, but quite frankly, he is a chiropractor (just like Dr, Berg). I don't consider his credential to be suitable for me to consider him an authority on the metabolic sciences." Actually I think you may be thinking about someone else as Dr Goldhammer is both a chiropractor and an Osteopath; not just a chiropractor like Dr Berg - who from what I understand doesn't even have a current license as chiropractor. So very different. Osteopath go through almost the same training as MDs and can prescribe medicine - so again nothing even similar to Dr Berg. And Dr Goldhammer is not running a supplement business only a medical clinic like many doctors. Also Dr Goldhammer as I have mentioned has lots of real world experience in the field of extended water fasting more than most doctors of any type and he is very active in advancing the science in the field through clinical work - lab work is something different and not his focus. He is very active in his nonprofit foundation and they are building a collection of peer reviewed articles - again nothing similar to Dr Berg. I write the above as comparing him to Berg is shall we politely say not very kind... Also I have read many of your suggestions in the past and to date I have found nothing more on point to the issue of exercise and extended fasting than Dr Goldhammers's work. You seem very sincere and open minded so you may want to spend some more time reading his articles and watching his videos - just a thought.... feel free to ignore my suggestion if you have made up your mind...

An interview with Dr Carvalho where talks about how to look at studies and think about health. He seems calm, smart, trained in research and a good communicator - he does real research at USC. https://theproof.com/making-sense-of-nutrition-with-gil-carvalho-md/

My goals for fasting are varied but improved insulin resistance is probably the most important as I have had type 2 diabetes for a very long time. I went from being very sick with mega doses of insulin daily to only being moderately sick with much lower doses of insulin after doing 15 and 16 day fasts without electrolytes or other supplements. But it is difficult to say exactly what role extended water fasting played in my improvement as I also have been doing daily walks, weights and eating well. although I did see quick results after extended fasts. I think I will try a longer fast with the long shot of pancreas improvement. Again I am a N of 1 so nothing to be relied on but maybe something o add to the range of ideas that you rely on? I also like developing will power to not be attached to food but that is a bit off our topic. Losing visceral fat is also a good result of extended fasting. I still agree with about 80% of what you have written which is pretty good I think - smiling. We will have to agree to disagree on about 20% of what you say. I found someone on YouTube Dr Gil Carvalho who is well qualified (MD and Phd) calm and seems to be honest not sure, but you might like him and perhaps have already watched some of his videos.. https://www.youtube.com/hashtag/nutritionmadesimple Finally - I love exercise and really hope that in the future it is proven that exercise and extended fasting go together well thank you for all your ideas - and I am still in awe of your notebooks! You are very organized!

"Anyway, as usual, I have gotten carried away in my writing. Sorry for being so verbose, but I hope it has some meaning for you ????" I like your posts and was looking forward to reading this one! I agree with perhaps 80% of what you write. "Listen to proponents of one side vs the other side, and take action based on which one you believe in more.' I follow your second choice as I don't feel it is normally possible (99%+ of the time) to read and understand actual research unless you are trained in the field. The level of statistics that you need to understand is very high. As is the biochemistry. Verhoeven - unless I am mixing him up with someone else has little to no credentials and is not a good source for me He is not an MD or Phd and is only a student. The article link that you posted is interesting but he does not appear to be the main researcher. Dr Goldhammer and his team seem to be partially or mostly non profit and are not focused on sponsoring others. His team also has extensive real world experience in the field literally thousands of medically supervised long water fasts over many years and in his research exercise is not included as a safety measure. I trust that more likely than not he is correct. So far you have shown zero evidence to contradict this position, and I am very open to hearing about a doctor or researcher with equivalent experience who has had good measured results with extended water fasts and exercise... When you say exercise helps with autophagy I agree with you - but doing an extended water fast and exercise together have not been shown to be something good (at least I have not heard about it and you have not posted any facts to support this idea - you do not have extensive experience with extended water fasts (not intending to be rude but going with what you wrote: ("More importantly, I believe it because it has worked well for me in practice, where a sedentary approach to fasting was a disaster.") I am not sure how you can say that with your limited experience with extended water fasting exercise while doing an extended water fast it is a good idea. Perhaps a gentle walk or light yoga might be OK with an extended water fast - but maybe not. "it is only MY opinion because almost all of the well vetted scientific research I've seen supports that view, " Not sure what you mean so far as you have not posted any research showing that extended water fasts and exercise are a good idea. "There are no studies that empirically confirm that being sedentary while fasting is beneficial." Dr Goldhammer has written about his research and he uses a Dexa scanner to show visceral fat going away and very little muscle being used during long fasts with no exercise. This to me is very good evidence supporting the no exercise with extended water fasting theory. Now if many other doctors could do the same Dexa scans after an extended water fast this would be much better of course, but for now it seems taht more likely than not no exercise with extended water fasts is best for your health. Remember I am talking about long water fasts not short ones... Remember Dr Goldhammer is doing extended water fasts up to around 40 days which is very, very different from 7 to 10 day water fasts... Thank you for sharing an example of your notebooks - you clearly are well organized - my notes are very unorganized as in using scarps of paper and piling them up... not a good system at all!

Again thank you for your thoughtful post and I respect your thoughts and observations! But I don't see quite what you do: 1) As you mention in the end of your post you have not read direct studies or heard of them by experienced researchers that support the idea that exercise while doing an extended fast is a good idea. This matches my research. 2) I have watched a number of Verhoeven's videos and he does have a calm voice and some nice graphics and interesting information but he is not in the league of experienced and well educated researchers - also I don't like his attitude at times... (but that is a subjective comment). He is basically an exercise trainer who is now a Phd student - he has not graduated nor does he run his own research studies - so he is not authority to be relied on. 3) We have a different view of what an extended fast is - seven days is a fairly short fast... so your actual experience is quite limited (mine is also fairly limited I don't count 15 or 16 days as a long fast - normally 21 days is where you start to hear about great results) 4) "understanding the metabolic processes that underlie both fasting and exercise, and people like Attia and Verhoeven provide the link between very difficult to understand research and the truth..." as mentioned above Verhoeven is not qualified to rely on as a resource at least not in my opinion and I am not a scientist or MD so my opinion is not that valuable... But I have those I know with the education and experience to know what they are talking about who agree with my thought about who is qualified. "Regarding Goldhammer, I'm sure their clinic has helped many people but the research that comes from them is really as a sponsor of others' research, and that leads me to believe it may be a bit biased. What's more, the type of research papers that result are more related to clinical statistics as opposed to fundamental biochemistry and physiology." I was not aware that they are really a sponsor of other's research I thought they are doing research both on their own and in collaboration with others. Can you show proof of your comment please? To some extent everyone is biased which is why they are publishing articles so that others can comment on their results. Not sure why clinical statistics of real life results would not be really good information as opposed to only theory? Can you explain why you say that please? 5) Dr Attia is clearly very smart and very interesting and a man who is not afraid to reverse his option I respect him. But I have not heard him comment in his videos about the advantage of long fasts and exercising so unless I missed something - always very possible - lets assume he doesn't agree with extended fasting and exercise as I don't want to speak for him. 6) Dr Cahill clearly did some very important research and is indeed someone to respect. I have read his explanation of what happens to the body during the fasting process and again I may have missed it but I don't see anywhere - where he suggests extended fasts should include exercising. If I missed this please let me know. 7) "instead of having to rely on others opinions." Here we will have to agree to disagree I have studied statistics in graduate school but only up to a masters degree not a Phd and I clearly don't have the knowledge or experience to judge the quality of scientific research papers. You must be much smarter than I am and I accept that (note not being sarcastic). A month ago I was talking on the phone with William a retired doctor about a conference he had gone to with various research appears being presented. One paper in particular he remembered as the static were simply wrong - my point being statistics are very difficult to understand even with a great deal of education and experience... ???? "those three electrolytes are seriously depleted in in a 72 hour fast." I have not heard that this is typically a problem with short three day fasts - any information to back that up? During long water only fasts normally it is not a problem but it could be. which is why experienced researchers and doctors such as Dr Longo and Dr Goldhammer and others always suggest Doctor supervised long fasts. i am in Thailand so i can't go easily to somewhere like True North where they supervise your fast. So instead I read very carefully and slowly increase my fast lengths and if I have any problems I will stop. 9) Sounds like you have a good refeeding program. For a longer fast - two weeks or longer I would probably follow the advice of having light fruit to break your fast. Thanks again for your thoughtful response - we agree in many things - but not everything - which is OK...

I enjoyed reading your response and yes you remembered correctly the clinic in Germany. I may be wrong but I don't think they practice true water fasts. They are closer to what Dr Walter Longo suggests with his fasting mimicking diet - not exactly but similar it seems. So let's focus on True North for the moment - they are at least partially a non profit organization maybe entirely I am not sure, but certainly not a big business and they don't promote supplements etc. as many others due. Link to the non profit foundation for their research: https://www.truenorthhealthfoundation.org/about The reason they are good to discuss is that they do have real research in this area as in published studies. High blood pressure and fasting is something they have done well with. Some sraticles on other areas such as limited success with cancer. They do not state that water fasting cures everything just the opposite. I would say that Dr Goldhammer has a very good understanding of the subject and very important is the fact that he has extensive experience with tens of thousands of fasts which most other researchers do not have. Do you know of any current researchers with similar levels of experience with extended fasting as at True North? As for Cahill he is very famous and wrote about a number of topics including what happens when the body is fasting but seeing as he died about ten years ago I wouldn't say his research is the latest... Also I did not read his articles and papers I read a summary as I am not an MD or scientist and I don't have a high level understanding of biochemistry or statistics - which I would say is essential. Dr Jason Fung has education and experience on his side but I don't agree with all his conclusions - but he is very interesting and as you say there are elements of truth... As for Berg he seems to be way off target at times... Ekberg is better and seems more honest but still he is not always correct. I have watched a number of Dr Attia's videos and he doesn't seem to have experience with long water fasts - but I may easily have missed this please let me know if you heard him say he does long water fasts. Note seven days is not a long fast... And I have limited trust with anyone who promotes products... He may a good man but money subtly changes what we think... I have read a number of books (intended for normal non scientists) and watched many videos over the last few years and had discussions with scientists which I accidentally met. So my opinion is not professional at all but reasonable for a non professional as I do have some experience with medium length water only fasts - 16 and 17 days. 5 to 7 day fasts are not that long and not so difficult and do not produce much results - at least not for me. I have heard that around 21 days is when you really start to get results. I may go for 21 days as an experiment next time. Carefully refeeding after long fasts is very, very important. Electrolyte supplementation is an interesting concept and some find it very useful. I don't get headaches etc while doing long fasts so I don't use them. I am only tired. So in summary I have not seen any serious research at all stating that exercise while doing a long water fast is a good idea. If you would be so kind as to let me know if you have seen any that would be great. One documentary that I saw on YouTube (not a serious work) did hint that in Russia they do exercise on a water fast... Again thank you very much for your post!

I can't get insurance do to pre existing conditions but if I could find a high deductible plan taht accepted me and gave me their wholesale rates for my deductible taht would be good. As an example in America I had a plan with around a $5,000 decidable or something like that. My wife had our daughter (in America) and above the deductable everything was paid for in a very nice hospital. For the first $5,000 we ended up paying a reduced rate which was the same rate that our insurer paid in effect a wholesale rate... Around 15 years ago I spoke with an insurance broker in Bangkok who told me taht insurance plans where customers paid a wholesale rate were not available in Thailand. Maybe they are now?

Thank you for suggesting a very interesting point of view suggesting that exercise during extended fasting is good for preserving lean body mass if I understand you correctly? I am familiar with Dr Attia but other doctors don't agree with everything he says. And it has certainly not been proven that exercise during long fasts are a good idea. Actually not much of anything has been proven about long water fasts lots more research is needed. Does Dr Logo feel that exercise is a good idea? Dr Goldhammer and his team at True North (includes MDs) have done recent research and have fasted in a clinical setting literally thousands of people over many years with minimal problems and zero deaths. They say clearly that rest is very important for healing and exercise is while doing extended water fasts is a bad idea - again they have lots of documented experience. In Germany another established clinic has done research but they don't seem to do actual water fasts...Not sure what other medical clinic has done research with large numbers of patients? I have water fasted for up to 16 days and for me (N of 1...) normal exercise is simply not possible - for me normal exercise is an hour a day of hill walking and lots of light weights. So I don't know maybe it would be good for me to exercise I have an open mind and would love to read more... I would love to see studies that back up your point. Please send me a message if you don't want to post on the forum.

Agreed that the labor departments are reasonably friendly. I had a labor department staff person years ago tell me that the process was easy and encouraged me to try myself.

You are not wrong when you say more study is needed. But step by step evidence is coming out in support of the benefits hits of fasting. Dr Walter Longo has not won the Noble prize but people say he is in the running... howeever he is is a very serious scientist and he has done studies in animals and in humans supporting the benefits of short fasts and fasting mimicking diets. https://www.valterlongo.com/fasting-mimicking-program-and-longevity/ Dr Alan Goldhammer is not as focused about research perhaps but at his True North Center in California they have been doing long water fasts for many years without problems and lost of success. They are working on studies showing fasting lowers blood pressure better than medicine and other studies. Note he is not an MD but works with Ads and those with Phds https://www.healthpromoting.com/water-fasting/fasting-research So is there lots of proof about the benefits of water fasting our there? Not yet - but recently more and more research is being done. Meanwhile I have heard it said that the effects of water fasting are often possible with lots of exercise and a very healthy lifestyle but fasting is deeper and faster... Again the benefits of extended water fasting are not proven but seems likely...

Completely agree with your comments about Berg and Ekberg.

I use Accucheck Guide and it is close to the readings when my doctor takes blood sample but not perfect.... If you check ratings by Consumer Reports they will tell which meters are the best - again not perfect. Interesting article: https://diatribe.org/are-blood-glucose-meters-accurate-new-data-18-meters

Being in English is helpful but still lots of forms and waiting in line - I wouldn't do it unless you have lots of extra time and don't mind this sort of paperwork...

If it's easy to get to the miinistry office at Din Daeng, there's a 'complaints' office on the ground floor. Can't miss it, big signage. From above "...what documentation is required from the Company, " The 'documents' required are the basic every day start up and ongoing documents. Don't let anybody tell you that the documents are very complex and you need a lawyer to do this. Totally not true. You don't need a lawyer agreed. But the amount of paperwork takes time and you want all to go smoothly - have local CPA do it for you (not expensive at all) has worked well for me especially during COVID times . They came to my office and did everything they then filed everything and saved me a trip to the labor department and waiting incline very much worth their fee, If you don't mind trips to the local labor department and enjoy doing paperwork and are on a tight budget then do it yourself - as I recall the forms were in Thai...

You are correct - I have not been to CM Ram in a long time... and have no plans to return - my experience there was not a very good one. With the worst part being the long waits even with an appointment. It is a given that good doctors and nurses are important. The doctors and nurses were OK at that time; I saw an older man who I believe was a medical school teacher. Good to hear that Dr Vipawan is caring! All the doctors at Bangkok hospital have been good listeners. But I have not yet found a single endocrinologist in Chiang Mai who has a focus on diet/nutrition and exercise for treating type 2 diabetes. If you told me that Dr Vipawan was a diabetes specialist with a focus on diet and exercise and drugs only as a last resort type of doctor I would be very interested in seeing her even if CM Ram still had long waits in the Endocrinology department. My experience with diabetes over many years has been taht diet and exercise are very important but many doctors seem to know very little about nutrition... By the way has CM Ram updated their file system to be computerized? It used to be folders that were retrieved before an appointment... If they have improved their system then probably the wait times would drop quite a bit. PS Do you have a Rottweiler? They are beautiful dogs and a friend told me that they are great with kids. I have two German Shepards and which are great with my kids and protect my farm - outside Chiang Mai so guard dogs are great to have...

Local labor departments can be different - don't fool around by cheating - not worth it. You can actually hire two staff and pay them their salaries.

I have done this with a bit of help - the paperwork is not hard but best left to the pros until you have gone through it at least once. Depending on your location you can normally get a two year permit and yes they may come out to visit you. although not always. So have your office with company name put up. Only two employees needed since you have a Thai wife.

I don't have many Phalaenopsis (Butterfly) orchids ar home and they have many at the hospital - I enjoy looking at them. Pianos don't mean that much to me but for others they probably do mean something. Doctors are important and sometimes nurses are even more important. Also good cashiers and pharmacists are important. I also like it when I have to go to a number of different clinics they have customer service staff to make sure everything goes smoothly. Clean bathrooms at a clinic and hospital are also important. As is the newest equipment and convenient parking and so on... I am happy to pay a bit extra for all the above. I understand that not everyone feels the same. Some people probably want a good doctor and don't care about the environment... I respect that but not me. Sometimes I feel quite stressed at the hospital and the nice environment calms me down. As point of reference I am also willing to pay extra for nice restaurants and hotels although theses days I don't travel at all and very rarely eat outside. I prefer home cooking!

In regards to your only one area comment - I am sorry to say it has not been only one area - I wish that you were correct! Yes, friends often do share the same point of view - very good point - but in this case no-one that I know likes to wait for long periods of time not just friends... But no doubt there are some people who will completely agree with you... Good news that CM Ram has improved their parking! I hope all patients can easily walk to the hospital in less than a minute not just a few. Good to hear that you don't wait long - maybe they have made an effort to update and improve - which is great. Note on rare occasions I have to wait at Bangkok hospital also this is when the doctor is called away for an emergency or urgent care, The extra cost at Bangkok Hospital is so small that I don't pay any attention to it. And as I clearly mentioned if you factor in time savings Bangkok hospital is much cheaper - at least for those of us who are still working and have children. I completely agree with you that it is good to go where you get the care that you need - and when I said being comfortable I meant that. As for being a Cost accountant funny that you should mention that as while I am not a cost accountant, nor did I say I was - I did enjoy cost accounting and still do. It is funny because most accountants did not have much of an interest in the field. Instead I was a tax accountant - which is not considered fun by most but I find it very interesting like playing chess... In summary you seem very happy where you are getting your medical care and this is great! I was not happy at CM Ram and it felt like a breath of fresh air to visit the then new Bangkok hospital. Doctors that did not make you wait, all new equipment and easy parking. I hope that both of us dont need to visit either hospital too much in the near future! All the best!

Actually I am an accountant by training so I am very good at costs. I have had diabetes for more than 30 years so I have had (sadly) lots of experience with the costs of doctors and hospitals. I have a number of friends who have used both hospitals - no one that I know would disagree with my opinion about costs. What part of my post do you disagree with? 1) Parking? Unless they have recently built a large parking area walking distance to the hospital then they have challenges as I stated. At Bangkok hospital you simply park in the back and have a one minute walk at most. 2) Wait times for appointments? If your CM Ram appointments are on time with no extra waits - that is really great and I am seriously happy for you! But my experience has been waits - even with appointments - it seems like an appointment means they have your files on hand but it is still first come first served...Also they must have computerized by now - in the past retrieved paper files! 3) I also said that CM Ram has good doctors and nurses - do you disagree? Also I have observed that many doctors, specialists especially serve more than one hospital. Do you agree? 4) Atmosphere - this could be subjective but Bangkok hospital is new and well decorated with beautiful orchids everywhere. Plus a piano etc. Maybe CM Ram is now as beautiful - not sure as I have not been there for a while. 5) Having a good doctor for a long time - this would be probably the only reason I would go to CM Ram. Maybe hey could have a certain specialty that only they have in CM another good reason... 6) As for fees I have compared actual fees for doctors and they are similar - with Bangkok hospital being a bit more expensive but for me it is much cheaper when you factor in time saved. Maybe this is what you meant when you mentioned - opinions - if so you are 100% correct! In the end it is good to go where you are comfortable and if you prefer CM Ram you that is good.