I'm involved in many support forums.

A few patterns I've noticed.

The people who have been mostly managing their conditions via diet without understanding whats happening. Basically they eat healthy, and it mostly works.

People who love food / don't want to cook healthy and refuse to acknowledge the possibility that's causing problems.

People who say they eat healthy but really don't. (Salad once a week) Or a variation, people who ate a salad, didn't get better and claim diets don't work).

The ones who are at deaths door and are finally desperate enough to try anything.

Actually following a strict diet like KETO / AIP. Paying close attention to trigger foods, etc. These ones often can reduce or eliminate medication.

Learning to be honest with yourself about food is one of the major challenges. Giving up various food addictions can be brutal.

I agree that on the surface, it sounds dreadful. The problem is that many doctors have found through experience that patient compliance with a daily pill is much better than with dietary changes. If a doctor wants to actually help a patient, the treatment that a patient will actually do becomes the most effective by default.

Having said that, I do think that doctors need to be aware of and make sure the alternatives are discussed with the patient. The paternal MD attitude of just tell the patient what they think the patient needs to hear should not be tolerated. If I ever get that vibe from a doc I move on and find someone who will respect me as a patient.

I think that happens because that is what most patients want. They don't want to give up pizza and alcohol. Give me a magic pill instead so I can do what I want.

Keto is not a simple diet change. It is very difficult to stick to and comes with a lot of prohibitions. Adherence is low and side effects do happen.

I suspect patients feel the same.