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Doctor’s advice on medications

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Doctor’s advice on medications

If you are taking any medication for lifestyle diseases, ask yourself: why am I taking this medication for the rest of my life? Doctors often prescribe medications quickly because that is what they are taught in medical schools. Once you are on medication for a lifestyle disease, you become a lifelong patient. This means you need to visit the doctor every time you need a refill. In India, many patients also expect a prescription; if a doctor doesn’t prescribe medication, they feel cheated. Getting people off medications is not common practice, as it is not beneficial for doctors or pharmaceutical companies. Here are some observations:

1. Symptom focus:

Doctors focus on symptoms and aim to reduce them to normal levels. They often do not understand or explain the true cause of the problem. Usually, the blame is placed on the patient for eating too much and not exercising enough.

The same is also true of pharmaceutical companies whose focus in developing drugs is on reducing symptoms. For example if a drug can lower your blood sugar without increasing insulin resistance (which is the real cause of diabetes), it gets approved. Another example is the Blood Pressure medications which only lower the BP without reducing atherosclerosis (the real cause of high BP).

2. Prescription practices:

Doctors prescribe medication because that is what they learn at medical schools and what is expected under their medical license.

3. Lack of nutrition knowledge:

Doctors often do not discuss nutrition because it is not a subject taught in medical schools. Time constraints also play a role, as doctors need to see many patients.

4. Medical standards of care:

There are well defined standards of care that must be followed by all doctors to maintain a medical license. Not adhering to them can lead to lawsuits, especially in the US. Different specialties have their own governing bodies, such as the American Diabetes Association (ADA) for diabetes.

Sometimes same diseases can be treated by different specialist which create confusion as they are governed by different standards. Such is the case with members of American Institute of Clinical Endocrinologists who also treat diabetic patients.

5. Interests of governing bodies:

Governing bodies for various medical cal specialties often look after the interests of their members. They quickly adopt guidelines that lower medication thresholds but are slow to revise them upwards when new research suggests otherwise. This can lead to conflicting guidelines, as seen with diabetes management. In 1996 the cutoff for fasting glucose level was lowered from 140 to 126 for diabetes patients. It was quickly adopted as it meant more patients and more drug sales. But in 2018, when ACP lowered it to HbA1C levels of up-to 8.0, they did not follow and stuck to their own conflicting standards of 7.0 by ADA and 6.5 by AACE.

It is human nature; once you get used to higher income levels, no body wants to go back to lower income levels. There is a Hindi couplet that talked about it over 400 years ago:

बढ़त-बढ़त सम्पति-सलिलु, मन-सरोजु बढ़ि जाइ।

घटत-घटत फिरि न घटै, बरु समूल कुम्हिलाइ॥

“Badhat badhat sampati salil, man saroj badh jai,

Ghatat ghatat, puni na ghate, varu samul kumbhlaye.”


“As one’s wealth increases, his desires also increase, just like a lotus flower in a pond, which rises when water level rises. When water level goes down, the lotus flower is unable to adjust and it perishes.”

6. Chronic condition beliefs;

When symptoms reduce, doctors usually advise against stopping medications because they believe, as they are taught in the medical school, that the chronic conditions are incurable, and symptoms are low only because of the medications.

As we discuss various diseases and medications in future blogs, you will face these challenges. My health group members often ask about reducing medications. I stay clear from that discussion and it is a discussion between you and your doctor. However when you do have that discussion, be prepared. The goal of this blog is to empower readers to take charge of their health and reduce chronic medications by adopting a plant-based whole food (PBWF) diet and active, intermittent fasting based lifestyle.

How and when to stop medications?

Once you correct your diet to PBWF diet and incorporate regular walking and early dinners, you will see improvements in your energy levels and sleep quality. You should monitor markers like blood pressure and blood sugar at home. When these markers drop below the latest thresholds, consult your physician. They may advise reducing the dose. If your doctor is not aware of the latest guidelines (like JNC-8 for BP and ACP2018 for diabetes), bring up the topic and explain your dietary and lifestyle changes.

I am not a doctor and do not advise on medications. This decision is between you and your doctor. My goal is to empower you to make informed decisions. What I coach, in terms of diet and lifestyle, will improve your health and markers like BP, blood sugar, and cholesterol. As these markers improve, share them with your doctor and discuss reducing or stopping medications. Some doctors believe medications for lifestyle diseases should never be stopped and continued for life. If you encounter this, consider a second opinion.

A leading proponent of Plant Based Whole Food movement, Dr. John McDougall, in his 10-day live-in program in Santa Rosa, California, asked all his patients to stop medications on day one. This was because changing to a PBWF diet rapidly improves markers, and continuing medication can lead to problems like hypoglycemia in diabetic patients. Diabetic patients, in particular, need to reduce insulin and medications in consultation with their doctors immediately.

Recent research shows that aggressively controlling symptoms can harm overall health, even if it controls a specific disease marker. This has led to debates and revisions of aggressive medication guidelines, which not all doctors are aware of. This subject was covered extensively in my blog on common myths under “Better Safe Than Sorry.”

I am strictly against stopping medications before making dietary and lifestyle changes. Always ensure dietary changes precede medication reduction. The pace at which medications should be reduced depends on your compliance with guidelines and the severity and history of your illness. Some members reduce their medication by half every month, while others do so more or less aggressively. If revised guidelines suggest you should never have been on medication, your doctor may agree to stop it immediately. For example, revised BP guidelines are 140/90 for people under age 60 and 150/90 for those over 60. The revised diabetic guideline issued by ACP in 2018 is an HbA1C of 8.0 or less. Please consult your physician before making these changes.

To read this article on Times of India, click here.

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