This blog is an adaptation of Dr Westman’s video on ‘Do You Really Need That Medication?’ which we have included at the bottom of this article.
When you went to medical school, you were taught about different medications, what you would need to treat your patients. Did they ever teach you how to treat patients using lifestyle as opposed to medications?
Well, you have to realize that I went to medical school a few years ago, actually decades! But I’ve been at Duke University in a medical school pretty much ever since. After training, I went to Duke and then stayed here as a professor, so I followed what medical schools do. We got a lot of training in how the body works and how the body can go wrong in terms of heart disease and things like that. We had pharmacology classes, where we were taught how different drugs work (pharmacology being the science of drugs and how they work). And, in clinical practice, the training I received in internal medicine and even today in family medicine, we really get trained just about medication care, giving medications. So no, I have to say I really wasn’t taught lifestyle treatment within the training and apprenticeship that we do, residencies, and fellowships. It’s as if the medical educational process really focuses on medication care.
When you talk about medication care, it’s medications for the treatment of chronic medical problems, like diabetes, heart disease, lung disease, arthritis, heartburn, GI problems, irritable bowel syndrome, fatty liver – the doctors are just taught to use medications and I was that way, too. But I went out to get special training to learn something new.
I was very shocked to learn at various conferences that during a medical student’s entire medical degree, they may have had only one single lecture on nutrition, lasting no more than an hour. Knowing what you know, can you actually believe that this is the case?
Well, you know, it’s shocking, and when you think about, let’s say, running a car – we’re very careful about the fuel we put in our car, right? Can you imagine that a doctor hasn’t been taught anything about what’s put in the body? It is shocking, because nutrition, what we eat and drink, is probably the most important thing that has to do with human health, or (the health of) any animal for that matter.
When someone goes to a veterinarian, the veterinarian says, “Well, what are you feeding the animal?” I’m lucky if a patient tells me that another doctor has asked them about what they’re eating or drinking, or about their exercise. If you put all lifestyle aspects into one bucket, we’re talking about things that you can do that aren’t medications: we have nutrition, exercise, and stress management.
It’s a sad state in medical schools, including D.O. schools. What they teach is not nearly enough. It’s pretty harsh and sad. Now that I’ve learned more about it, talking to lots of academics, I’ve found that the medical profession divested itself of nutrition training back in the 1980s. It used to be that a medical student in the U.S. would learn about nutrition. In fact, one of my students on my rotation recently knew more about environmental issues about food than he knew about nutrition and food in the human body! Medical students and doctors are learning like the general public about nutrition from companies that want you to eat their products and about other sorts of promoters of certain ways of eating that really aren’t based in science and health, which I thought is what medical school should be teaching – what’s based on science and health. I’d like to see nutrition come back into medical education.
When you see somebody in your clinic, who follows the (ketogenic) diet to the letter, you actually de-prescribe medication on the very first day. It just shows you how powerful food is as medicine.
I think it was Hippocrates who said, “Food is thy medicine.” Ancient doctors knew this. It’s all they had. The idea that we would not even mention it in a clinical encounter with someone is just shocking.
I have to take diabetes medicine away on the first day to avoid low blood sugar, if patients are on lots of diabetes medicine. So, yes, I can take people off twelve medicines over time, when I’m treating diabetes, high blood pressure, but I want to look at this at an even earlier stage. If you’re on one medicine, maybe you could actually get off that one through a lifestyle change that would mean you don’t need that medicine. The most common two that are prescribed and make the most money for drug companies are anti-cholesterol and anti-heartburn medicines. Those are medicines I take away from people because they change their lifestyle.
My dream is that a doctor would give you a choice. “Here, we’ll give you an effective lifestyle change (we choose the keto lifestyle, because it’s an easy one to teach and follow), or, you can take medication. It’s up to you.” Most doctors don’t give you that choice! They say, “Well, here, your cholesterol is high, take this medicine”, or “Oh, you have heartburn, no problem, we’ll give you this medicine.” In fact, one of the heartburn medicines is in trouble now, because years later, it was found to potentially cause cancer.
Any drug you take has consequences that we don’t know about. I learned that from a professor of pharmacology, who said, “Show me a drug which is very specific and only does one thing… I would have to show you a drug we haven’t studied much!” Most drugs have effects on other parts of the body, not just the place that we’re using it for. For example, proton pump inhibitors for heartburn – there are proton pumps all over the body, not just in the stomach. And, in terms of cholesterol medicine, most people don’t know that you can lower cholesterol by changing your lifestyle. The defense that organizations and doctors will take is that “Yes, it’s in the guidelines to help someone change their lifestyle, but my patients never do it.” So there’s this defeatist attitude.
If you have a doctor who is prescribing you medicine, ask if there is a possibility that a lifestyle change might have the same effect. If they say no, then they don’t understand – they’re not giving you that choice. Realize, however, that they have only been taught about medications, so I can’t really fault the doctor down the street, who has never been taught this.
The beauty and wonder of the internet is that you can now learn from all sorts of different doctors about all sorts of ways of doing things. So, if you’ve been told that you need a heartburn medicine, a cholesterol medicine, or a diabetes medicine – that’s my bread and butter, fixing diabetes, reversing it, and taking people off medicine. But we can actually prevent the occurrence of diabetes, which is huge! Most doctors don’t understand that – they don’t give you the choice.
You want an effective lifestyle change, and fortunately, the keto lifestyle is an effective, safe one that has been studied for over 20 years.
You see a lot of people in your clinic. What are the most common medications that you are able to de-prescribe?
I think of this in a couple of ways. One is symptomatic treatment of something like heartburn, which might allow you to get better overnight. Once people are no longer eating carbs and I have instituted a lifestyle change for them, I tell them, “If you wake up in the morning and you don’t have heartburn, try it without the pill.” In as quick as three days the heartburn is gone, even in people who have had refractory heartburn on medications. (People who still had heartburn even though they were already taking medicine for it.) Medically, that’s not so serious – nobody is going to be dying of heartburn. But, to the individual it’s a big deal. You don’t want to be taking a pill for heartburn and suffering from doing that.
The other kind of dilemma we’re in, is that many of these medications are so strong and effective, that you no longer have the symptom. So, many patients don’t realize that while they’re taking the heartburn medicine and doing the keto diet, that they don’t need the medicine anymore. Similarly, with more serious medical issues, the medicines have become so strong, the symptoms go away, and yet you may still suffer the long-term consequences of taking the medicine to manage the disease, while there is an alternate way, namely, changing your lifestyle.
The other medicine I do something about on the first day, is diabetes medicine – the injectable insulins. If I don’t adjust this medicine on the first day, someone might get low blood sugar – a hypoglycemic event, which is dangerous. That’s where I’m cautious and tell people that if they’re on insulin or other diabetes medicine, they shouldn’t do this without medical supervision, because this is very powerful.
The third group of medicines is high blood pressure medicines. This is the little sleeper – even medical doctors don’t understand that lifestyle is what causes hypertension. They wouldn’t see that lifestyle can fix it, because they don’t work with effective lifestyle changes. There are so many people on hypertension medicines. The interesting thing here now is that these drugs have become so inexpensive, that it is no longer a costly thing for the medical system to treat all these people with high blood pressure, with medicines. It’s a conundrum! It’s too bad insulin and pills are so cheap, because then there’s no motivation for someone to actually try something different.
I really glow in the positive effects people feel when I take away the medicines that have side-effects. When someone has nausea or diarrhea due to a medicine, they feel so much better after I take that medicine away. The proof really is in the people I have followed for months to years, they come back to me and are following a healthier lifestyle and aren’t on medicine anymore. It’s not common to need medication if you’re following a healthy lifestyle, and I wish that doctors would at least take a nod, or look into this. If they don’t understand how to do it themselves, they should at least refer to someone who does, or actually look in a diet book! We have a new book out – End Your Carb Confusion – which has helped a lot of people. Ultimately, there are ways to get this information that does not require a doctor’s prescription and it does not require you to know this stuff at a rocket science level. There are great books that will teach you about a healthy lifestyle, where you won’t need those medications.
You have a presentation called ‘Two Pathways’, where you show how patients can either choose the medication path or the lifestyle path. How successful is the lifestyle path?
Depending on the disease and how many you have, eventually, it’s almost 100 percent effective. Medicines are used because you are leading a lifestyle that is not matched to your metabolism. It may take time, and of course it may take some education about what foods to have.
I guess I am an unusual doctor, because I talk about food! I talk about if you are satisfied with the foods you’re eating and if you have found recipes. Food really is more powerful than medication and I want to try to catch people before they even go on medicine; that’s where the huge potential is. You really don’t have to start going down that pathway. Once you’re on medicines like insulin, it traps you into a lifetime of diabetes, which is why doctors say, “I don’t think you’re going to get better.” That’s just because they’re not changing to a healthier lifestyle. You don’t have to be on medication. So, to answer your question, it’s almost 100 percent. But, people actually have to do it. The difficulty often lies in matching foods that you loved in the past with substitutes that you’re happy with and to introduce you to a new type of eating that is actually tasty and healthy.
What parting advice do you have?
What you eat and drink really matters. I wish the dean of the medical school would get up on day one in front of all these medical students who are going to be doctors, helping you with your health, and tell them that what you eat and drink matters.
Consider for a minute what you are eating and drinking – where it came from, if it is highly processed, if it’s addictive (can you actually stop eating it or does it tug at you?). Would you put dirty gas into your car? Absolutely not!
The importance of what we eat and drink is probably one of the most crucial lessons you can teach your children.