Getting off of medications

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I have been interacting with an attending who believes that patients can get off of their diabetes, cholesterol, and high blood pressure meds if they maintain a good diet. I have seen a few patients do this, but they eventually went back on them.

What do you think? I think it is an unrealistic expectation.

 

[Keona]

It depends on their underlying health conditions. If they have had a previous stroke or mi they need lifetime meds. If not then I think it is feasible for highly motivated patients.

 

[rokshana]

I have been interacting with an attending who believes that patients can get off of their diabetes, cholesterol, and high blood pressure meds if they maintain a good diet. I have seen a few patients do this, but they eventually went back on them.

What do you think? I think it is an unrealistic expectation.

Is it possible? Sure...but generally there has to be drastic changes and sometimes the damage is done and there is no going back but lifestyle changes can slow the progression...

 

[surgonc2017]

If they have bariatric surgery, sure.


Sent from my iPhone using SDN mobile

 

[Raryn]

I have been interacting with an attending who believes that patients can get off of their diabetes, cholesterol, and high blood pressure meds if they maintain a good diet. I have seen a few patients do this, but they eventually went back on them.

What do you think? I think it is an unrealistic expectation.

Depends on the patient.

400 lb patient on four antihypertensives and three diabetes medicines, two of which are extremely high dose insulin? Probably not going to happen without bariatric surgery. Even then, might not happen.

220 lb guy recently diagnosed with DM and HTN, doing well on his metformin and lisinopril, who seriously makes an effort, cuts out all the simple carbs, goes to the gym 3-4 days a week, and goes on to lose 30 lbs? Can probably get off his medications if he keeps up with the lifestyle changes.

Evidence is clear that losing just 5-10% of your body weight will impact your various metabolic parameters significantly. If they're only mildly deranged to start with, getting off of medications is entirely possible.

 

[grapefruit17]

I believe there were studies done on this, I read about it a while ago. Only a small portion of diabetics are able to consistently control their a1c through lifestyle modifications. I did a powerpoint on it, ill have to look and see...

The thing is, its a circle. Obesity-->diabetes-->depression/feeling down consistently with low self worth-->OSA (poor sleep, further exacerbating depression)-->fatigue on ADLs (leading to a decrease in self care). It all interconnects in my mind. I think initially people will be motivated and try hard. But then they'll be caught in the loop and just succumb to medication.

My current dementia pt with diabetes and uncontrolled a1c still regularly goes to KFC buffets and BK. He has dementia, but his mental capacity is intact enough to understand he's hurting himself.

 

[FrustratedFamDoc]

In all my newly diagnosed type 2 diabetics, I offer that this is a potentially curable illness with lifestyle changes, but the issue comes in that you're asking someone to do something absolutely and completely different that what they currently know. It's almost akin to asking a vegan to eat at a BBQ joint. In general, people don't really change and this goes for lots of things. There are several other barriers (knowledge, motivation, depression, just don't care, etc) but asking someone to completely change what they currently are is monumental.