Healthy Changes means maybe stopping some medications | The Body of Evidence

Healthy Changes means maybe stopping some medications


 

Patients frequently ask me whether they will ever be able to stop their medications. Be it for their blood pressure, cholesterol or Type 2 diabetes, they always want to know whether, if they change their diet and start exercising, taking medications will no longer be necessary.

In truth, I've seen very few people manage to come off their medications, although there have been a few notable patients who drastically changed their lives and managed to normalize their cardiac risk factors. But, as a general rule, we tend to view conditions like diabetes as something that will require lifelong treatment.

That may change with the publication of the DiRECT study, a randomized trial from Scotland and England. Investigators recruited subjects with obesity and newly diagnosed Type 2 diabetes and randomized them to either usual care or a weight-loss program. The weight-loss program required a significant effort.

For the first three months, patients had their normal diet replaced completely and got only a low-energy formula that provided them with about 800 calories per day. (Most people eat over 2,000 calories per day.) After this initial phase, they had two to eight weeks of gradual food reintroduction, followed by monthly visits for weight-loss maintenance. They were also encouraged to take 15,000 steps a day, as measured by a step counter. All their blood pressure and diabetes medications were stopped at the beginning of the program and restarted only if necessary.

Despite the hardships of maintaining that program, at one year, the average weight loss was 10 kg (22 lbs.) in the intervention group, compared to 1 kg (2.2 lbs.) in the control group. Nearly a quarter of people in the intervention group were able to lose more than 15 kg, whereas no one in the control group managed that degree of weight loss. But most importantly, 46 per cent of the people in the intervention group were able to achieve a remission for their diabetes, compared to just 4 per cent in the control group.

The results are striking, though there is always the worry that the results will not persist long term. Many diet trials do well at first, but people regain the weight. During the initial calorie restriction, subjects lost on average 14.5 kg. But they regained 1 kg during the food reintroduction phase and another 1.9 kg during the weight maintenance phase. At one year, patients' weight seems stable, but we will have to see whether they can keep the weight off after four years of followup.

One wonders how easily people can comply with an intense low calorie liquid diet such as this. Symptoms like headache, dizziness, constipation and increased sensitivity to cold were common during the study. But the trial was run under what was termed "real-life" conditions, meaning that it could easily be implemented by local GPs with non-specialized staff delivering the medical care. Also, despite the hardship, 79 per cent of people were able to complete the diet protocol.

Time well tell how feasible and practical this lifestyle intervention truly is. But this study does make one thing clear. New Type 2 diabetes (diagnosed within the past six years) need not be a permanent condition. Substantial weight loss can reverse the insulin resistance that causes diabetes and allow patients to potentially stop their medications.

The holidays are a time for overindulgence and New Year's a time for resolutions that, unfortunately, tend to be short-lived. Lifestyle changes are not easy. Eating less and moving more are easier said than done.

But lifestyle changes are indeed possible, and there is good evidence to show that very achievable weight loss goals can result in substantial health benefits and potentially even reverse the onset of diabetes.

So my wish to you this holiday season is for a physically active and metabolically healthy 2018.