Ah the holidays. A time for friends and relatives to get together to share memories, food, and (if you have a family like mine) find out which of your relative(s) has/have been buying into the latest conspiracy theory or is seeing a nautropathic doctor. This is why SkepticRD recommends taking a walk after dinner or having your favorite low calorie alcoholic beverage handy (to be consumed in moderation of course). For those relatives who are following a new diet, or who are touting their latest supplement as a miracle drug, one of the reasons they often give is "I just don't like to take pills." Sometimes if I have had more than my moderate share of dry red wine I will ask "Why?" Usually the answer is a blank stare or a rant about Big Pharma. Any evidence given? Not often.
Now, I will be the first to admit there are plenty of chronic health conditions, including my specialty of diabetes, that can be controlled with lifestyle changes, and there is even good scientific evidence to back it up. I will also admit that there are plenty of people who want to try to rely on taking medications instead of changing their lifestyle for a variety of reasons (lack of education, etc) because I see people like that every single day. I also see plenty of other people who are spending lots of money on herbal products that aren't working (wait, aren't those pills), and people who are in terrible pain or otherwise miserable because "I just don't like taking pills." So when is it a good idea to actually take medication?
1) First of all, if you have an acute (i.e. short term) infectious process going on, such as strep throat, a urinary tract infection, etc, that is caused by bacteria, fungus, and/or certain parasites. How do you know you have a bacterial infection as oppossed to a viral infection (like the common cold)? By going to see your physician and getting tested, that's how. And if you do get prescribed a course of anti-biotics, you must take the full course or your infection can come back much worse. Sure, there are other things you might do to prevent yourself from becoming ill again in the future, but right now you need to clear up what you have.
2) If you are in pain and unable to carry out your daily functions and/or the pain is hindering you from getting better. For example, someone who recently had surgery might be in so much pain that they feel nauseated and don't want to eat. Because they are not eating properly they in turn feel weak and can't get out of bed, let alone do any therapeutic exercises, and they will be more likely to have trouble healing that surgical wound because of poor nutrition. If they take the right amount of pain medication, however, they may be more likely to keep up good nutrition and heal faster. Of course this can be taken to an extreme, like when people take a bunch of cold medicine so they can come to work and then infect the whole office, or when someone takes enough pain medicine and continues walking on a broken ankle, but for those of you who do take something to help you feel better and get better, the evidence is skewed in your direction. I also have plenty of people say to me (and on the internet), with the requisite smarmy attitude, "Well, I don't take anything, I just think about what I did to get myself sick." Well, of course we should all do that! If you haven't been washing your hands before you eat and you got a cold, then start washing your hands! But you might also need to take something so that you sleep instead of laying awake all night so you can breathe.
3) When the condition you have is life threatening. If someone is having a heart attack I am not going to stand by and tell them to eat more vegetables and get rid of the white bread. I am going to dial 911, perform CPR, help them get admitted, and hopefully give them the best that medical science has to offer. Once they are going to live and are stable, then we can start talking about lifestyle changes. Sometimes, depending on the condition, a lifetime medication change must be instituted. For example, Boyfriend of SkepticRD has Type 1 Diabetes (meaning his pancreas makes no insulin at all), and he needs to inject insulin up to four times per day in order to live. Of course as long as he watches his carbohydrate intake he requires less of it, but he still needs take medicine to live.
4) When the lifestyle changes cannot be implemented overnight but you need to get some function now. When my depression was at its worst, I could barely get out of bed, let alone exercise or cook myself healthy food. If I was ever going to return to some semblance of normalcy I knew I had to take something. Once I started taking medicine and felt better I was able to start returning to the gym and cooking much healthier meals, and keep better track of how what and when I was eating was affecting me.
5) When the lifestyle changes just can't take care of the problem alone. Sometimes by the time a person with Type 2 diabetes realizes they can actually eat better and lose weight they have already been walking around with out of control blood glucose levels for years and the cells in their pancreas that make insulin have begun to die off. They may be able to reduce their medication and/or insulin injections but they may still have to take something to keep their blood glucose levels under control. Some parents of children with Attention Defict Hyperactivity Disorder (ADHD) have tried every single dietary measure (those with or without evidence) known to humankind and still did not find focus until a medication regimen was implemented.
Some other tips for finding the right balance between lifestyle and medication so it favors you.
1) Before assuming that your physician really is in the hand of Big Pharma, stop and consider that maybe, just maybe this person actually does have your best interests at heart and is trying to help you get better. If the person doesn't want to listen to your questions or point you to someone who can address them, maybe you do need to find a new physician, but don't make assumptions merely on the basis of them recommending a medication.
2) Ask if you can have a period of reprieve to work on lifestyle changes if you haven't yet done anything. Usually if your blood glucose levels, or your blood pressure, or your weight, etc has not made a significant improvement after two weeks of lifestyle changes, you might need some outside help. It might still be temporary, but you will need to get better.
3) When your doctor prescribes something, see if they can give you an idea of what the medication is supposed to do and any common side effects. Pharmacists can also help you answer those type of questions, and doing research on an evidence-based website can help you as well. They can also tell you if there are any alternatives if you are not happy with the side effects. They can also give you tips on how to alleviate side effects, some of which are as simple as taking certain medications with food.
4) If you have side effects that are expected but unbearable, please let your doctor know so an alternative can be found or you can re-evaluate the need for the medication.
5) If you have side effects that are not expected, especially if it involves fever, chest pain, and/or shortness of breath contact your physician right away or go to an urgent care center.
6) If you think you are ready to reduce your dose of medication or stop it because you have a new and improved lifestyle, tell your physician what you are doing so you can taper off safely and/or set up a time for follow up. A good physician or other health care provider will be happy that you are truly healthy.
7) Be very careful about how deal with the lifestyles of other people. If someone eats as healthy as they are going to eat, and exercises how much they are going to exercise, and they still have to take an antidepressant, and they are content with their life, then they probably want to be left alone. You can still share what worked for you, but don't try to impose it on anyone else. (In other words, don't be "that guy" that destroys relationships by being arrogant and assuming what works for you works for everyone else). Oh, and you might want to stop giving advice to people whose condition you know nothing about unless they asked for your advice or gave them permission. Not that I ever have this trouble. No.
Take home message--sometimes you just have to take medication, but you can make it an informed choice.