Best Meds for a Holistic Health Plan

I feel compelled to allay my patients’ concerns that I am going to prescribe them a bunch of pills. “I am by no means a med pusher,” I share early in the encounter. I often detect a sense of disarmament and a sigh of relief.  

Most people do not want to take medicine. Me neither—I get it. We have been conditioned to believe that medication is used to treat disease. Being labeled with a disease and put on medication makes us feel unhealthy. Medication means problem, deficit, not whole. We feel less than, inadequate, and disempowered. These days, we (understandably) believe that all physicians do is prescribe and tinker with medications. It is no wonder those who want to avoid medication also would generally prefer to avoid the doctor’s office altogether. 

The majority of the conditions that afflict our health these days can be prevented, and even treated with lifestyle behavior changes such as losing weight, reducing the salt in your diet, avoiding excess alcohol, stopping smoking, and my personal favorite—being physically active. These tenets of Lifestyle Medicine, while seemingly simple and perhaps unglamorous, are truly the best medicines we have. After years of training in the traditional health care system and exploring the world of biohacking, I am certain that we grossly overuse (and borderline abuse) both prescription medications and supplements.

That said, there are certain prescription medications—yes, pills—that are health supporting, and perhaps even enhancing. I’m referring to medications that (when combined with healthy lifestyle changes, of course) confer a health protecting and performance enhancing benefit. Medications with such a robust evidence base for risk reduction that it would be imprudent to shun them. Medications that really must be considered as part of a comprehensive health plan for vitality and longevity.

As a physician, it is my responsibility to help people access a tailored therapeutic strategy to help improve their day to day performance, reduce the risk of chronic disease, and improve their odds of enjoying a long and robust life. Medications can be a core component of this strategy when:

1)    The medication has health promoting effects. In pharmacology, “pleiotropy” refers to all of a drug's actions other than those for which the agent was specifically developed. The term is often used to describe the additional benefits of a drug that extend beyond its original indication. For example, certain medications have widespread anti-inflammatory and antioxidant properties, which keep our bodily processes and cellular machinery operating more efficiently.

2)    The medication serves as therapeutic bridge for risk reduction. Consider a patient with high blood pressure despite dedicated lifestyle changes. Perhaps the patient could (and will) may achieve and sustained a healthier blood pressure by reducing salt intake, losing weight, and improving stress management. Right on! But while the patient is making those changes, they should also be on anti-hypertensive medications given the deleterious health risks of uncontrolled high blood pressure. Perhaps they will be able to come off of the medication at some point in the future, but until then, let’s use the proper medication for risk reduction.

3)    The medication provides necessary symptom relief. We should be focusing our energy on addressing the root cause of “dis-ease.” And modern medicine, due to a variety of misaligned incentives, is too quick to slap on a medication as a band aid for symptom relief. That said, the targeted and ideally limited use of medication for symptom relief can sometimes facilitate faster healing. Consider, for example, NSAIDs to help a patient with a musculoskeletal injury participate in physical therapy and light movement. Or an antidepressant to help a patient with depression and anxiety engage in psychotherapy.

Medications, if used appropriately and tailored to a patient’s unique physiology psychology, can play an important role in a holistic health plan.

In this series of posts, I will share some of the prescription medications that I keep on hand in my formulary. And then in a follow up series, we will tackle supplements and nutraceuticals.

Let’s start with a personal favorite: metformin.