What medications are often stopped when eating a low carb diet?
As a pharmacist in Ontario, my favorite part of helping people to adopt a low carb lifestyle is assisting them in stopping their medications. For 20 years I did the opposite- I handed out one new medication after another, knowing that often the problem was not actually being fixed. Being able to do the opposite is much more satisfying. Here’s a rundown of which meds are most often stopped and why this is good for your health.
1- Meds for gastroesophageal reflux disease (basically a fancy name for heart burn.)
This includes what we call PPI’s- proton pump inhibitors- such as Nexxium, Losec (or Prilosec in the USA), and Pariet and H-2 blockers such as Zantac and Pepcid. Both of these family of meds decrease the amount of stomach acid produced. Low carb clinicians find that the majority of their patients don’t need these medications after they have eaten low carb for a while. This is great because long term side effects are starting to be observed in people on PPI’s. The research on this is not great and the increase in risk is not large but it makes sense that our bodies were designed to operate with a certain amount of acid in the stomach and that altering it may have unwanted effects. One of these is a slightly higher risk of infection, because stomach acid is part of the body’s defense against microbes. There is also decreased absorption of nutrients that need an acidic environment for absorption such as calcium, magnesium and vitamin B12. This can lead to conditions such as anemia and osteoporosis (weak bones).
2- Meds for cholesterol
Despite what many people think about a keto diet‘s effect on cholesterol, it is not uncommon for people to stop their cholesterol meds while eating low carb. This is great for a couple of reason. First of all, the most commonly used cholesterol meds, called “statins”, deplete the body of something called co-enzyme Q10. Lower Co-Q10 levels are associated with worsening heart failure. The most common side effect of “statins” is muscle pain. This can range from mild pain, to severe muscle destruction that can be life threatening. A lot of health care providers believe that the mild muscle pain is benign, however a small study done of statin users with mild pain showed more than 50% of those with muscle pain while on statins had actual muscle damage, even after the drugs were stopped.
3- Meds for blood pressure
The need for blood pressure medication commonly decreases as people begin to adopt a low carb lifestyle. This could be simply due to weight loss, as this has been shown to decrease blood pressure. The more likely explanation involves insulin, however. Insulin increases blood pressure by several mechanisms. As carbohydrate intake drops, insulin drops, and with it blood pressure. This is good news because, although blood pressure meds don’t have a lot of scary side effects like the other medications listed here, in my experience, there is a steady and predictable increase in the number of blood pressure medications that people need as they get older, if they don’t manage to reverse the problem with diet and weight loss.
4- Pain medication
From fibromyalgia to arthritis to chronic headaches, people who adopt a low carb diet report an improvement in pain and inflammation. This naturally leads to a reduction in the need for medication. Many of the medications used for fibromyalgia can lead to neurological side effects as well as weight gain, and they are not terribly effective. Non-steroidal anti-inflammatory drugs, although often effective for pain, are associated with stomach problems from mild pain to severe stomach bleeding. The longer they are taken, the greater the risk for more serious problems, so it is definitely of benefit for people to be able to stop these medications. Another class of pain medication that people are happy to come off of is of course narcotic pain killers. These are not only addictive, they have side effects such as constipation and drowsiness that can interfere with quality of life.
5- Meds for blood sugar
Medication for diabetes are the most obvious drugs that people eating low carb get to stop. Insulin is one of the first drugs to go and people love this because nobody enjoys injecting themselves daily. Many of the other medications for diabetes work by stimulating an increase in insulin release in the body. The problem with this is that one of the effects of insulin in the body is to stimulate weight gain. In fact if you inject insulin into a healthy individual, they will gain fat. (This was done in an experiment to some unfortunate humans.) So stopping insulin and insulin stimulating drugs when appropriate on a low carb diet, often has the happy side effect of weight loss. There is one family of diabetes medications that does not cause weight gain, because the medications work by forcing your body to lose a lot of sugar through your urine. Sounds great right? Except that the body is not used to having so much sugar in the urine, and so infections which are brought on by high sugar are a common side effect. The most common of these are urinary tract infections and yeast infections but there have also been rare cases of gangrene of the genitals, which in some cases was fatal. This is a tragic situation when the same benefit can be seen by simply not ingesting the carbs that these drugs are eliminating from the body.
One medication that low carb practitioners are not in rush to get rid of is metformin, a medication used for diabetes and pre-diabetes. People are excited to get off of all of their medications when they start a low carb journey, however keeping metformin in the picture offers a lot of metabolic benefits. Some studies are even suggesting that metformin can extend lifespan in healthy individuals; there are individuals who take this medication without even having the usual signs of pre-diabetes or diabetes. This might be going a bit far but it shows that metformin has a lot of metabolic benefits. The biggest downside to metformin is that it causes stomach upset, but most people who have taken it for years are not bothered by this.
In all, many medications are stopped when adopting a low carb lifestyle. This saves money- either to the consumer, the health care system, or private insurance. When to stop these medications and how (tapering versus stopping suddenly) should be discussed with your physician, nurse practitioner or pharmacist. Unfortunately many health care practitioners are not familiar with low carb and aren’t confident in assisting with the deprescribing of these medications. It is not uncommon for people to go from six or more medications to none, within the course of a year or less on low carb nutrition plan. My hope is that as many individuals as possible across Ontario can experience the benefits of low carb and reduce their medication usage.