Do you have any medical problems?

Do you have any medical problems?

I ask patients this question frequently. Some immediately get irritated with me and tell me to “just look in the computer.” And as with every patient, I do look in the medical record regarding their prior medical problems, recent clinic/ER visits/hospital admissions, and medications. However, asking the question tells me a lot about how tuned in they are to their medical problems, and it gives me some idea of their medical literacy. Their involvement and degree of concern about their medical problems often figure into whatever is going on.

Patients often will say “no,” and when they do, my follow-up question is, “Do you take any medications?” They will then list the many medications that they are taking. Apparently, there is an unspoken understanding that if you take medication for a medical problem, you no longer have that medical problem.

The truth is medications rarely solve underlying medical problems. They mostly treat symptoms. Insulin for type 1 diabetes mellitus (T1DM) is an exception. In T1DM, the pancreas doesn’t make insulin, so replacing it is in fact correcting the underlying issue. However, overall, very few medications function that way.

Blood pressure medications treat hypertension (HTN), but they don’t make your hypertension go away. Decreasing your underlying insulin resistance—which is the primary driver of HTN—requires eating better.

Medications for type 2 diabetes mellitus (T2DM) don’t make your diabetes go away. They help control your blood sugar, but reversing your diabetes requires eating fewer things that raise your blood sugar in the first place. Taking insulin for your high blood sugar but continuing to eat things that raise your blood sugar is like spraying water on a fire after you just added more firewood and hoping the fire goes out.

Medications prescribed after a heart attack don’t make your atherosclerosis go away. There is debate about whether you can reverse atherosclerosis once you have it, but there are certainly no medications that make it go away.

Cholesterol medications decrease your LDL, but whether this improves your cardiovascular risk is not settled science, despite what Big Pharma has led you to believe.

Medications for atrial fibrillation can keep your heart rate from going too fast, but they don’t make the atrial fibrillation go away. Taking a blood thinner for atrial fibrillation to prevent strokes is not a guarantee you won’t have a stroke, but it does decrease the risk.

Medications for depression mess with the neurotransmitters in your body (your entire body, not just your brain) and can numb you to feeling depressed. But they also numb you from feeling the good things in life, like joy and pleasure. Some people need them sometimes, but they are widely overprescribed.

Lifestyle modifications can meaningfully treat underlying medical problems.

Nutrition: Eating less sugar, flour, and seed oils can actually reverse underlying metabolic dysfunction, including T2DM. Check out https://www.virtahealth.com/ for more details.

Exercise: Including resistance training (i.e., lifting weights) can significantly improve your metabolic health and longevity. (Claiming you get exercise because “I’m on my feet a lot for work” doesn’t count. That just means you’re a human doing what humans have always done.)

Sleep: Prioritizing sleep is crucial to good metabolic function. Every organ system gets better with sleep and every organ system gets worse without it. No exceptions.

Community and purpose: Having healthy relationships and contributing to the world are proven to improve health.

Other: Getting sunshine every day, being outside, and taking vitamin D all help with mental health.

Solving your medical problems is in your hands. Big Medicine doesn’t have solutions for chronic disease.