Changing Lifestyles, Changing Habits: Can Diet, Exercise Replace Medication?
Do you take medication for high cholesterol? Or have you just found out you need
to start taking medication? If either of these is true, you may be wondering
whether it’s possible for you to avoid taking these drugs by changing the kind
and amount of food you eat and by exercising.
The answer isn’t simple. Some people will always need to take medication to
keep their cholesterol under control, no matter how much they change their food
and exercise plans. They naturally produce more cholesterol than is healthy.
Others may be able to reduce their medication dosage by eating differently and
becoming more active. And there are some people who are able to stop taking
medication after embarking on a serious program that eliminates unhealthy foods,
strictly limits even the kinds of healthy foods you can eat and incorporates
exercise and stress management.
Study results after intensive lifestyle changes
The changes you would need to make depend on what your health status is now. If
you already have high cholesterol and heart disease, chances are you’ll need to
make bigger changes than if you’re simply trying to prevent the development of
In the 1990’s, Dr. Dean Ornish, of the Preventive Medicine Research Institute
in California, conducted a study called the Lifestyle Heart Trial. For one year,
people with heart disease were separated into two groups—an experimental group
and a control group. The experimental group changed their diets so that fat
comprised only 10 percent of their food intake daily. (In comparison, the
American Heart Association recommends a diet that has no more than 30 percent
fat daily.) They also ate no meat. Participants exercised every day and took
part in stress management training and smoking cessation. Nobody in the
experimental group took cholesterol-lowering medication.
The control group, on the other hand, followed general advice from their
family physicians about healthy lifestyle changes, but they did not follow the
specific regimen of the experimental group. Additionally, 60 percent of control
group members took cholesterol-lowering medication.
After 1 year, people in the experimental group had a 37.2 reduction in LDL
(“bad”) cholesterol, fewer episodes of angina and a reduction in narrowing of
the arteries. The control group patients, on the other hand, experienced a 6
percent reduction in LDL cholesterol, had more episodes of angina and they
experienced increased narrowing of the arteries. Narrowing of the arteries
creates a higher risk of heart attack.
Participants were then invited to take part in a 5-year follow-up study. At
the end of five years, changes were even more pronounced:
- The experimental group had a 72 percent reduction in
angina versus a 36 percent decrease for the control group.
- In terms of narrowing of the arteries, the experimental
group experienced a 7.9 percent improvement, while the control group
experienced a 27.7 percent increase in narrowing.
- The experimental group had twice as many cardiac events
as the experimental group. These included heart attacks, angioplasty
procedures, bypass surgery, other hospitalizations related to cardiac issues
and cardiac-related death.
- The experimental group experienced the same reduction in
cholesterol levels as the control group patients who took cholesterol-lowering
Supportive healthcare team can help you make intensive changes
Making changes similar to those made by the people in the Lifestyle Heart Trial
takes a great deal of discipline and determination. For most people, it’s pretty
much a 180 degree change in lifestyle.
If you’re seriously interested in seeing what you can do to bring down your
cholesterol levels, talk with your doctor. Explain that you want to make
comprehensive changes. Talk with a dietitian or a nutritionist to figure out
what kinds of meals you can plan. Remember, comprehensive changes incorporate
not just diet and exercise, but quitting smoking and stress management as well.
Your healthcare team can help you locate professionals who can guide you in all
of these endeavors.
Good habits help medication work better
If you do decide to see whether you can eliminate or reduce your need for
medication, it’s important to work with your doctor on this. If you do actually
bring your cholesterol down, your doctor’s involvement is necessary because
you’ll probably need to adjust your medication dosage.
Even if you’re not able to completely eliminate medication, having a healthy
lifestyle helps your medication work better and typically leads to an improved
quality of life overall.
S. Holt. Journal of the American Medical Association,
1998;280:2001-2007; The Natural Way to a Healthy Heart, M. Evans and
Company, Inc., New York, New York, 1999. American Heart Association; National
Heart, Lung and Blood Institute