Medical Minimalism

Last December, a guest at Pritikin, a businessman from Los Angeles, walked into his first medical appointment at the Pritikin Longevity Center in a stupor.

“It didn’t take long to realize he was in a drug-induced stupor,” recalls his physician Dr. Sam Sugar, one of 10 doctors at the Pritikin health resort.

The 80-year-old businessman was on 17 medications and 15 supplements and herbs. They had been prescribed by six different doctors from the Southen California area who had rarely, if ever, spoken to each other. Dr. Sugar ran a thorough analysis of all the meds, supplements, and herbs and their possible interactions. He uncovered 34 risky combinations, some very serious.

Each day for the next three weeks, while his patient exercised and dined on the fresh, healthy foods at the Pritikin Center, Dr. Sugar meticulously monitored his health, keeping track of all symptoms while slowly paring down the drugs and supplements.

When his patient left Pritikin, he was taking one pill. One. And he felt fabulous. “He got this REBOUND in energy and overall health," Dr. Sugar recalls. “He felt 100% better. It was so very, very rewarding to watch.”

Minimizing Drugs, Optimizing Health

The program Dr. Sugar's patient was on, called MedCheck, is newly launched at the Pritikin Longevity Center. “While the current trend among many doctors is putting people on more and more drugs, MedCheck’s goal is getting people off drugs,” explains Dr. Sugar, Director of the MedCheck Program, who is board certified in internal medicine and in addition to his work at Pritikin, a faculty member at Northwestern University Feinberg School of Medicine.

It’s part of a nascent culture in America termed “medical minimalism.” “Don’t get me wrong. When carefully prescribed and monitored, medications are great,” clarifies Dr. Sugar. “But for too long, patients as well as doctors have fallen prey to the medical mystique of a pill for every ill. We need to begin a whole new mind-set and say to ourselves: “I don’t want to take anything more than what I absolutely need. And certainly, I don’t want to take anything that makes me feel bad.”

Unfortunately, there’s a lot of bad stuff happening right now. “America is the most over-medicated society in history,” asserts Dr. Sugar. “Unknowingly, millions of people are ingesting risky combinations. Symptoms include fatigue, depression, anxiety, muscle pain, lower sex drive, weight gain, and even death. Our statistics bureaus don’t rank drug reactions as cause of death, but if they did, drug reactions would be the 5th leading cause of death in the U.S.”

Two Million Americans at Risk

A recent study of nearly 3,000 Americans aged 57 to 85, funded by the National Institutes of Health and published in the December 24, 2008, issue of the Journal of the American Medical Association, warned that at least two million older Americans are taking a combination of drugs or supplements that can be a risky mix.

Here are just two examples of how easily we can get ourselves into trouble.

For pain relief, many people take codeine, often in the form of Vicodin or Tylenol-Codeine. The body’s metabolic enzymes convert codeine into morphine, and it’s the morphine that relieves pain. But something as innocuous as grapefruit juice can paralyze the metabolic process that turns codeine into morphine, which means the codeine would have little or no effect. “So the patient who’s drinking grapefruit juice keeps swallowing more and more codeine, hoping for relief, but then, what if he or she stops drinking grapefruit juice? Within days, the body could build up toxic doses of morphine,” cautions Dr. Sugar.

Herbs and Supplements

Also rife with potential problems are herbs and supplements. “People just don’t understand that there’s a reason herbs like St. John’s wort and ginkgo biloba are so popular – they’re very powerful. Herbs and supplements can have a profound effect on how your prescription medications work – and how you feel.”

In the MedCheck Program at the Pritikin Longevity Center, the physicians begin by spending hours analyzing each patient’s list of medications, supplements, and herbs as well as their everyday foods with the assistance of computer databases that pinpoint all potentially perilous interactions.

Observes Dr. Sugar: “We often find little nuances that the general population of physicians, with their average seven minutes of face-time with each patient, have virtually no chance of ever picking up.”

Meticulous Observation

What also makes MedCheck unique is the follow-up – the meticulous observation each day of all symptoms and vitals for a total of one to three weeks. As the physicians evaluate and adjust medications, supplements, and foods, they and the rest of the clinical staff at Pritikin – the registered dietitians, psychologists, and exercise physiologists – keep daily, often hourly, tabs on the patients, asking, “How are you feeling? How are you sleeping? How’s your energy? Fatigue? Bowel habits? Depression? Pain?”

Optimal Regimen and Lifestyle

The end result is a new regimen of medications and supplements, often dramatically minimized, and a healthy new way of living, including healthy food and daily exercise.

“When all is said and done, the chief reason people feel better at Pritikin is because we change their foods,” explains Dr. Gayl Canfield, Director of Nutrition at Pritikin. “The foods they start eating and enjoying here – all the fresh fruits, vegetables, whole grains, and beans – are rich in biologically active compounds that have beneficial effects.”

And the body responds very quickly. Within three weeks, several published studies on the program at Pritikin have documented that most people with hypertension leave with their blood pressures in normal ranges, medication free. Most Type 2 diabetes leave with blood sugars in normal ranges, and medications eliminated or dramatically reduced. Cholesterol levels fall on average 25%; inflammatory markers like C-reactive protein drop about 40%. The program is so successful that U.S. legislation was recently passed allowing Medicare to cover participation in it beginning in January, 2010.

Consults With Home Physicians

Pritikin’s physicians also consult with patients’ home physicians and prepare comprehensive discharge guidelines.

“Working with home physicians is the cornerstone of our ability to make change that is both beneficial and lasting,” sums up Dr. Sugar.

“I am not aware of any other program like MedCheck anywhere. It’s exciting because it’s all about helping people take charge of their lives.

“It’s not rocket science. It’s just good medicine.”