Food or Pharma? The most prescribed medications in North America and the role of diet in the treatment process.

The pharmaceutical industry in North America is staggering in terms not only of its profitability but its presence and relevance in the current healthcare context. 

There are highly effective prescription medications available to treat many of the most common healthcare ailments, but medication is often not the only course of action available to people looking to address their health concerns.

Today’s article takes a closer look at seven of the most widely prescribed classes of medication on the market and reveals the dietary & nutritional interventions that are known to offer similar, synergistic or at least complimentary effects. 

You will find that the primary physiological effects of certain medications can be replicated by food but in other medications dietary changes may only provide a supportive role.  

Many people may require both dietary and pharmaceutical intervention to achieve the outcome that is best for their health. For this reason,  today’s article is meant to be educational rather than prescriptive in nature. 

You should always follow the instructions of your personal health care team.

The Medication:  Vyvanse ( lisdexamfetamine)

Primarily Used to Treat:  ADHD ( most commonly in children)

Dietary Treatment Options:  There is limited evidence available that supports the effect of dietary intervention in ADHD. It remains important that a child eats a diet rich in fruits and vegetables, whole grains and healthy sources of fat and protein ( ie: nuts, beans, fish , lean meat). 

There is some evidence to suggest that increasing the intake of omega-3 fatty acids ( walnuts, ground flax seed, salmon, sardines)  and reducing the intake of artificial food colouring (most commonly found in sugary drinks) may help certain children with ADHD symptoms.  

The Medication:  Lipitor ( atorvastatin) & Crestor (rosuvastatin)

Primarily Used to treat: High Cholesterol (LDL) 

Dietary Treatment:   There are five dietary steps you can take that, if carried out diligently, are known reduce your LDL cholesterol by a similar amount to statin medication and may also potentially lessen your need for these medications in future, but only your doctor can make this decision.

1. Increase your soluble fibre intake: In order to do this, you will need to consume a variety of fruits and vegetables, certain whole grains ( ie: oats), as well as legumes ( beans, lentils)  on a regular basis.

2. Add soy protein to your diet on a daily basis: Regularly consuming multiple soy protein-rich items daily such as tofu, tempeh, soy milk/yogurt, edamame (soy beans) and veggie burgers/soy meat alternatives. 

3. Use  2 tbsp of enriched plant sterol margarine on a daily basis:  Use it in place of butter on items such as toast and potatoes. There is a reasonable chance that you have either already heard of this product or encountered it on your local grocery store shelves. If not, look for Becel Proactiv Margarine or PC Blue Menu Margarine with plant sterols.

4. Incorporate tree nuts place of less healthy snack options:  Use tree nuts as a healthy snack in place of less healthy alternatives such as sweets, chocolate, cookies etc. 

5. Minimize saturated fat intake:  The best way for the average person to do this is by cutting back on fatty varieties of meat and dairy and opting for leaner alternatives. Opting for fish or legumes over red meat is another way to achieve this.

The Medication:  Fibrates ( various) or Statins (various)

Used to treat: High Triglycerides ( TGs) 

Dietary Treatment:  From a dietary perspective, there are 5 main things you can do to reduce your blood triglyceride levels:

1. Reduce your consumption of saturated fats: which are most often found in full-fat dairy foods and fattier cuts of red meat. Choose lean meat and dairy more often.

2. Consume whole grains rather than refined grains: Opt for whole grain whole wheat bread and pasta, brown rice, quinoa and steel cut oatmeal rather than white bread, white rice and instant oats. Swap baked potatoes for sweet potatoes.

3. Reduce your alcohol intake:  If you are regular drinker, you can start off by consuming half as much alcohol on a weekly basis as you normally do and see if that helps contribute to a reduction in TG levels. 

4. Consume omega-3 rich foods:  If you are not already, incorporate the following foods you’re your diet on a weekly basis: salmon, tuna, trout, sardines, mackerel, walnuts, ground flax seeds. Do so by swapping them in for other selections, rather than consuming extra calories through these foods.

5. Cut down on sugary beverages & sweets: Such as pop , fruit drinks, blended drinks and other beverages with added sugar. Cakes, donuts, muffins included. 

The Medication:   Humira ( adalimumbab) / Remicad ( infliximab) / Enbrel ( etanercept)

Primarily Used to treat: Rheumatoid Arthritis (RA)

Dietary Treatment:   There is currently only limited evidence that dietary intervention will help relieve the symptoms of RA, and certainly there is no evidence that diet has the potential to remedy the issue long-term ( as there is with cholesterol, TG etc). The best available evidence points to  an increased intake of omega-3 fatty acids & anti-oxidant rich foods as the most important consideration for those living with RA. 

1. Increase omega-3 acid consumption: walnuts, ground flaxseed, chia seed and fatty fish (mackerel, salmon, sardines, trout).

2. Increase consumption of anti-oxidant rich foods by including a variety of fruits and vegetables but also other anti-oxidant rich food groups such as nuts and beans. 

The Medication:    Nexium (esomeprazole) 

Used to treat:  GERD (aka heartburn/acid reflux) & peptic ulcer

Dietary Treatment:   Being wary of certain problem foods & behaviours that are known to trigger symptoms of GERD is the primary way your diet can play a role in treatment.

Problem foods may include:

1. Fatty/Fried foods

2. Spicy foods

3. Caffeine

4. Chocolate

5. Onions 

6. Peppermint

7. Citrus fruits 

8. Tomato & tomato products 

9. Alcohol 

10. Carbonated Beverages

Reducing your intake of food in the categories above may help with your symptoms of GERD. You do not necessarily need to avoid them completely, but you should be mindful of them and monitor your intake and symptoms to determine which foods in which amounts may cause you issues.  It is also advisable that people who suffer from GERD do not consume meals too close to bed time, do not lie down immediately after meals and consume several smaller rather than few larger meals. 

For those looking for further specific dietary strategies for dealing with a peptic ulcer, please have a look here

The Medication:  Lasix ( furosemide) Altace ( ramipril)  Apo-hydro (hydrochlorothiazide) 

Primarily Used to treat:  High Blood Pressure ( Hypertension)

Dietary Treatment:    You can lower your blood pressure through changing your diet, potentially so much so that you will not need medication, but that will be for your doctor to decide depending on a variety of factors. The most effective way to lower your blood pressure is by following what is known as the DASH Diet plan.

You can learn more about it at links located here and here.

The DASH diet generally emphasizes plentiful intake of fruits, vegetables and whole grains, incorporating nuts, seeds and legumes and restricting the intake of sodium, saturated fats and sweets.

The Medication:    Januvia (sitagliptin)  & Glucophage ( metformin)

Primarily Used to treat:  High A1C levels in Type 2 Diabetes

Dietary Treatment:   Effectively implemented nutrition intervention in type 2 diabetes is well recognized to be able to reduce A1C. Because of the complexity and severity of diabetes, you will be most likely to achieve success with the support of a dietitian, however these are a sample of the changes you can make to help contribute to a lower A1C.

1. Incorporate dietary pulses (beans, peas, lentils) for several meals a week ( ¾ cup = 1 serving). They can be used to replace meat at either lunch or dinner.

2. Limit your saturated fat intake by limiting high fat meat and dairy choices and opting for leaner alternatives when possible. 

3. Replace high glycemic (GI) index carbohydrates such as white rice, white bread, baked potatoes and instant oatmeal with lower GI alternatives such as steel cut oatmeal, sweet potatoes, brown rice, whole grain bread and quinoa. Learn more here.

4. Space out your meals in the same way on a daily basis and consume a similar amount of carbohydrates at each meal. You may need the help a dietitians assistance to achieve this.

5. Eat an overall healthy dietary pattern: Mediterranean, vegan and vegetarian dietary patterns are all associated with positive effects on blood glucose control and A1C. These diets all emphasize whole grains, vegetables, fruit, nuts and seeds among other healthy components.

Take Home Message

Many of the most commonly prescribed and sold medications in North America have effects that can be either replicated or supported by dietary changes. This does not  mean that food alone will be enough to get a  person off of a medication, but in some cases it may. That decision will be for your health care team to make and depend on the severity of your condition.

There is another obvious benefit to dietary vs pharmaceutical approaches and that is the fact that healthy and nutrient rich food provides a plethora of benefits whereas medications usually target only a single pathway. Although in many cases medication is necessary to treat certain conditions, the goal of toady’s article is to inform you that diet has a major role to play as well and you should explore both avenues diligently to achieve your best possible state of health.



Andy De Santis RD MPH