September 9, 2013

Talk to your Doc: Prescription Medications and the Whole30®

talk to your doc

Our new “Talk to your Doc” articles will feature a series of guest posts written by medical professionals. Our goal is to help prepare you to discuss issues related to the Whole30, your medical condition, and your general health concerns with your doctor.  Today’s article was written by Luc Readinger, M.D. (You may recognize the name – Dr. Readinger also wrote the foreword for It Starts With Food!)

You’ve read It Starts With Food. You’re super-pumped to dominate your Whole30, saying sayonara to foods that are holding you back and making you sick. You’re ready to unleash your inner healthy-eating beast. Problem is, you’re on one or more prescription medications. You want to do this right, so as advised in It Starts With Food, you set up an appointment to discuss things with your doctor. Before you head over to his or her office, understand that physicians hold many different individual views on nutrition. In all the hours of medical education we sit through, a very small percentage of these are spent discussing nutrition topics. Our views even vary as to the degree of influence dietary composition has on a person’s health. (My opinion: it’s very important.) Some physicians have little interest in the topic, while some have very strong opinions on what constitutes an optimal diet. Nutrition is a lot like politics these days: it’s a highly contentious and sometimes polarized issue.  By virtue of the fact that you may not know where your physician stands on nutrition and diet, it can feel intimidating to go in and discuss it with him or her for fear of invoking a sharp fire-and-brimstone rebuke.  But, for your health and safety, it needs to be done.


Note: This section was titled, “The Number One Medication You Must Absolutely Discuss With Your Doctor Prior to Your Whole30,” but that was kind of long. First, do not get discouraged from trying a Whole30 because you take insulin or diabetes medications.  The potential benefits far exceed the hassle of having a discussion with your healthcare provider and adjusting medication. That having been said… If you take insulin, it is essential to talk with your doctor before doing the Whole30. Although not specifically meant to be low-carb, a strict Whole30 eating plan tends to be lower in carbohydrates than the standard American diet (SAD), and lower than what most people are eating on an otherwise unrestricted diet.  If you’re on insulin and radically decrease the amount of carbohydrates you’re eating without adjusting your insulin dose, your blood sugar will go low. If blood sugar dips too low without intervention, you may lose consciousness or die. There are a few strategies that can be used if you’re taking insulin and want to do a Whole30. The best one depends on the individual. First, long-acting insulin could be discontinued and replaced with shorter-acting insulin administered based on blood sugar levels—what’s commonly known as a “sliding scale.”  This is one of the safer approaches that will still provide blood sugar control. Another tactic might be to stop insulin altogether. This option will work well for someone who does not need very high doses of insulin. Yes, blood sugars may run high over the course of the 30 days, but one advantage with this approach is knowing exactly where blood sugar levels will be with the Whole30 diet alone. It’s possible that by controlling diet, insulin may no longer be necessary. Using and adjusting any oral medication for diabetes in conjunction with this strategy can be used to help keep blood sugar in check as well.  Weekly follow ups can fine-tune things to ensure blood sugars are staying within a reasonable range. Many other variations could be devised based on the concepts above, but as they say, don’t try this at home. Always consult a medical professional. Oral medications that directly lower blood sugar also need to be taken into consideration. These medications include the sulfonylurea class of medicines, the most popular of which are glipizide and glyburide/glibenclamide.  (This may vary by geographical region.)  While not as potentially dangerous as insulin unless taken improperly, decreasing carbohydrate intake while on these medications could drive one’s blood sugar precipitously low.

High Blood Pressure Medication

If you’re taking medication for high blood pressure, relax. There, did it go down a little bit? In all seriousness, this is another case where you want to consult your healthcare practitioner prior to launching your Whole30. (I’ve had patients who no longer needed their blood pressure medication while eating as prescribed on the Whole30.) If you are taking medication for high blood pressure, I recommend purchasing a blood pressure cuff to use at home. These are available at any drugstore. Monitor blood pressure for the duration of the Whole30, one or two times per day. If blood pressures fall below a doctor-advised predetermined level, or if symptoms of decreased blood pressure occur (some include light-headedness especially when going from sitting to standing, generalized fatigue, etc.) then it’s time to talk to your doctor about backing down on the amount of medication being taken.

Thyroid Medication

Changes in the thyroid gland occur gradually. It takes about six weeks to see the full effect of any thyroid hormone medication changes. As chronic hypothyroidism (low thyroid) responds slowly to medication changes, it changes slowly with dietary interventions as well. It is still a good idea to check in with your doctor before embarking on the Whole30, and might be worthwhile to look at thyroid hormone levels before and after the program. This is especially true if you have an autoimmune thyroid condition like Hashimoto’s, which may respond well to a gluten-free diet and addressing any gut issues.

Blood Thinners

One other medication to make note of is the blood thinner warfarin, also commonly referred to by its trade name, Coumadin.  Warfarin works by inhibiting an enzyme that recycles vitamin K1, leading to a decrease in this vitamin, which is essential to the blood clotting process.  Originally developed and used to fatally poison rodents, it was eventually discovered that warfarin could be used medicinally to inhibit blood clots. Regardless of the diet you eat, consuming vitamin K can reverse the therapeutic benefit of warfarin.  Food sources of vitamin K include leafy greens and members of the Brassica family (like cabbage, cauliflower, broccoli, or Brussel’s sprouts).  Rather than avoid these delicious superfoods altogether, I recommend eating a consistent and measured amount of these foods every day.  You will have to take more warfarin than if you weren’t eating them, but I believe the benefits outweigh the risks. Any time you want to change the amount of greens and and/or Brassica you’re eating, talk to your doctor and make sure that your blood levels of warfarin are monitored closely to keep the dose within a therapeutic level.


On a statin medication like Lipitor? You can still come to the Whole30 party. I don’t know of any immediate or long-term dangers with the combination of a statin medication and a paleolithic diet, but if you haven’t had a discussion with your physician about why you’re on a statin medication, it might be time to do so*. *My professional opinion, based on the current evidence I’ve seen, is that the risk of taking a statin outweighs its benefits (with a few exceptions).  Cholesterol is necessary for the synthesis of multiple hormones. LDL (the lab test used to adjust the dose of statin medications) is not the best biomarker to assess the risk of heart disease. To top it off, statins have been implicated in the development of dementia, diabetes, muscle aches, liver damage, and depletion of CoQ10. There has been a lot written about cholesterol, heart disease, and the role statins play in all of it—entire books, in fact. Further discussion of this controversial topic is beyond the scope of this article.

In Closing

While we have not covered all medications or medical conditions, we’ve reviewed some of the more common ones, and those that are the most affected by your Whole30. I hope that your healthcare provider encourages you to make positive, health-improving changes in your life and facilitates those changes along the way. And as a final caveat and piece of advice, if you follow the disease-promoting standard American diet and have no intention of changing… seek the advice of your physician immediately.

Be sure to check out Part 2 of this series: What do do if your doctor says no.

drreadingerLuc Readinger is a family functional integrative medicine physician practicing in Wisconsin.  He occasionally posts something on his website:

This site does not provide medical advice, diagnosis, or treatment. The information presented here is general information for educational purposes only, and is not a substitute for medical care. You should not use the information in place of a visit, consultation, or the advice of your physician or healthcare provider.  If you believe you have a health problem or if you have any questions regarding your health or a medical condition, you should promptly consult your physician or  healthcare provider. Never disregard medical or professional advice, or delay seeking it, because of something you read on this site. Seek the advice of a medical professional before embarking on any diet or lifestyle modification.