The Family Health Guide

You don't have to take a pill

We've gotten used to taking pills for much that ails us, but these days, the medicine cabinet is looking like a rogues' gallery. There's been bad news about a handful of drugs, and problems with hormone therapy and antidepressants have also been bannered in headlines.

We don't lack for alternatives. Plenty of research shows that exercise, diet, and other lifestyle changes are effective weapons against many chronic diseases. But often it seems like the nonpharmacological approach doesn't quite get its due.

Let's be honest: there's the wonderful convenience of taking a pill. It's just so much easier than changing what we eat, mustering up the time and willpower to exercise, or fighting the uphill battle of weight loss. And the health care system, as currently configured, doesn't do much to support a nondrug approach.

But for those wary of taking medications who want to take the road less traveled, here's a brief overview of six common conditions and approaches to managing them without medication or supplements.


If you're heavy and the problem is arthritic knees, losing weight won't make the arthritis go away, but there's a good chance it will make it less painful . Even for those who aren't heavy, exercise that doesn't put "load" on the joints — swimming and bicycling are good examples — works to reduce pain. For walking, the right shoes can make a huge difference for people with arthritic knees. A knee brace is another thing to try. It can realign the knee, taking pressure off the "compartment" of the joint that's the most arthritic.


You can adjust your diet in several ways to lower levels of "bad" LDL cholesterol. Your LDL level may drop by 5% or so if you keep foods high in saturated fat (namely, meat and full-fat dairy products) off the menu. Every additional gram of soluble fiber per day — the sort of fiber found in oatmeal, beans, nuts, and fruit — may reduce LDL levels by about 2 mg/dL. Diets that have included margarines fortified with sterols — compounds that block cholesterol absorption — have brought about LDL drops of 10% to 20% in some studies. And in others, low-fat, "plant-based" diets that are very heavy on the vegetables (10 servings a day) and legumes and nuts (4 servings a day) have dialed down LDL levels by almost 10%.

The problem is that all of these approaches fall short of what the statin drugs can accomplish: a drop of 25% to 35% in LDL. The exception may be a diet that includes a veritable dream team of LDL-lowering foods (plant sterols, soy protein, soluble fiber, and almonds). And HDL? Exercise is probably the best way to boost levels of the "good" cholesterol.

Cognitive decline

Memory training and other "brain exercises" seem to help healthy older people stay sharp, although there's been some question how well the gains translate to real, everyday activities. Scores of studies have been done and, by and large, the results in people with early, and even full-fledged, Alzheimer's have been positive. But the bar for success is set pretty low: a positive finding is often a slowing of the rate of cognitive decline, not reversing it. Evidence for the mental benefits of physical exercise may be stronger and more consistent than the evidence for mental gymnastics.


Many studies have found that regular physical activity seems to have an antidepressant effect. Some research has shown that a fairly strenuous exercise program results in a 50% decrease in depressive symptoms, a drop comparable to that seen when people take antidepressant medications or receive cognitive behavioral therapy. The particulars of the program seem less important than sticking with it.


Regular physical activity is a powerful brake on blood sugar levels because well-exercised muscle becomes more receptive to the insulin that helps it pull sugar in from the bloodstream — sugar that the muscle tissue needs as "fuel" to function properly. Eating fewer sweets and easy-to-digest carbohydrates also helps keep the lid on blood sugar levels. When it comes to developing diabetes, it's not just that exercise is good for you. It's more potent than any medicine yet invented.

Whether exercise and diet alone can control blood sugar levels once people are diabetic is harder to answer. The American Diabetes Association (ADA) used to recommend that people newly diagnosed with diabetes try exercise and diet first before moving to medication. Now the ADA says people should start taking metformin right away because few people were able to keep their blood sugar levels in line with exercise and diet and that failure winds up making the underlying diabetes harder to manage.

High blood pressure

If there's one condition that you can change without a pill, it's high blood pressure or, as doctors call it, hypertension. Take your pick: lose some weight, get more exercise, eat less sodium, change your diet. They all work.

Any of these lifestyle strategies will also make blood pressure–lowering medication more effective. Whether they can replace the pills depends on how high your blood pressure is.

May 2008 update

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