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Home Direct Primary Care Practice Medicine by Subtraction, Not Addition
19Nov

Practice Medicine by Subtraction, Not Addition

by Joshua Fischer

Recently a patient asked me if I recommend any supplements for a particular medical condition. The answer is that I do, indeed, sometimes recommend supplements to my patients. (In fact, there’s a link on this website through which patients can purchase quality supplements at a discounted price – this is provided as a convenience to my own patients, though really anybody can use it, whether they work with me or not). However, readers of this blog will note that I don’t talk about supplements all that often, and this is consistent with my medical practice in general. 

This is not because I have anything against supplements per se. Some in fact have good evidence for them and can be quite beneficial. But it’s rare that a supplement is the most important part of the healing process, and often they are a band aid of sorts for something else that is going wrong in a patient’s life. 

Perhaps a person eats a nutritionally deficient diet, and they take a vitamin to make up for that deficiency. Or they have high blood sugar from eating too many refined carbohydrates, so they start supplements such as cinnamon and berberine (both of which are in fact great supplements to take if you have blood sugar issues). Or they can’t sleep due to poor bedtime habits, so they start taking supplements like Ashwaganda and Magnesium to help them get better rest. 

Some of these things can indeed be helpful, but really the better answer to the above problems would be to eat a proper diet, to cut concentrated sources of carbohydrates out of the diet, or to develop better sleep habits, not to take a pill. 

Alas, pills are easy to take, whereas making lifestyle changes requires a lot of time and effort. 

Pills also gel nicely with our consumerist oriented approach to healthcare, which goes as follows: I have a medical problem. I purchase a product that will cure that medical problem (a medication, a procedure, a supplement). I passively consume that product, and I am healed. While this works fairly well if you have to take an antibiotic for an infection, or have to have surgery to take out an inflamed appendix, it falls short for chronic healthcare conditions. 

The fact is that your health is largely in your own hands. Not only are you capable of fixing many of your issues, but you are in fact the only person on earth who has the power to do so. A good doctor can guide you in the right direction, but ultimately the healing has to come from within you. 

Which brings me back to supplements. The addition of supplements can often be very helpful, and I do utilize this tool in my practice. But it’s almost never as important as the subtraction of the bad lifestyle habits that lead to disease in the first place. Do the right subtraction from your life – of junk food, of sugars, of stress, of poor sleep, of sedentary behavior – and most of your health will take care of itself. 

In other words: practice medicine by subtraction, not by addition.

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