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Short Summary
Main recommendation: Review every medication with your doctor, since many drugs can affect ketosis or weight loss, and aim to taper or switch them when your condition is stable. Dr. Eric Westman stresses that changes should always be made with physician approval and monitoring, not on your own.
Key Points
- Insulin, steroids (including nasal sprays and joint injections), oral diabetes medicines, antidepressants, and pain medicines like gabapentin can interfere with ketosis or weight loss.
- Beta blockers may block fat-burning, though Westman notes there are few good studies on this; switching to a different medication is preferable if your doctor agrees.
- Symptoms such as weight loss stalling during a disease flare (e.g., Crohn's) may be caused by the illness itself, not only the drug.
- Westman says that in his experience, many people do not need extra supplements if they eat whole foods, and supplementation should be targeted to specific symptoms.
- Westman says he does not rely on medications and tries to get people off them.
Details Worth Noting
- Concrete instructions: Do not change or stop any medication without your doctor's approval. For stable conditions, you can try a trial off a medication (e.g., St. John's Wort for mild depression or Topamax) and wait a couple of weeks before judging its effect on weight loss or ketosis. For blood pressure medicines, one method is cutting the dose in half while monitoring blood pressure at home, tapering over about two weeks. Keep a home log of blood pressure readings.
- Westman recommends a multivitamin without iron, unless iron was prescribed for another reason. If muscle cramps or constipation occur, consider adding magnesium. Taking extra magnesium and potassium may be reasonable if you want to avoid waiting for side effects.
- For cardiovascular statin decisions, Westman suggests entering your information into the cardiovascular risk calculator at cvriskcalculator.com and showing the result to your doctor, since the latest U.S. guideline tends to push toward fewer drugs.
- Over-the-counter cold and flu medicines may contain sugars; they may be needed briefly for symptom relief, so check labels.
- Morning fasting blood sugar around 110 mg/dL is not, in Westman's experience, cause for alarm in people adapting to a low-carb or keto diet.
- People without a gallbladder generally handle fat fine and, in Westman's view, usually do not need added supplements.
- Thyroid medication changes after major weight loss are a judgment decision to make with your doctor, monitoring symptoms and blood levels.
Bottom Line
Medication decisions on a keto diet should be individualized, monitored, and coordinated with your doctor, with the goal of reducing unnecessary drugs when conditions allow.
