As she neared 40, Rachel Silber Korn knew that her health was out of control. The mother of two, doula, and childbirth educator from Potomac, Md., weighed 285 pounds, rarely exercised, binged on ice cream -- even though she had been diagnosed with type II diabetes -- and had to take medication to control her diabetes, blood pressure, and cholesterol.

At her annual physical, her doctor let her know things did not look good. "My doctor told me I was already dead on paper,” she says.

After a couple of weeks of crying, Silber Korn decided it was time to make a change. She started slowly, walking during her half-hour lunch break, and cutting down on what she ate and not bingeing on candy bars. The weight started to come off. When she’d lost about 40 pounds, she started going to the gym and ramping up her workouts.

It took her nearly two years, but after 75 pounds of weight loss, Silber Korn was able to get off the medication she was taking to control her high triglycerides and blood pressure. Soon, she hopes that she’ll be able to reduce or eliminate her diabetes medication as well. She still takes a statin to reduce her risk of heart disease.

Millions of Americans are overweight or obese, inactive and eating poorly, and chained to a pillbox full of medications for a constellation of related conditions, particularly high blood pressure, diabetes, cholesterol, and osteoarthritis.

If you’re one of them, experts say that the chances are good that you could dramatically cut back on the number of medications you have to take daily, or even transition off them entirely, if you make just a few lifestyle changes.

“Often, a single individual will have all these conditions,” says Jason Wilbur, MD, clinical associate professor of family medicine at the University of Iowa Carver College of Medicine. “And I’ve seen a number of these people successfully avoid medications or get off of them by making a lifestyle change. What you have to do might sound really obvious, but it’s not as easy as it sounds, because it requires a real commitment.”

Of course, you'll want to team up with your doctor to do this. Don't take yourself off a medicine without talking it over with your doctor. Your doctor should be one of your biggest fans as you work on this transition.
Hypertension

If you have high blood pressure, you may only have to lose a small amount of weight to see the kind of changes you’ll need in order to reduce or eliminate your medications.

“There’s clear-cut evidence, and has been for decades, that just losing 5% to 10% of your body weight will often normalize blood pressure in people with mild to moderate hypertension,” says Timothy Harlan, MD, associate chief of general internal medicine and assistant clinical professor of medicine at Tulane University School of Medicine in New Orleans and a former restaurateur who hosts the “Dr. Gourmet” web site and is the author of Just Tell Me What to Eat!

“Say that you’re a 250-pound man with a BMI of 29,” Harlan says. “If you lose about 20 pounds, you may be able to go off your blood pressure medication altogether. I see this every single day in my practice. People who really embrace this and work at losing weight will do great.”

With more severe hypertension and more significant obesity -- like Silber Korn’s -- it may take longer to get off medication, but it can still often be done with lifestyle changes, Harlan says.

One diet that has been found to lower the average systolic blood pressure an average of 5 points -- which is about what you can expect from most blood pressure medications -- is the American Heart Association’s DASH diet (Dietary Approaches to Stop Hypertension, www.dashdiet.org), combined with reduced salt intake.

Another healthy diet that has been found to reduce hypertension is the so-called “Mediterranean diet.” It’s not as exotic as many people think -- that is, you don’t need to be eating Greek salads and hummus every day. “The Mediterranean diet just means eating more legumes, fruits and nuts, and vegetables; more fish, leaner meats, less dairy, whole grains, and alcohol in moderation, plus much more unsaturated than saturated fats,” Harlan says. “That’s all it is.”

Exercise by itself -- even without weight loss -- can reduce your blood pressure, although whether it’ll be enough on its own to get you off medication is another question.

“In the short term after you exercise, your blood pressure will be up. But after you’ve been exercising aerobically -- that means moderate to vigorous exercise for at least half an hour most days of the week -- for about two months, you’ll have a lower resting blood pressure,” Wilbur says.

Two months? It’s true, Wilbur says -- lifestyle changes are not a quick fix for any of these conditions. You could take medication and see significant changes in just a couple of weeks. “But these are lifelong issues. Do you want to have to take all these pills for the rest of your life?”
Diabetes

Just as with hypertension, losing a small amount of weight -- sometimes as little as 10-15 pounds, according to the American Diabetes Association -- can lower blood sugar. Exercise also helps to keep blood sugar in better balance, experts say.

So what’s the best diet to help you lose weight if you have diabetes? Because you don’t want wild swings in your blood sugar, it’s particularly important to consult your doctor when making major dietary changes. But a low-fat diet diet and the Mediterranean diet have been found to significantly improve blood sugar, although the Mediterranean approach seems to top the charts.

In an Italian study that randomized half of people newly diagnosed with diabetes to a low-fat diet and the other half to Mediterranean diet principles, 30% of the low-fat diet participants did not need to go on diabetes medications, while 66% of Mediterranean dieters were able to avoid medication.

“About 25% fewer patients had to be on medications pursuing the Mediterranean diet,” Harlan says. “But either way, you can reduce your chance of going on medications, or improve your chance of going off them, by at least 30% with dietary changes. That’s huge.”

Exercise also lowers insulin resistance and improves triglyceride levels -- key components of controlling or preventing diabetes.
High Cholesterol

Studies have found that some people can reduce LDL ("bad" cholesterol) by 10% to 15%, increase HDL ("good" cholesterol) by 20%, and lower triglycerides by as much as 30% by pursuing an exercise program. There is some debate about whether moderate or vigorous exercise is better, but some exercise is definitely better than no exercise!

“But even if you can’t reduce [your weight] enough and you still have to take medication, studies show that statins combined with a healthy diet will reduce cholesterol that much more. It’s synergistic to do both.”

Your diet matters, too. If your LDL cholesterol level is too high, ask your doctor for pointers on what changes to make in your eating habits. More fruits, vegetables, and whole grains are a good start.

Quitting smoking can also help your cholesterol levels. So if you smoke, that's another reason to work on quitting.
Osteoarthritis

You can’t reverse the damage that’s already been done by osteoarthritis by losing weight and exercising. But you can  reduce the risk of further damage to your joints, improve your ability to function, and ease your discomfort -- all of which may make it easier for you to go off or reduce medications for arthritis pain.

“The single-most important treatment for arthritis -- at least lower extremity arthritis, such as in the ankles, knees, and hips -- is exercise,” Harlan says. “Time and time again, research tells us that whether you’re obese or overweight or not, healthy or not, and no matter how bad your cartilage is, exercise helps mobility and pain levels.”

Will these lifestyle changes work for you? It’s all individual. Harlan notes that some people may have a genetic predisposition to certain conditions that no amount of healthy eating and exercise can entirely erase. “I have patients who are skinny and trim but still have blood pressure of 190 over 100,” he says. “That’s not something you can change with lifestyle alone.”

But if your blood pressure, cholesterol, and other health issues have crept up with your weight and doughnut intake, pursuing a more healthy lifestyle can set you on the path to cutting the cord between you and your pillbox.