A look at pharmacist-led deprescribing using therapeutic nutrition intervention

Achieving radiant health through nutrition is an ancient trend that southern Alberta pharmacist Melissa Hozack is helping to revive.

“In 400 BC, Hippocrates said, ‘Let food be thy medicine and medicine be thy food.’ How can we promote health instead of looking at sick care?” said Hozack, a consultant pharmacist and owner of Redcliff Pharmasave, at the 2018 Calgary Drug Trends Summit on Oct. 25.

“Weight loss is just a side-effect,” noted Hozack, who was her own first case study six years ago, losing 100 pounds in seven months. Since 2013, she’s seen about 1,000 patients go through her ketogenic diet-based therapeutic nutrition program, collectively losing about 37,000 pounds — 40 pounds per patient, on average. There are many benefits, including a higher quality of life and less time off work due to illness.

Read: Pharmacist-led nutritional intervention touted in reversal of type 2 diabetes

Hozack’s intervention uses a low carbohydrate diet and multiple touch points for patient care, including daily food journaling, recipes, weigh-ins and a change in mindset through education. She also monitors patient progress with weekly consultations, which can be completed with a qualified health coach.

Why is all this important? During her presentation, Hozack referred to Obesity Canada statistics that showed more than one in three Canadians have obesity that may require medical support. She noted obesity-related disease has skyrocketed since low fat dietary guidelines were issued in the 1980s, and the prevalence of obesity is projected to increase over the next two decades. It’s also taking a direct toll on the health-care system, with the annual costs of obesity estimated between $5 billion and $7 billion, and it’s projected to rise to $9 billion by 2021.

Read: Employers urged to boost tracking of obesity efforts

In her own case, Hozack was taking 12 medications for inflammation-related disease before changing her diet, and ended up going off all of them. “What if we didn’t need the medications?” she asked. “We can now give options.”

Therapeutic nutrition addresses the underlying problem: eating too many carbohydrates, too many highly processed foods and too much sugar, said Hozack. The body produces too much insulin as a result, “and you end up with problems with insulin resistance . . .  It’s that simple.”

It takes all this into account. “It gets rid of overconsumption of the wrong kinds of foods and corrects a wide variety of conditions, with weight loss being one of the most noticeable side-effects,” she said.

Therapeutic nutrition also ensures patients get an adequate amount of protein in their diet, keep carbohydrate consumption low and fill up with fat, said Hozack, noting patients have to keep up that eating plan as part of a lifestyle change to maintain their results over the long term.

Hozack described a case study of a 59-year-old, 5 foot 9 male weighing 260 pounds with a body mass index of 38 who was on multiple medications for diabetes, hypertension, high cholesterol, hypothyroid and sleep apnea. The cost of his medications, covered by his workplace benefits plan, was nearly $8,000 each year. The cost to the health-care system over 40 years for one patient on a similar amount of medications would total $317,308, not counting additional medications if his health were to deteriorate, noted Hozack.

Read: Obesity treatment scarce in benefits plans, report finds

A last ditch effort to help the man lose weight was bariatric surgery, at an approximate cost of between $20,000 and $25,000 to the health-care system, plus after-care costs, as well as the indirect costs of taking six weeks or more off work and possible complications.

Instead, the man enrolled in the therapeutic nutrition program, lost 45 pounds and, after a blood test confirmed his previous conditions had normalized, he went off all medications under Hozack’s guidance.

Hozack emphasized that when it comes to deprescribing, patient safety is always at the forefront of health-care providers’ decisions. “Those regular check-ins at our pharmacy are crucial to their success,” she said. “We don’t want people trying to do it on their own. They have to be monitored. Their pharmacist and doctor have to know what they’re doing.”

Read more coverage of the 2018 Calgary Drug Trends Summit.