Lifestyle Medicine and Medication Safety in Viet Nam: Deprescribing, Dose Adjustment and When Lifestyle Change Alters Treatment Needs

Lifestyle Medicine and Medication Safety in Viet Nam: Deprescribing, Dose Adjustment and When Lifestyle Change Alters Treatment Needs

Last reviewed: 24 September 2026

Lifestyle Medicine is sometimes discussed as a way to reduce reliance on medication. That can happen. Meaningful changes in diet, physical activity, body weight, sleep, alcohol use or smoking can improve blood glucose, blood pressure and other markers of chronic disease, and some people may eventually need less medication. But clinically, the more important question is not whether someone can “come off medication.” It is whether a treatment that was appropriate before those changes is still the safest and most appropriate treatment now.

This matters because successful lifestyle treatment can itself create a medication-safety issue. A dose prescribed when blood glucose or blood pressure was substantially higher may become excessive as those measures improve. On the other hand, stopping medication simply because one number has improved can also cause harm. Some medications provide cardiovascular, kidney or other benefits that extend beyond the biomarker they change. Medication safety is therefore not separate from Lifestyle Medicine. It is part of good clinical care. The 2025 Lifestyle Medicine Core Competencies include comparing treatment through Lifestyle Medicine with medication, monitoring lifestyle-related disease and using clinical data to guide ongoing care.

What does deprescribing actually mean?

Deprescribing does not mean encouraging patients to stop medication. In clinical practice, it refers to a planned and supervised process of reducing or discontinuing medication when the balance between benefit and harm has changed. In the context of Lifestyle Medicine, this may become relevant when improvements in a patient's condition alter medication requirements. The 2025 American College of Lifestyle Medicine clinical practice guideline specifically recommends adjusting the type and dose of pharmacological therapy according to the impact of lifestyle intervention on medication needs, with ongoing review and monitoring as the patient's response changes.

This makes deprescribing part of good prescribing rather than an anti-medication philosophy. If a medication remains indicated and beneficial, there may be good reason to continue it. If a dose has become excessive, it may need to be reduced. If the original indication has changed, withdrawal may be considered. If stopping a medication creates greater risk than continuing it, deprescribing is not the appropriate outcome. The objective is therefore not to achieve the fewest possible medications. It is to use the right treatment, at the right dose, for the person's current clinical situation.

Why can Lifestyle Medicine change medication needs?

Lifestyle interventions can influence many of the same clinical parameters that medications are intended to modify. Changes in dietary pattern, energy intake, body weight, physical activity, sleep, smoking and alcohol use may affect glucose regulation, blood pressure, lipid profiles and, in some situations, medication exposure or tolerance. When these changes are gradual, medication review may occur through routine follow-up. When an intervention is intensive or the clinical response is rapid, waiting until the next scheduled visit may not always be appropriate.

The pace of monitoring should therefore reflect the intervention, the medications involved and the patient's clinical risk. This becomes particularly important when a medication can cause significant harm if its effect becomes excessive, or when a change in diet, smoking or other behaviors can alter how a medication behaves in the body. Put simply, when physiology changes, treatment needs may change too.

Type 2 diabetes is one of the clearest examples

Type 2 diabetes provides a particularly clear example because medication adjustment in response to therapeutic lifestyle change is explicitly addressed in current Lifestyle Medicine guidance. The 2025 American College of Lifestyle Medicine guideline recommends that clinicians and other healthcare professionals adjust pharmacological therapy according to the effect of lifestyle intervention on medication needs. Its deprescribing framework emphasizes ongoing medication review, individualized planning, communication across the care team, patient education and appropriate glucose monitoring.

The American Diabetes Association's 2026 Standards of Care take a similar approach. Treatment plans should be reviewed over time, and medications with greater hypoglycemia risk, particularly insulin, sulfonylureas and meglitinides, should be reconsidered when risks begin to outweigh benefits. Importantly, the Standards recognize that treatment deintensification may be needed after weight loss or optimization of lifestyle behaviors when fewer pharmacological agents are required to maintain individualized glucose targets.

That does not mean that every person whose glucose improves should stop diabetes medication. The indication for each medication still matters. Some therapies provide cardiovascular, kidney, weight or other metabolic benefits in addition to lowering glucose. Current diabetes guidance, for example, recommends certain sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for people with particular cardiovascular, heart failure or kidney indications, in some situations irrespective of hemoglobin A1c. Medication review therefore needs to consider the whole patient, not only the latest glucose result.

There is another medication-safety issue that becomes particularly relevant when dietary changes are intensive. The 2026 Standards identify very-low-carbohydrate eating patterns, prolonged fasting, dehydration and excessive alcohol intake among factors associated with diabetic ketoacidosis in people using sodium-glucose cotransporter inhibitors. Diabetic ketoacidosis is uncommon in people with type 2 diabetes using these medications, but it can occur and may sometimes present without markedly elevated blood glucose. This does not mean that these medications or lifestyle interventions are inherently unsafe. It means that prolonged fasting or major dietary restriction should not be considered in isolation from the patient's medication regimen and clinical risk.

Evidence on exactly how to deprescribe after lifestyle change is still developing. A 2026 survey of 67 Lifestyle Medicine clinicians involved in therapeutic decision-making found that 53% did not use an established protocol for deprescribing diabetes medications. Nevertheless, respondents commonly described individualized approaches based on glucose monitoring and patient progress, and medications associated with hypoglycemia, such as sulfonylureas and mealtime insulin, were most frequently addressed first. The findings support active medication review while also illustrating why a single universal deprescribing algorithm is difficult to apply to every patient.

Blood pressure can change too

Lifestyle interventions are also central to hypertension management. The 2025 American Heart Association and American College of Cardiology guideline strongly recommends approaches including achieving or maintaining a healthy weight, following a heart-healthy eating pattern, reducing sodium intake, ensuring appropriate dietary potassium, increasing physical activity, managing stress and reducing or eliminating alcohol. Lifestyle and other nonpharmacological interventions can lower blood pressure and, for some patients, may change the amount of medication required to achieve appropriate control.

That benefit also creates a reason to monitor treatment. If blood pressure falls substantially while the previous antihypertensive regimen remains unchanged, some patients may develop dizziness, orthostatic symptoms or other consequences of excessive blood-pressure lowering. Home blood-pressure monitoring can therefore be particularly useful when substantial lifestyle changes are introduced in someone already receiving treatment. Current guidance emphasizes home monitoring as part of ongoing hypertension management and medication titration.

Again, an improved blood-pressure reading is not by itself a reason to stop medication. Some antihypertensive medicines may also be indicated because of heart failure, chronic kidney disease, previous cardiovascular disease or another condition. Medication decisions should reflect the complete indication and risk profile rather than a single blood-pressure measurement.

Medication safety extends beyond diabetes and hypertension

Lifestyle changes can affect medication safety in ways that have little to do with weight loss or improved metabolic markers. Smoking cessation is a good example. Components of tobacco smoke can induce liver enzymes involved in the metabolism of several medicines. When someone stops, reduces or restarts smoking, blood concentrations of some medicines can therefore change. Nicotine itself is not the main cause of this interaction.

Clozapine is an important example because reducing or stopping smoking can increase drug exposure and the risk of toxicity. Specialist medicines guidance recommends monitoring and dose adjustment under specialist supervision when smoking status changes. The lesson is clearly not to discourage smoking cessation. It is to support cessation while anticipating and safely managing medication interactions.

Diet can matter as well. People taking warfarin do not need to avoid healthy vegetables simply because many contain vitamin K. What matters is avoiding large and unpredictable changes in vitamin K intake that can destabilize the International Normalized Ratio used to monitor anticoagulation. A major dietary change, including starting a weight-loss diet or becoming vegetarian or vegan, may therefore justify additional discussion and monitoring. Consistency is generally more useful than unnecessary food restriction.

Kidney disease provides another reason to individualize otherwise healthy advice. Potassium-rich diets and potassium-based salt substitutes can help lower blood pressure in appropriate patients, but additional caution is needed in people with significant chronic kidney disease or impaired potassium excretion. Kidney Disease: Improving Global Outcomes guidance also emphasizes that hyperkalemia associated with renin-angiotensin system inhibitors can often be managed with measures to lower serum potassium rather than automatically stopping a medication that may provide important kidney or cardiovascular benefits.

These examples make a broader point: a lifestyle intervention can alter medication safety even when the medication was not originally prescribed for a lifestyle-related condition.

When should medication not be deprescribed simply because health has improved?

One of the risks of oversimplifying Lifestyle Medicine is assuming that improvement should always lead to fewer medications. It should not. A treatment may still be reducing future cardiovascular, kidney, thromboembolic or other risks that are not fully reflected in today's glucose, blood pressure or cholesterol result. Some medications also require careful tapering or specialist supervision if they are to be discontinued.

Remission requires similar caution. In type 2 diabetes, remission is not the same as cure, and recurrence remains possible. Clinical surveillance therefore remains important even when glucose-lowering medication is no longer required. Decisions about other medications also need to consider cardiovascular, kidney and other indications that may remain relevant independently of glucose control.

For this reason, the number of medications a patient takes is a poor measure of whether Lifestyle Medicine is working. More meaningful questions are whether health and function are improving, whether unnecessary treatment burden has been reduced, and whether the medications that remain are evidence-based, indicated, proportionate and safe.

What does safe medication adjustment look like in practice?

Medication safety should be considered before a higher-intensity lifestyle intervention begins rather than only after a problem occurs. Clinicians need an accurate picture of what the patient is taking, including prescription medications, over-the-counter products and supplements, as well as medicines prescribed by different specialists. Each medication should have a clear indication. Depending on the condition and treatment, baseline assessment may include glucose, blood pressure, kidney function, electrolytes, symptoms, weight and other disease-specific measures.

The next question is which treatments could become unsafe if the lifestyle intervention produces a rapid clinical response. A person using insulin or another medication associated with hypoglycemia may need more frequent glucose monitoring. Someone receiving antihypertensive treatment may benefit from reliable home blood-pressure measurements. Patients taking warfarin, medications affected by changes in smoking status, or treatments requiring kidney or electrolyte monitoring may need a different follow-up plan. The intensity of monitoring should follow clinical risk rather than a fixed schedule applied to everyone.

Patients also need to know what should trigger earlier contact with the healthcare team. New dizziness, faintness, recurrent low glucose readings, symptoms of hypoglycemia, unusual bleeding, substantial changes in home measurements or other unexpected symptoms should not simply be interpreted as evidence that the lifestyle intervention is “working.” They may indicate that treatment needs to be reassessed.

When medication is changed, the indication, rationale and new plan should be documented and communicated to the relevant members of the care team. Follow-up should then confirm both sides of the equation: that overtreatment has been avoided and that the underlying condition remains adequately managed. Deprescribing is therefore a clinical process, not a one-time event.

What does this mean under Vietnamese law?

In Viet Nam, medication adjustment must remain within the legal and professional framework governing medical examination, treatment and prescribing. On 26 February 2026, the Office of the National Assembly issued Document No. 26/VBHN-VPQH, the consolidated text of the Law on Medical Examination and Treatment. Article 62 requires practitioners assigned to provide medical examination and treatment to examine patients, determine treatment and prescribe medication in a timely and accurate manner and to take responsibility for their decisions. Article 63 requires medicines to be used only when genuinely necessary, for the correct purpose, safely, rationally and effectively, and requires prescriptions to be appropriate to the patient's diagnosis and condition.

For outpatient prescriptions of chemical medicines and biological products, Circular No. 26/2025/TT-BYT, issued by the Ministry of Health on 30 June 2025 and effective from 1 July 2025, provides more specific requirements and remains in force as of 24 September 2026. It states that practitioners holding a valid practice certificate or practice license with the professional title of bác sĩ or y sĩ have authority to prescribe medicines within the scope of the Circular. Prescribing must also comply with the Law on Medical Examination and Treatment and be consistent with approved medicine information, recognized diagnostic and treatment guidance, or the current Vietnamese National Formulary. When medication in an existing prescription needs to be corrected or adjusted, the prescriber must issue a new prescription replacing the previous one.

The Circular is directly relevant to Lifestyle Medicine for another reason. It requires prescribers to guide medication use and provide advice on nutrition and daily living. Patients or their representatives must also be instructed to notify the prescriber or attend an appropriate healthcare facility when abnormal signs occur after medication use.

For diseases and disease groups listed in Appendix VII, Circular 26 allows the prescriber, based on the patient's clinical condition and stability, to prescribe each medication for more than 30 days and for a maximum of 90 days. This can improve continuity for people living with stable chronic conditions, but it does not remove the clinical need for earlier reassessment when the patient's condition changes substantially during that period.

The practical implication for Lifestyle Medicine programmes in Viet Nam is important. Dietitians and nutrition professionals, nurses, exercise professionals, health coaches and other members of an interdisciplinary team may identify medication-safety concerns, support appropriate monitoring and communicate relevant changes to the clinical team. They should not independently instruct a patient to change a prescription unless they have the legal authority and professional scope to make that prescribing decision.

Clinical pharmacy can strengthen this process. Decree No. 131/2020/NĐ-CP, which remains in force, regulates clinical pharmacy activities in healthcare facilities. For individual patients, clinical pharmacy activities include reviewing indications, contraindications, drug selection, dose, route and timing of administration, clinically relevant drug interactions and adverse drug reactions, as well as participating in monitoring medication use and providing medication-related advice in coordination with practitioners. This provides a strong basis for involving clinical pharmacists when patients have multimorbidity, polypharmacy or complex medication regimens that may be affected by substantial lifestyle change.

What should healthcare organizations build into Lifestyle Medicine care?

If Lifestyle Medicine is delivered only as education about food, exercise, sleep or stress, medication safety can easily remain outside the programme. A safer clinical model connects lifestyle treatment with medication review, risk assessment, appropriate monitoring and timely access to the practitioner responsible for prescribing.

Before a higher-intensity lifestyle intervention begins, the team should know what medications the patient takes, why each is being used and which treatments may require earlier reassessment if clinical parameters change. The care plan should make clear what will be monitored, who reviews the information, what findings require earlier contact and who has authority to change treatment. When several specialists are involved, responsibility for medication decisions should also be clear enough to reduce conflicting instructions, duplication and gaps in follow-up.

Electronic health records can support this process when medication changes, lifestyle goals, home monitoring and laboratory results are visible to the relevant care team. Clinical pharmacists can add another layer of safety, particularly for patients with multimorbidity, polypharmacy, complex interactions or medications requiring close monitoring.

This is also an area suitable for quality improvement. Healthcare organizations could examine whether medication review occurs before intensive lifestyle treatment, whether patients at higher risk have a documented monitoring plan, whether medication-related adverse events occur, whether treatment changes are communicated to the appropriate clinicians and whether follow-up occurs after medication adjustment. In this way, deprescribing becomes part of a governed clinical pathway rather than an informal consequence of lifestyle advice.

What should patients understand?

The most important message is straightforward: successful lifestyle change can alter medication needs, but prescribed medication should not be changed without appropriate clinical review.

Patients should tell their healthcare professional when they are planning a substantial change in diet, energy intake, physical activity, alcohol use or smoking, particularly if they take medications for diabetes, blood pressure, anticoagulation, kidney or heart disease, or medicines known to interact with smoking. The same principle applies to prolonged fasting or major dietary restriction when relevant medications are being used. Significant weight change, repeated changes in home glucose or blood-pressure readings, and new symptoms should also be discussed rather than managed by independently reducing, stopping or increasing medication.

Lifestyle Medicine and pharmacological treatment should not be presented as competing choices. They are therapeutic tools that can be used together, and the balance between them may change as a person's health, risks and treatment goals change.

The better question is not “Can I stop my medication?”

A more useful question is: “Now that my health and physiology are changing, is my current treatment still the safest and most appropriate treatment for me?”

Sometimes the answer will be a lower dose. Sometimes one medication may no longer be required. Sometimes a different treatment may be more appropriate. In other cases, continuing the existing medication will remain the safest choice because important cardiovascular, kidney or other benefits remain even though a particular biomarker has improved.

For Lifestyle Medicine in Viet Nam, this distinction matters. The field should not promise freedom from medication. Its contribution is to address modifiable drivers of chronic disease using evidence-based care while making sure that medication and other treatment evolve safely as the patient's needs change. When lifestyle treatment and medication management are connected in this way, deprescribing is not a measure of success by itself. Appropriate treatment is.

References

1. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443-451. First published online 28 October 2025. doi:10.1177/15598276251379821.

2. Rosenfeld RM, Grega ML, Karlsen MC, et al. Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine. 2025;19(2 Suppl):10S-131S. doi:10.1177/15598276251325488.

3. Macfield J, Staffier KL, Kelly J, Moghe R, Karlsen MC. Medication Deprescribing Practices Among Lifestyle Medicine Providers: A Cross-Sectional Survey. American Journal of Lifestyle Medicine. Published online 27 March 2026. doi:10.1177/15598276261430281.

4. American Diabetes Association Professional Practice Committee for Diabetes. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes, 2026. Diabetes Care. 2026;49(Suppl 1).

5. American Diabetes Association Professional Practice Committee for Diabetes. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes, 2026. Diabetes Care. 2026;49(Suppl 1):S183-S215. doi:10.2337/dc26-S009.

6. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11). doi:10.1161/CIR.0000000000001356.

7. Kidney Disease: Improving Global Outcomes. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 2024;105(Suppl 4S):S117-S314.

8. Office of the National Assembly of Viet Nam. Document No. 26/VBHN-VPQH consolidating the Law on Medical Examination and Treatment. 26 February 2026.

9. Ministry of Health of Viet Nam. Circular No. 26/2025/TT-BYT on prescriptions and prescribing of chemical drugs and biological products in outpatient treatment at medical examination and treatment establishments. 30 June 2025.

10. Government of Viet Nam. Decree No. 131/2020/NĐ-CP on the organization and activities of clinical pharmacy in medical examination and treatment establishments. 2 November 2020.

11. NHS Specialist Pharmacy Service. Considering drug interactions with smoking and Managing specific interactions with smoking.

12. Cambridge University Hospitals NHS Foundation Trust. Dietary advice for patients taking warfarin. Version approved 16 April 2025.

This article is intended for professional education and general information. It does not provide an individual medication plan. Patients should not stop, reduce, increase or otherwise change prescribed medication without appropriate review by a qualified healthcare professional.

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