Chicken and egg

Are you on so many medications because you feel so sick? Or do you feel so sick because you’re on so many medications? At some point, the line between chicken and egg can get pretty blurry.

As a physician, I’ve become almost numb to the giant lists of pills that many patients are on. And there are times when I’ve contributed to that same list by prescribing yet another medication. But I’ve never forgotten the advice I received from a seasoned physician mentor while I was in medical school, who told me “No one should be on more than three drugs. So pick 3, any 3 and discontinue the rest.”

Now, that was probably going a little too far the other way, but there is definite wisdom in his advice. We jump to pills too quickly. There is almost an expectation that something will be prescribed as a result of a medical encounter. And pharma companies spend millions convincing us we need their latest solution for a problem we didn't even know we had.

No wonder that in the past 20 years, the total number of prescriptions filled by Americans increased nearly 85% from 2.4 to 4.5 BILLION per year. During that same time, the number of people taking 5 or more drugs on a regular basis tripled. In fact, it’s no longer unusual to see someone on 10 or more chronic prescription medications. And remember, those numbers do not include drugs available over the counter (like aspirin or Benadryl®) or any supplements.

The effects of all those drugs in infinite combinations in genetically distinct individuals are impossible to predict. But one potential outcome is a side effect to one or more of the medications – which can lead to even more prescriptions. 

For example, you might get placed on amlodipine (Norvasc®) for high blood pressure. That leads to ankle swelling, which lands you on a diuretic (water pill).  That causes low blood potassium levels and exacerbates your overactive bladder.  Which leads to a potassium supplement and finally tips the scale to you going on Myrbetriq®.  All of which actually makes your bladder symptoms better and your ankles skinny again - so you’re happy.  And your blood pressure and potassium levels look good - so your doctor is happy. 

It all works together, but is it the best solution?  And did anyone address all the lifestyle factors that contribute to high blood pressure before starting any drugs in the first place? In case you're wondering, those include high sodium intake, excess caffeine, excess alcohol, excess weight, inactivity, non-restorative sleep, smoking, and pain.

I’ve seen people need far lower medication doses once they reduce their sodium intake.  And people go off of blood pressure medications altogether once they lose weight or their sleep apnea is addressed. Or they stop drinking a pot of coffee - or three gin and tonics - every day.

In my world of cardiology, most of what I treat is related to lifestyle and especially diet.  Which is why I typically spend more time talking about food than about medications with my patients.  And why I started Step One Foods.

Shrinking your medication list can be challenging and takes time - and should never be undertaken without your personal physician's oversight. Each medication was prescribed for a reason and that reason may still need to be addressed. But just because it's a challenge, does not mean it shouldn't be attempted - especially if you're stuck in the chicken/egg scenario. 

So the next time you’re in for a visit with your main healthcare provider, ask to have your medication list critically reviewed with a fresh look to determine why you’re taking what you’re taking – and what might be dispensable over time.  

Changing your diet is a CRITICAL part of this process.  Which is why Step One is here to assist with the nutrition piece. Our foods were formulated specifically to help lower cholesterol, reduce your sodium intake and keep you feeling fuller longer so it's easier to lose weight.  That should help reduce the need for statins, antihypertensives, and blood sugar lowering medications over time.  Or at least help cut the doses back a bit.  

Reducing dependence on prescription medications is a realistic goal for most - and a great resolution for 2019!  And we're here to help.