How meds put your health in a ‘chicken and the egg’ loop

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 the chicken and egg scenario 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 three — any three — and discontinue the rest.”

Now, that was probably going a little too far the other way, but there is definite wisdom in his advice…

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Pills, pills and more pills

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.

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It’s no wonder then, that in the past 20 years, the total number of prescriptions filled by Americans increased nearly 85 percent 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.

Pills make a strong band-aid but not a cure

It all works together, but is it the best solution? And did anyone address all the lifestyle factors that contributed to the 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 their 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 or the 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.

With your doctor’s blessing, and commitment on your part, you may find you’ll feel better on your journey to better health with fewer meds and better foods.

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Dr. Elizabeth Klodas MD, FACC

By Dr. Elizabeth Klodas MD, FACC

"Diet is a major driver of high cholesterol, but instead of changing the food, we prescribe medications. This never seemed logical to me.” Dr. Klodas has dedicated her career to preventive cardiology. Trained at Mayo Clinic and Johns Hopkins, she is the founder and Chief Medical Officer for Step One Foods. Dr. Klodas is a nationally sought out speaker and has an active role at the American College of Cardiology. Her clinical interests include prevention of heart disease and non-invasive cardiac imaging and she has published dozens of scientific articles throughout her career. Dr. Klodas has been featured on CNN Health for her mission to change how heart disease is treated. An independent study performed at leading medical institutions affirmed the ability of Step One Foods to deliver measurable and meaningful cholesterol-reduction benefits in the real world. The results of the trial were presented at the 2018 American Heart Association’s Scientific Sessions. Dr. Klodas has also authored a book for patients, "Slay the Giant: The Power of Prevention in Defeating Heart Disease," and served as founding Editor-in-Chief of the patient education effort of the American College of Cardiology. In addition to her practice and her duties at Step One Foods, she also serves as medical editor for webMD.