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What Doctors Don’t Tell You
Author: Cleaves M. Bennett MD FACP
Monday, January 07, 2008

Here are twelve things that doctors don’t tell you when they write out the prescriptions for your high blood pressure or high cholesterol or both:

  1. “David, I’m sorry to be the one to tell you this, but you’re going to have to take this prescription medicine every day for the rest of your life! As long you continue eating and living the way you do, you will need this medicine, and probably even a few more medicines as the months and years go by. Well, we’ll just have to see how it goes.”

  2. “Prescription medicines can lower the blood pressure and cholesterol numbers, there’s no doubt about that. However, there is only a small chance, say about 1% to 2% (to maybe as high as 5%), that this medicine will actually benefit you personally, by preventing a stroke or heart attack that you would have had over the next 4 to 5 years. A 1 to 2% benefit, at least that’s what all the studies have shown. They were conducted by the drug company itself, and monitored by the FDA, so you have to believe the results.”

  3. “Bottom line: reducing the risk of, is not the same as actually preventing a heart attack, kidney failure or stroke that somehow we knew you were going to have. If we doctors only knew ahead of time, out of 100 patients which 1 or 2 were going to get a heart attack, we could save all the others the costs and the side effects they would endure. But alas we don’t, so we have to treat everyone and hope for the best. All these drugs have side effects, sometimes quite severe, and to tell you the truth, sometimes I worry if I’m doing more harm than good.”

  4. “There’s something else I have to admit to you. To be absolutely truthful, neither I nor the drug company that makes this medicine can tell you if even the tiny advantage you gain by taking the drug every day for 5 years is still present during the next 5 years, let alone the 5 or 10 years after that. There is simply no valid information after about 3 to 5 years for almost any of the drugs that we doctors prescribe all the time, with the unspoken direction, everyday for the rest of your life.”

  5. Now you are only 43 years old. If you live into your 70’s, your bill for this one drug could be in the tens of 1000’s of dollars. To the extent that your insurance covers the costs at least partially, that is contributing to concerns about bankruptcy for 100’s of large corporations. Even the state and federal governments are very worried about the mushrooming costs of health care and all the drugs that people are taking everyday for the rest of their lives. It’s not just cholesterol and blood pressure pills. Think of all the others you see advertised all the time. Pills for heartburn, ED, diabetes, dementia, thinned bones, menopause, prostate problems, leaky bladders, smoker’s lungs, blocked leg arteries, arthritis, irritable bowel….. the list gets longer every year. And there are 2 or 3 different pills for each of those conditions, often given together at the same time.

  6. “Although we’re treating your high blood pressure this time with only a mild diuretic, I’ve actually never seen anyone bring their pressure down into a safe range with only one medicine. If you continue your present diet and lifestyle, usually it takes two or three drugs, which work in different ways to bring your BP down into a safer range.” “Now can you imagine what a pain in the b___ it’s going to be to take 3 different pills a day that don’t make you feel any better, cost a lot of money and may have very uncomfortable if not dangerous side effects?”

  7. “More bad news. Most people with high blood pressure usually have high cholesterol too, and there are 2 or 3 different kinds of medicines for that as well. Let’s see, that could get us up to 5 or 6 medicines in all. Again, being absolutely truthful with you, I doubt very much if anyone has ever actually tested these combinations of drugs to see if each one remains as effective in combination with the others as it was all by itself in the FDA approved drug studies. At this point, you and I would be in uncharted territory. I wish we knew, but we don’t. And remember, after 3 or 4 years, we don’t know if any of the drugs are still working.”

  8. “If both your blood pressure and cholesterol are high, and your waist circumference is greater than your hips, you may be in really big trouble. You are on the path to come down with diabetes too, although it could take many years before you start showing up with high blood sugars. This deadly combination of problems is called the “metabolic syndrome” because so many things are wrong with your inner metabolism. This syndrome is deadly. This syndrome kills. People with the metabolic syndrome get heart attacks and strokes and diabetes and kidney failure and end up with senile dementia on kidney dialysis in a nursing home. Oh yes, and likely blind with one leg amputated too. This is every senior citizen’s worst nightmare. And 23% of adults have it right now. Almost one in four. Better go check your waist.

  9. Ok, so here’s how treating your high cholesterol and blood pressure with pills tallies up so far: Maxide $43, Cozaar $65, Norvasc $60 and Vytorin $100 = $270 per month. For 10 years that totals over $32,000, assuming the prices don’t rise. And remember, there’s only a small chance that any one of the drugs will benefit you personally. Even that small chance may be diminished further because of the combination with other drugs, and because you will be going out beyond the 5 year window in which the drug company actually tested the drug and has shown a benefit. None of these pills is going to prevent diabetes. In fact Maxide is very likely to hasten its onset. Getting old in America is not for sissies.

  10. Bottom line: pills help, but they’re not anywhere near 100% effective.

Most people who take them are actually not receiving any benefit from them other than making their blood test numbers look better. For Lipitor, the best selling drug of all time, only a small percentage (about 1 or 2%) of people taking the drug receive any benefit such as preventing a heart attack or stroke. You must have other risk factors for heart disease as well. This would include smoking, + family history, obesity, diabetes, etc. If all you have is a high cholesterol with no other risk factors, it has not been shown that there is any benefit to lowering your high cholesterol with drugs. Lipitor is expensive, it does not make you feel any better and some of the side effects are life threatening. You do not see any of these facts mentioned by the happy people in their TV ads.

  1. You can do just as well by changing your diet to or near the diet for which our bodies are genetically adapted, the hunter/gatherer diet. This is high complex carb, very low fat, low salt, high protein and high vitamin, mineral and fiber diet. There’s more.

  2. Regular, near daily exercise that makes you sweat and tires you out physically, carried out over at least ½ hour brings benefits at every level of human wellness, strength and longevity. Exercise is essential to blood pressure and cholesterol reduction and effective stress management. After exercise you may find yourself more relaxed. There are a variety of other ways to relax, including meditation, yoga, biofeedback and oily massages in candlelight to name a few. Formerly for rock stars and gurus, these and other relaxation techniques are almost mainstream now at the start of the 21st century. For most, diet improvement is not enough. Daily exercise and relaxation techniques are the other two legs of the stool. You do not want to sit down on a one or two legged stool!!

I did this as a total program myself. In my 30’s I was a sedentary, stressed out, pack-a-day doctor eating a typical high fat/salt diet with a few too many inches around the middle. My grandfather, after whom I am named, was also a doctor. Tragically he had died of a hypertension induced heart attack at age 60 when I was still a baby. In fact, none of the males in my family made it to collect Social Security. I had a just-in-time epiphany which most probably has saved my life.

I quit smoking and after 2 or 3 years to clear out my lungs I started jogging. I worked with Nathan Pritikin, of the lowest fat diet fame, and after a few months of dancing around the edges, went on his diet very strictly. Over a period of about 12-18 months I dropped my cholesterol 100 points, from 240 to 140. I was jogging 6 to 10 miles a day, lifting weights 3-4 days a week, my waist size was about 31 in. and I was in fine shape. When I turned 50 I ran 2 marathons, during the second improving my time by > ½ hour.

I’ve kept my blood pressure and cholesterol low over the next 20+ years and avoided the family genetic curses, high blood pressure and cholesterol and diabetes. I still walk twice daily, seven days a week with my dogs. Mentally I am at the top of my game. I face the world with the same enthusiasm and confidence I had in my 30’s and 40’s.

If I can do it, so can you.

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