Integrative-medicine pioneer Andrew Weil, MD, talks about why Americans are taking too many drugs.
When Andrew Weil, MD, was growing up in the 1940s and 1950s, doctors wrote prescriptions in Latin. To fill that prescription, “you had to hand it to a pharmacist who stood behind a high counter intended to prevent you from seeing what he did,” Weil writes in his new book, Mind Over Meds: Know When Drugs Are Necessary, When Alternatives Are Better — and When to Let Your Body Heal on Its Own.” The upshot? Patients had no idea what medications they were taking.
Although times have changed and the Internet has made health information widely available, Weil notes, people still do not ask enough questions about the medicine they’re prescribed. That’s just one reason, he says, why prescription drug use in the United States has increased tenfold in the past 50 years, and over-the-counter drug use has skyrocketed as well.
Drugs are certainly life-saving in critical and acute illnesses, Weil notes, but when it comes to chronic illnesses such as diabetes, high blood pressure, heart disease, and GERD, lifestyle changes such as dietary change, exercise, and stress relief are critical. “Taking a drug just because a doctor says so is not necessarily a good idea,” he counsels. “Always try to understand why you need it.”
To get a better sense of when to take drugs — and when to look for alternatives — we spoke to Dr. Weil. Here’s what he had to say:
Dr. Weil, you’ve spent the majority of your career in integrative medicine, using lifestyle-based approaches such as nutrition, movement, and mind-body medicine to tackle the chronic-disease epidemic. Why do you think prescription drug use in the United States has increased so dramatically in the past 50 years?
Andrew Weil | Drug makers have had a profound influence on both physicians and the general public. The information that doctors rely on when prescribing typically comes from industry rather than objective sources. For example, pharmaceutical companies commonly fund research. In these studies, drugs are typically pitted against a placebo, almost never against diet and lifestyle changes that may work as well or better. The results drive clinical practice.
Advertisements paid for by Big Pharma are the major revenue source for medical journals, a situation that compromises editorial objectivity. The current medical school curriculum and the influence of Big Pharma condition doctors from their first days of training and throughout years of practice to have more faith in the power of prescription drugs than in the healing power of nature.
Regarding the public, direct-to-consumer marketing by drug companies has increased demand for their products. Due in part to this type of advertising, people have a strong desire to be medicated, believing it to be the only or the best way to effectively treat disease. Direct-to-consumer marketing by Big Pharma should be banned.
Lastly, many people prefer the “quick fix” of popping a pill. Nondrug therapies, such as lifestyle modification, require motivation and active participation on the part of patients and may take time to produce desired results. And the pill, as opposed to safe and effective nondrug approaches, is usually covered by insurance.
AS | When it comes to chronic disease, why do so many doctors prescribe drugs as a first-line treatment instead of using lifestyle modifications?
AW | Current medical training is heavy on high-tech treatment options, including drug therapy, and neglects the power of prevention, the impact of positive diet and lifestyle changes, and evidence for the safe and effective use of natural remedies and complementary therapies. With little or no background in these areas, healthcare providers are left to rely almost solely on medication. The circumstances outlined in question No. 1 further complicate matters.
My colleagues and I at the University of Arizona Center for Integrative Medicine are working to improve medical education so that future healthcare providers enter practice with an understanding of how to support and optimize a patient’s innate healing capacity. Of course, drug therapy is an important method for maintaining health and treating disease — but it’s not the only method.
AS | What are the consequences of overmedication?
AW | Safety is the biggest concern – polypharmacy (being on multiple medications) increases the odds for adverse reactions, drug interactions, and the unintended worsening of health problems.
Another worry is cost — the markup on pharmaceutical drugs is greater than on any other commodity in the marketplace. Big Pharma justifies this by citing the high cost of research, but that represents a small fraction of what they spend on advertising and promotion.
There are also environmental concerns — we get exposed to drugs that are excreted from the body or thrown out because they accumulate in our water supplies, in the soil, and in the foods we eat.
Overmedication also contributes to the pervasive notion that drugs are the only answer, but drug therapy is often best at hiding symptoms. Drugs alone do not address the root cause of disease.
AS| You have a very evocative statement in your book: “No difference exists between a drug and a poison except dose.” What do you mean by that?
AW | All drugs become toxic as the dose is increased. Doctors generally believe that the best medications are those that are powerful and work quickly. Unfortunately, concentration of pharmaceutical power inevitably concentrates toxicity. These potent agents are necessary in cases of severe illness, where benefit outweighs risk, but they are now used for almost every disease condition, even mild ones.
Strong reliance on these isolated, purified chemical compounds produces a high incidence of adverse reactions, ranging from mild discomfort to multisystem failure and death, even when the drug has been prescribed appropriately. Herbal remedies are far safer because the active components are present in a complex natural balance and in low concentrations.
AS | You write in your book that you want people to become wise consumers when it comes to medicine — to know when pharmaceutical products are really needed. So when are they needed?
AW | Use of pharmaceuticals should be limited to those situations where they are clearly indicated — critical care, terminal care, and the management of severe disease. I would like to see them play a smaller role in the treatment of common conditions where the risks are not justified. For chronic disease management, drug therapy should be offered in the context of comprehensive care that also includes lifestyle modification and nondrug therapies. Both doctors and patients need to become knowledgeable about less expensive and less dangerous interventions that are safe and effective.
AS | Are there any heartening trends afoot? What will it take, in your opinion, for more doctors to adopt a lifestyle-first strategy to tackle the chronic disease epidemic?
AW | We are faced with the growing realization that over-reliance on prescription-drug therapy has come at a terrible price — worsening antibiotic resistance and an unprecedented opioid addiction and an epidemic of serious adverse drug reactions are some of the most disturbing developments. Doctors are responding by prescribing fewer antibiotics for viral illnesses such as colds and the flu (antibiotics do not work against viruses), and by recognizing that narcotic medications are only indicated for short-term pain management following acute injury or surgery — they are not effective for the relief of chronic pain. In contrast, positive lifestyle changes such as an anti-inflammatory diet and healthy stress-management practices, as well as complementary therapies including acupuncture and mind-body techniques, are safe and effective ways of managing chronic pain.
Crisis offers opportunity. In these challenging times, my hope is that as a country we see the wisdom of integrative medicine and the lifestyle habits it encourages as part of the solution to our healthcare crisis.
Health and Wellness Associates
Dr Anne Sullivan
Heart-Healthy Lifestyle Tied to Lower Drug Costs
People with heart disease spend a lot less on medications when they take steps to lower their risk of complications by doing things like getting enough exercise, avoiding cigarettes and keeping their blood pressure in check, a U.S. study suggests.
For the study, researchers focused on adults diagnosed with the most common type of heart disease, known as atherosclerosis, which happens when fats, cholesterol and other substances build up on artery walls.
When these patients did as much as they could to avoid so-called modifiable risk factors for heart disease – inactivity, obesity, smoking, high cholesterol, elevated blood pressure and diabetes – their total average annual pharmaceutical expenditures were $1,400, the study found.
But patients who did little to modify these risk factors had total average annual pharmaceutical expenditures of $4,516, researchers report in the Journal of the American Heart Association.
“Individuals who are unwilling to modify their lifestyles so as to have a favorable risk factor profile would most likely resort to medications to control the risk factors,” said lead study author Dr. Joseph Salami of the Center for Health Care Advancement and Outcomes at Baptist Health South Florida in Coral Gables.
“A person getting little or no exercise has a higher risk of obesity,” Salami said by email. “Someone obese is more likely to have diabetes, high blood cholesterol and hypertension.”
For the study, researchers examined 2012 and 2013 data from the Medical Expenditure Panel Survey, a national snapshot of spending based on surveys of almost 76,000 American patients, families, doctors and employers. The total pharmaceutical costs, reported in 2013 dollars, include patients’ out-of-pocket fees like co-payments and co-insurance as well as the portion of the tab covered by insurance or other sources, Salami said.
Among the survey participants, 4,248 adults aged 40 or older had atherosclerosis, representing about 21.9 million people in the U.S. population. They were 68 years old on average, and 45 percent were women.
Overall, average annual drug costs for each participant were $3,432. About a third of this was for cardiovascular disease drugs and another 14 percent was spent on diabetes medicines.
The remaining expenditures – more than half of the total – were for non-cardiovascular disease and non-diabetes drugs and were significantly associated with the modifiable risk factors, the study team notes.
Nationwide, this adds up to annual drug spending of $71.6 billion for patients with atherosclerosis, researchers estimated.
One limitation of the study is that it might overestimate expenditures because it’s possible some people prescribed medications for heart disease might be taking them for other reasons, the authors note. Researchers also lacked data on the type of insurance patients’ had or for individual characteristics of patients, doctors or pharmacists that might influence drug costs.
Costs should be considered in the context of how well treatments work, and the study doesn’t address this, noted Dr. Aaron Kesselheim, a researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston who wasn’t involved in the study.
“In some cases, the benefit that patients get from these non-pharmacologic therapies may be much more substantial than the benefit that drug therapy can offer,” Kesselheim said by email. “In other cases, the drug might be more helpful.”
The study also isn’t a controlled experiment designed to prove that people will spend less on drugs when they make lifestyle changes to reduce their risk of heart disease, said Julie Schmittdiel of the Kaiser Permanente Northern California Division of Research in Oakland.
“It does suggest there is promise that addressing modifiable health behaviors will reduce costs,” Schmittdiel, who wasn’t involved in the study, said by email.
Knowing this might help motivate some patients to make changes, said Stacie Dusetzina, a pharmacy researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.
“I think many of us realize how hard these risk factors are to modify,” Dusetzina said by email. “But having incentives that include feeling better and saving money may help with motivation.”
Health and Wellness Associates
Archived: Jane Blakemore
Dr A Sullivan
How Statins Degenerate Your Brain Health
Tens of millions of people are taking drugs to lower their cholesterol levels. Most of those medications are in a drug class known as statins. Some doctors are even starting to recommend children use statin drugs to control their cholesterol levels.1 I couldn’t disagree more.
The challenge with statin drugs is that they address surface issues with cholesterol in a simplistic manner. But your body is a complex organism that uses cholesterol every day to build new cell walls, in the formation of vitamin D and in the production of hormones.
Statin drugs are HMG-CoA reductase inhibitors. They function by blocking the enzyme in your liver that naturally produces cholesterol for your bodily functions.
The drug essentially reduces your total cholesterol number, without addressing your high-density lipoproteins (HDL), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL) or triglyceride levels.
While your total cholesterol number gives you a general overview, it isn’t the information needed to evaluate your risk of cardiovascular disease. Instead, you’ll need to compare your HDL, LDL, VLDL and triglyceride numbers against your total cholesterol.
Statins May Trigger Neuromuscular Disease
Statin drugs are notorious for causing side effects like muscle damage and weakness. What has been less publicized is a potential link between statins and a progression of muscle wasting that may lead to a diagnosis of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
The World Health Organization (WHO) Foundation Collaborating Centre for International Drug Monitoring receives safety reports associated with statin medications and has noted a disproportionately high number of patients with upper motor neuron lesions among those taking statin medications.2
The lead researcher, Ivor Ralph Edwards, is an expert in toxicology, acute and chronic poisoning and adverse drug reactions.3 He also is the senior adviser at the WHO Uppsala Monitoring Centre in Sweden, and he says:4
“We do advocate that trial discontinuation of a statin should be considered in patients with serious neuromuscular disease such as the ALS-like syndrome, given the poor prognosis and a possibility that progression of the disease may be halted or even reversed.”
Researchers from Johns Hopkins Medical School cautioned patients that although they discovered a link between taking statins and the development of a rare neuromuscular autoimmune disease, this condition could be treated with steroids and other immunosuppressive drugs.5
The researchers stated there was no need to fear this popular “fantastic medication.”6
Dr. Andrew L. Mammen, a neurologist who treats patients with statin-associated myopathies at Johns Hopkins University School of Medicine, is quoted in a Johns Hopkins press release saying, “Statins save a huge number of lives. They dramatically reduce the risk of strokes and heart attacks.”
The implication is you need statins in order to reduce your risk of heart attacks and strokes, and you should take them despite the risk for developing a degenerative neurological disease for which you will require medication to suppress your immune system.
This despite the knowledge that total cholesterol numbers are not indicative of your overall risk for cardiovascular disease. I would advise you to seriously evaluate the risks and benefits and consider your alternatives before you start taking a statin drug.
More Adverse Effects of Statins
In 2012 Golomb was recognized for a study she led on muscle and tendon adverse events linked to statins, which showed that muscle problems were related to the strength of the statin being taken.8
Other studies concur that side effects from statin drugs may be different for different patients depending upon your past medical history, the particular statin and the dose used.9
Research from the London School of Hygiene and Tropical Medicine suggests that research results have been “cherry-picked” so the results presented the best possible light for the drug company.10 According to Pacific Standard:11
“Sometimes the negative side effects of statins are downplayed, and conclusions can be skewed by the limited parameters of the trials. As a 2007 Scripps Mercy Hospital study noted:
‘The incidence of statin-induced rhabdomyolysis (acute breakdown of skeletal muscles) is higher in practice than in controlled trials because of the exclusion of potentially susceptible subjects.'”
Another study found 17 percent of patients suffered side effects that included muscle pain, nervous system problems and nausea.12 Two-thirds who reported side effects stopped taking the drugs and approximately half stopped at least temporarily.
A review of the literature, published in the American Journal of Cardiovascular Drugs, evaluated 900 previous studies looking at the adverse effects of statin drugs.13
Adverse effects are dose-dependent, and your health risks can be amplified by a number of factors, such as taking other drugs (which may increase statin potency), metabolic syndrome or thyroid disease. Some of the consequences of taking statin drugs in strong doses or for a lengthy amount of time include:14,15,16
High blood sugar (type 2 diabetes)
Lower back or side pain
Loss of consciousness
Blistering or peeling skin
Immune system suppression
Polyneuropathy (nerve damage in hands and feet)
Increased risk of cancer
Degenerative muscle tissue (rhabdomyolysis)
If You Feel You Must Take Statins You Need to Take Ubiquinol or CoQ10
Statins work by inhibiting the enzyme your liver uses to produce cholesterol. However, the same pathway may promote the suppression of the precursor to coenzyme Q10 (CoQ10), an antioxidant your mitochondria uses to produce energy. In theory, when your body is deficient in CoQ10, mitochondrial energy production is depressed, which may trigger or accelerate neuropathies like ALS.17
If you take statin drugs without taking CoQ10 or the reduced form, ubiquinol, your health may be at serious risk. Unfortunately, this describes the majority of people who take statins in the United States. The loss of energy at the cellular level can damage your mitochondrial DNA and set into motion a vicious cycle of rising free radicals and mitochondrial damage.
CoQ10 is an effective adjunct treatment for heart failure, an important piece of information as statins may decrease the function of your heart muscle.18 In this study researchers found the control group, those who were not taking statin drugs to protect their cardiovascular health, fared better.19 They concluded, “Statin therapy is associated with decreased myocardial function as evaluated with SI (strain imaging).”
The importance of your mitochondrial energy function can’t be overstated. Statin Study Group, led by Golomb, concluded the malfunction of mitochondrial energy production due to the interference of statin medications was the underlying causative factor in all of the adverse effects associated with the medication.
After reviewing the evidence, if you choose to take a CoQ10 supplement it’s important to take the form your body can easily assimilate.20 CoQ10 can typically be used by people 30 and younger. However, if you are over 30 you’ll want to consider ubiquinol, the reduced version of CoQ10, as it is far more effective.
LDL Particle Number More Important Than Total Cholesterol
It is likely the focus on lowering cholesterol has missed the boat completely, as high total cholesterol is not the cause of heart disease, unless it’s over 300. Other risk factors are much more powerful. One of the more important tests you may consider to determine your real risk of heart disease is the NMR LipoProfile, which measures your LDL particle number.
This particular test also includes markers to determine if you are insulin resistant, a primary cause of an elevated LDL particle number. When your insulin secretion rises, so does your cholesterol production. Elevated insulin levels, or a decrease in insulin sensitivity, is related to the foods you eat and your exercise. Two other blood test ratios that will tell you more about your cardiovascular disease risk are:
HDL to total cholesterol ratio. This is a fasting test and should be higher than 25 percent. It measures the amount of HDL you have against your total cholesterol number.
Triglyceride to HDL ratio, which should be below 2.
Health officials in the United States urge everyone over the age of 20 to have their cholesterol tested once every five years. Part of this test is your total cholesterol, or the sum of your blood’s cholesterol content, including HDL, LDLs and VLDLs.
Keep in mind these are still simply guidelines, and there’s a lot more that goes into your risk of heart disease than any one number can tell you. It was only after researchers found total cholesterol was a poor predictor of heart disease that HDL and LDL cholesterol were measured. They give you a closer idea of what’s going on, but they still do not show you everything.
Naturally Improve Your Cholesterol Levels
The only time there is a real reason to take medications to control your cholesterol level may be if you suffer from familial hypercholesterolemia. This is a genetic condition, passed down through your family. It begins at birth and affects your LDL levels, sometimes causing heart attacks at an early age.21
In other instances, your cholesterol can be controlled by making different lifestyle and nutritional choices. The fact is that 75 percent of your cholesterol is produced by your liver, which is influenced by your insulin levels.22,23 This means if you optimize your insulin levels you will also be optimizing your cholesterol levels. In order to safely regulate your blood sugar, insulin sensitivity and cholesterol levels it is important to modify your diet and lifestyle choices.
Optimize Your Vitamin D Levels
Sensible sun exposure will help normalize your cholesterol levels and prevent heart disease.24
Don’t take Vitamin D without talking to a healthcare professional about the type and amount you need to take for YOU. If they don’t know, they will tell you to take anything you want. Also, ask is there anything you need to take with Vitamin D, because Vitamin can never be taken alone.
Normalize Your Weight and Reduce Carbohydrates, Especially Fructose
Normalize your weight using a plan of eliminating grains and sugars in your diet. Take special care to get no more than 25 grams of fructose each day. These products spike your insulin level and trigger the development of cholesterol. Ideally, you’ll also want to consume a good portion of your food raw.
Include Heart Healthy Foods
Make sure you are getting plenty of high-quality, animal-based omega-3 fats. Other heart-healthy foods include olive oil, coconut and coconut oil, organic raw dairy products and eggs, avocados, raw nuts and seeds, and organic grass-fed meats.
Increase Your Daily Movement and Exercise Regularly
While I strongly recommend incorporating Peak Fitness exercises, which also optimize your human growth hormone (HGH) production, non-exercise movement may be even more important. Ideally, stay active as much as you can each day. I recommend standing up at work, and try to get as much walking in as possible. Then, in addition to that, aim for a comprehensive fitness program that includes strength training and high intensity exercises.
Reduce Your Stress Levels
Each of us experience stress in a fast-paced life. You may consider addressing your emotional challenges using my favorite technique for stress management, Emotional Freedom Techniques (EFT). You can easily learn to use these techniques at home and incorporate them even when you’re out and about.
Improve Your Sleep Quality
High quality sleep helps reduce your stress levels, normalize your insulin levels and function optimally through the day. If you have trouble falling asleep or staying asleep you may want to try some of the strategies in my previous article titled, “Want a Good Night’s Sleep? Then Never Do These Things Before Bed.”
Avoid Excessive Alcohol or Tobacco
Alcohol is high in net carbohydrates, which affect your insulin levels. Tobacco has an effect on your arterial system, temporarily raising your blood pressure.
Replace Vegetable Oils
Replace harmful vegetable oils and synthetic trans fats with healthy fats, such as olive oil, butter and coconut oil (remember olive oil should be used cold only; use coconut oil for cooking and baking).
Include Fermented Foods
Include fermented foods in your daily diet. These will not only optimize your intestinal microflora, which will boost your overall immunity, but will also introduce beneficial bacteria into your mouth. Poor oral health is another powerful indicator of increased heart disease risk.
Don’t Quess, ASK!
If you have any questions or need a healthcare plan just for you, then call us, set up an appointment and let us work together on this.
Health and Wellness Associates
Archived : JM
Why Grapefruit and Medications Can Be a Dangerous Mix
Before you cut into that grapefruit ( or tangelos or seville oranges )or down that glass of juice, be sure to check whether it is safe to pair grapefruit with the medications you are taking. This includes vitamins and supplements.
Both the juice and the fruit itself can interact with more than 50 drugs, such as cholesterol medication and all statins, high blood pressure medication and allergy, cold and flu medications, cardiac meds including coumatin/warfarin, and all injectibles.
Grapefruit and medications could cause problems in two ways. First, grapefruit can block a key drug-metabolizing enzyme in your body, which in turn could lead to increase in the blood levels of certain drugs. IF that happens, it increases the risk of experiencing a side effect from that drug. On the flip side, it can also block absorption of certain drugs in your intestines. In that case, you could have less of the drug in your bloodstream than what you need, so the drug in your bood stream than what you need, so the drug might not be as effective for its intended purpose.
Surprisingly it does not take much of the fruit for a grapefruit and medication interaction to happen. As little as 1 cup of juice and two wedges of the fruit can be enough to cause problems.
If you regularly eat grapefruit or drink its juice find out if your medication interacts with the fruit. Some medications, but not all medictions will be labeled ” Do Not Take With Grapefruit”, or on the inserts when you pick up your medications. These labels will not be on injectibles. Injectibles are sometimes given in a clinic or office, and many times the personnel giving the injection does not know chemical interactions. Dr. David Bailey of University of Western Ontario was the first chemist/pharmacologist to identify this problem with all injectibles.
Watch out for These Grapefruit and Medication Interactions
Besides some of the medications listed in the article
watch out for:
Lipitor, Pravachol, simvastin, Zocor, and all cholesterol medications
All high blood pressure medications, including Afeditab and Procardia
Organ Transplant medications : cyclosporin, Neoral, Sandimmune,
All auto-immune medications for Multiple Sclerosis and Rheumatoid Arthritis
Anti-anxiety medications, including alprazolam, xanax and prozac
All cardiac medications, including amiodarone, Cordarone, Nexterone
All allergy medications, including diphenhydramine ( Benedryl), Allegra and Claritiin
All cough and cold medications
It is also recommended to stop eating tangelos and seville oranges, used to make orange marmalade, because these also affect the same enzyme as grapefruit.
Ask your healthcare worker or the pharmacist if there is another medication that does not act with these fruits. You might find out that they dont know about the tangelos or seville oranges. You Do!
But it is always best, just not to eat the fruits.
Health and Wellness Associates