In 1989 I was preparing a lecture for the residents on the first decade of statins. While reviewing the data two papers reference contained data that formed my future in medicine. The first point was that women suffer heart attacks with normal cholesterol level and the only predictor of a cardiac event was a prior cardiac event. The second paper measured insulin levels in men having cardiac events and the insulin level was more predictive than the cholesterol or use of statins. This data is more than 30 years old and we are just starting to have the dialogue about the use of statins. It also occurred to me throughout my practice, whenever a patient had a cardiac event they were already on a statin. How could this be? So, if statins do not work, how many other drugs do not work or do not improve the lives of patients.
Looking at the most widely used drugs on the market, the list will include drugs for acne, depression, cholesterol, diabetes, and hypertension. Taking into account that the modern world no longer suffers from communicable diseases, are we on the correct path in treating the diseases of the modern patient.
The Hit Parade
Over 20 years ago, I started looking at the vitamin D levels in patients referred for osteoporosis. The drug Fosamax had just been released, and the goal of therapy was to reduce the incidence of hip fractures and spinal fractures. The bisphosphonates, like Fosamax and Actonel, showed marginal improvement and over time were associated with bone structure that put the patient at risk for non-stress fractures of the thigh bone and loss of integrity of the jaw bone with subsequent loss of teeth. But what about the low vitamin D I kept asking. At every scientific meeting, the role of vitamin D deficiency was dismissed. But in 2004 the world health organization declared a worldwide pandemic of vitamin D deficiency. And with that came magnesium deficiency, zinc deficiency, selenium deficiency, vitamin K2 deficiency and on and on and on. Yet at my specialty national meeting and at the local state level the medical societies continued to dismiss the environmental impact of vitamin insufficiency.
In the primate world, the natural vitamin D level is 60 yet the normal range reported by commercial labs is over 30. In fact, the USDA is recommending that is being lowered to 20. This is despite data that shows when a population has mean levels close to 60 numerous diseases of the modern world diminish. This is not lost on Finland when they had a public health initiative that placed all newborns on vitamin D. The result was a 75% decrease in the incidence of type 1 diabetes or juvenile diabetes.
Wait, weren’t we just talking about bones. And now we leaped over to diabetes? Yes, all systems are interdependent and while bone metabolism is dependent on vitamin D, the cells of the pancreas that make insulin also require vitamin D for replication and survival.
Adding insult to injury is the use of medications to combat heartburn. Another drug class marketed as a preventive measure for cancer of the esophagus. During my internship in 1980, our patients survived with Mylanta and Tums. The enormous marketing machine led by pharma industry and Wall Street made heartburn medicine a billion dollar a year industry. What were the unintended consequences? Increase in coronary disease, decreased absorption of calcium and vitamin D, increased renal disease and the list goes on. A recent study in the JAMA reported that patients treated with diet instead of PPI drugs fared better. The diet changes including avoiding caffeine, soda, and alcohol while transitioning to the Mediterranean diet. That means a diet rich in vegetables, fruits, and legumes. There goes another 13 billion healthcare dollars spent unnecessarily.
The data is not looking good for these two classes of drugs. So, let’s move on. Have you watched 10 minutes of television and thought to yourself “Does everyone have diabetes?”. New drugs are flooding the market, the old cheap drugs are being abandoned and no data has shown improved control. Stay with me, if vitamin D is necessary for the pancreas to survive, and the pancreas controls diabetes and antacids decrease the absorption and production of vitamin D. If we take everyone off antacids, give vitamin D to all the patients that are depleted, and change the diet, can diabetes go away? YES. The patients with type 2 Diabetes should be on vitamin D, inositol, magnesium, alpha lipoic acid and a ketogenic diet. I have taken numerous patients off insulin or lowered their use of insulin by 90%. Type 1 diabetes is a different story but I have yet to meet a family with children newly diagnosed with type 1 diabetes that had the vitamin d level of their children measured. WHY? There are 350 billion reasons every year. That is the number of dollars committed to treating diabetes in the US alone. Finland took an aggressive approach to juvenile diabetes and placed all newborns on vitamin d supplement. What happened is a 75% decrease in the rate of new cases and after 3 years, the curve is reversing.
Nothing is more exciting to me than teaching patients how to control their destiny. An 83-year-old came in this past week. Over the year, she has lost 17 lbs., has lowered her use of insulin from 60 units a day to 8 units a day. She supports her pancreas with the aforementioned supplements. Every single patient has been enthusiastic in their desire to come off as much insulin as possible. And they sleep better, have more energy and are excited to lower the huge financial burden of all these drugs.
So, now we know that the drug list includes statins, or cholesterol-lowering drugs, insulin for many patients, antacids and more specifically protonic pump inhibitors PPI but are there more drugs on the hit list? Yes.
The most widely prescribed drugs in the world are psychiatric drugs and acne drugs. Yes, acne. Accutane worldwide lands it in second place for money spent. Seroquel, a potent anti-psychotic is the most widely used sleep aid. Let’s start with antidepressant medications. Our brain is wired to use neurotransmitters for function and consciousness. Putting it simply, we rely on a balance of serotonin, norepinephrine, and dopamine. But where is the serotonin from? Our gut with a feedback loop in the brain that allows further balance with reuptake of the serotonin in the nervous system. The majority of drugs act by inhibiting the reuptake mechanism in the brain. Within 6 months of therapy, the therapeutic response requires increasing doses in order to maintain the desired effect. Why? The brain does not understand where the serotonin is going. The delicate balance is lost.
Eventually, we turn to drugs that modify the metabolism of dopamine and norepinephrine. Head to head studies with exercise, 30 minutes a day proved more effective than these drug classes. Check off another class of drugs we could significantly lower their use. If we add up dollars spent for statins, antacid medications, diabetic drugs, and drugs for depression, what does that number look like? Trillions of dollars. When I do a full medication assessment, the majority of patients benefit from dose lowering if not completely stopping many of these medications. These changes also translate into significant financial relief given the ever-increasing co-pay or deductible burden shouldered by so many patients.
Moving on. Acne. What parent doesn’t feel for their child as they cross the bridge to adulthood and suffer through a period of acne? We have recently been referred a number of patients in their 20s who had one or two courses of the full dose of Accutane. They now suffer from dry eyes, dry mouth, dry skin, depression, anxiety, and numerous endocrine irregularities. It is catastrophic. They find it difficult to eat, suffer from anorexia symptoms and are deficient in numerous nutrients. The patients say that food tastes like dirt and feels like rocks are going through their bowels. It is almost impossible to reverse these symptoms. It is unconscionable for any physician to prescribe this medication without first taking a nutritional approach. We recommend eliminating dairy and wheat, low dose antibiotic, topical antibiotic, skin lasers that eliminate the acne bacteria and if Accutane is used, first try topical retinoid, then oral in extremely small doses, once or twice weekly for six to ten weeks. Close monitoring of liver and kidney function is not required with this regimen.
The next class worth reviewing is the overuse of oral antibiotics leading to a worldwide crisis of antibiotic resistance. The Pew Charitable Trust is funding research on overuse of antibiotics and the looming threat of superbugs, bugs that are resistant to all currently available antibiotics. Let’s do it by the numbers. A third of all antibiotics prescribed in the US is not needed. This translates into about 50 million prescriptions a year. 13 percent of patient visits to doctor offices, emergency rooms, and urgent care clinics results in an antibiotic prescription. Half of the prescriptions were for the upper respiratory symptoms which are mostly viral in nature. This practice of over-prescribing has led to more than 2 million serious infections and 23 thousand deaths in a year due to antibiotic resistance.
The problem is confounded by the increasing use of antibiotics in livestock. Hard to imagine that our addiction to animal products will become another nail in our coffin. Eighty percent of all antibiotics used in the USA are given to animals. This results in the transmission of antibiotic-resistant bacteria in the meat products. It gets better, they excrete the antibiotics in their urine and feces which finds its way into our water supply and soil. But let’s not stop there, antibiotics are sprayed on fruit trees and vegetables as well. As daunting as this problem may seem, next time you ask for antibiotics at your doctor’s office, you are part of the problem, not the solutions. This lesson was brought home to me recently when a patient reported severe asthma attacks and hives after eating an ice cream cone. There was so much penicillin in the dairy product, his severe allergy to penicillin resulted in an immediate allergic reaction at the ice cream stand. I hate to say it but we can only vote with our wallets so support every company that proves they do not use antibiotics in their livestock feed.
Should we total the number of consumer health dollars that are wasted on these classes of drugs? Now you may be saying what is one to do? Educate yourself, come off drugs that are not critical, change your diet, exercise regularly and take up a new hobby. I would add, jump in freezing water once a year, it could prolong your life.
– Patricia Hopkins, MD