Gimmee a Pill!

When I was a child I had four great-grandparents.  Two were from Russia and two were from Poland.  My grandparents were actually born in the United States.  My last great-grandparent died at the age of 96 when I was 31 and in training after medical school.  She was someone I knew as a full person and not just as a grandparent.  Interestingly enough she actually came to the United States not once but twice.  She returned to Russia because she did not like the conditions in New York City when my maternal grandmother was five years old.  She quickly returned to the United States when she got back to Russia.

My great grandmother suffered from congestive heart failure and loved to eat anything salty.  Pickles, lox you name it she ate it and then she would call me up and complain she was short of breath.  She wanted no part of diet restriction and all she would say was “Gimmee a pill”.  Then she would infer that I wasn’t as smart as I should have been because I didn’t have a pill to solve her problem.

We as a population have become much like my great grandmother.  Maybe she was on to something.  The area of life which comes to mind the fastest is that of weight loss.  No one wants to hear or deal with the knowledge base we have.  Eat less, actually a great deal less, and get some exercise, actually a great deal of exercise, and guess what?  You will lose weight and keep it off.  Whoa that’s just not going to cut it. “Gimmee a pill” screams America and what America wants is big Pharma to continue to serve up.

What is a significant weight loss induced by pills?  Give up?  One would hope it would be 20-30 pounds, or in the case of gastric bypass or the Biggest Loser TV show, at least an entire person worth.  You will find out that’s not the case.

Should drugs even be used in what is generally a self induced problem?  Obesity is epidemic in this country, and childhood obesity has become a national disaster that will dwarf all health care spending deficits.  As you will see in my next blog, approving these drugs is not an easy task, and as most people will remember the diet drug combo known as Phen-Fen was removed from the market only when its serious side effect of heart valve problems became an issue.  This has made it even harder to approve these drugs as the heart problems did not become evident for many years after the drugs were marketed.  What is “reasonably safe” and is this a problem for which there is a “medical solution”?

I will discuss these issues in my next blog.  Until then I’m going for ice cream.

Tags: childhood obesity, congestive heart failure, Obesity, weight loss
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Losing Weight to win at Life

In my last blog I wrote about the Metabolic Syndrome. This syndrome figures very prominently in the day to day practice of medicine. The syndrome increases the risk of death and can be treated. However, the treatment is very difficult. Guess what the best treatment is…losing some weight. Although I am not kidding we all know just how difficult that can be.Therapeutic lifestyle modification which includes reducing weight, the total intake of fat and saturated fat, increasing the intake of fiber and increasing physical activity can make a major difference.

In one study of 522 patients 172 men and 350 women who were followed for 3.2 years the risk of diabetes was reduced by 58%. In another study the average weight loss in the treatment group was 9lbs and in the control group was 1.75 lbs.

After therapeutic lifestyle modification, medicine helps to control many of the factors. Stopping smoking is of course a major concern and in another blog I will write about the issues with the various methods.

The drugs are the standard ones we use to treat the specific issues. For high blood pressure, ACE (angiotensin converting enzyme) inhibitors are very helpful. They also are useful in the protection of kidney function in those patients who have diabetes. If you are allergic to ACE inhibitors than ARB’s (angiotensin receptor blockers) are useful but more expensive as they are not yet generically produced.

The treatment of high triglycerides and low HDL is difficult as this is often genetically based. Exercise will help raise HDL’s by 10% and weight lose will often be enough to bring the triglycerides into range. The use of statins will help some, and they are often used because the entire lipid profile is off. Fibrates and niacin are also helpful, but as mentioned in other blogs (July 30, June 19) we are now working on a drug to use instead of niacin because of its poor tolerability.

Diabetes is treated in the usual manner by diet and at times medication, metformin is very useful in this syndrome. Exercise also helps.

Often patients are sick through no fault of their own. This is one area that hard work and lifestyle can make you better. If you think you have this the next step is simple, see your doctor and get to work. The life you save is your own.

Tags: ACE, ARB, diabetes, HDL, lipid profile, Metabolic Syndrome, Therapeutic lifestyle modification, triglycerides, weight loss
Posted in Coronary Artery Disease, High Blood Pressure | No Comments »