Will I have to take my prescription medication forever?

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This topic has come about many times during my professional life as a pharmacist and my answer is always the same, maybe, but only if you really want to. You see in my previous post ‘How big do you really want to get? – Muscle Talk’ I quite plainly wrote we all look like we do as a direct result of the effort we put into it. This is obviously an oversimplified and exaggerated opinion but I hold the same for many things, and whilst for health it is never black and white, the effort you put into your health, in general, is reflected in your condition.

Now I’ll stop all the grumblers right now before we get too far, I am not suggesting those with a genetic condition are at fault, neither am I suggesting that everything that happens to you is a direct consequence of something you did. I am however saying the choices you make, or do not make, can have a significant impact on your health.

The Type II Diabetes Example

Metformin is a medication used for type II diabetics, it increases the body’s ability to utilise insulin and is often the first drug given to type II diabetics. One of my university lecturers hammered into us that type I diabetics tend to thin whilst type II diabetics tend to be fat/big/larger/fuller, however you like to sugar coat it (pun intended). Whilst type I diabetes is a genetic/autoimmune condition (for the majority of cases) a type II diabetic is diabetic due to their physical condition. It’s true, some are unlucky enough to be in a position whereby they are genetically pre disposed to type II diabetes, but most are just fat; plus just because you’re more likely to get something it doesn’t mean you 100% will or cannot take action to reduce your risk.

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Sometimes tough love is what is needed to shock loved ones into facing their problems. You can’t change the cards you are dealt, but you can change how you play them.

Only so much can go around

Imagine you have just invented the greatest tasting juice in the world, but you can only produce 2 litres of this magic juice a day. Two litres is plenty for you but as you start to share it with your friends and family you start to realise that it not enough. Only so much of the juice can go around and soon you find yourself with too little to satisfy your needs. Well insulin works in a similar manner. Your body generally produces what it needs and this amount can vary depending on your requirements, but there is a maximum output and this needs to be respected.

Well done! But has the problem gone away?

As you get bigger and bigger the amount of insulin required to service your size also increase, and this is where the problem starts. Soon you do not have enough for your size and your blood glucose cannot be adequately controlled. So what does your doctor give you? Metformin of course, this helps the body better utilise the insulin that is being secreted and all of a sudden your diabetes is under control. Well done! But has the problem gone away? No, effectively you have just painted over the cracks in the wall, but eventually that structure will crumble. As time passes your pancreas has a hard time keeping up and eventually it begins to slow down, now it really is secreting less. Of course you visit your doctor once again and he prescribes something else. This time the medication not only increases the uptake of insulin but it also increases the amount the pancreas secretes. Well done! But has the problem gone away?

Is Your Medication a Crutch?

I was going to put the sub heading as ‘medication is a crutch for the lazy’ but decided against it because many people lead very busy lives and may be unable to do what is necessary. Whilst that may be true, I can think of only a few reasons so important that your health needs to suffer? If your house was about to fall down do you really think getting to work on time would be you biggest concern. Will getting that new widescreen TV matter if you have no wall to hang it?

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Smoking increases you risk of heart attack, stokes, cancer, respiratory problems and more, yet it’s not unccomon to find patients being treated for these conditions regularly smoking. Are they victims?

What if your marriage was falling apart, would you not invest time into repairing the damage before it completely disintegrates? There is a point of no return and once its crossed there’s only so much that can be done. Like most problems the longer you leave it worse it will get and the more effort will be required to resolve it.

I could write an entire article about the many ways most of us waste our time and create a false sense of busy but that would be beyond the scope of this article and blog, instead let’s discuss exercise.

Exercise does a lot more than just burn calories

When most people hear the word exercise they most associate it with weight loss? I wouldn’t blame you if you did too, but exercise extends beyond weight loss and beyond muscle building too. Excluding the benefits it has on our physical appearance (vanity), exercise also changes us from within.

Endorphins

Countless studies have shown that those who exercise regularly benefit from a positive mind-set, a boost in mood and lower rates of depression. This effect is not only related to the increased self-confidence, which comes from an improved body image, but also from the release of endorphins. Endorphins are the body’s self-secreting antidepressants and no prescription can buy them.

Endorphins are released as a direct result of exercise and interact with receptors in the brain, they have been shown to:

  1. Produce an analgesic effect (a.k.a painkiller) by reducing the brains perception of pain
  2. Improve mood
  3. Reduce stress and anxiety – which are contributing factors to high blood pressure
  4. Improve sleep

Endorphins are the body’s self-secreting antidepressants and no prescription can buy them.

Personally I’ve never been a fan of prescription antidepressants but I will agree they have their place in therapy. Anxiety, depression and sleep disturbances are often conditions accompanied with a minefield of psychological issues that need resolving with the help of a professional, but not you’re GP. No! For the most part these patients need psychological help from someone who is willing to listen for more than a 5 minute consultation. Again this will be going beyond the scope of this article but I would recommend, in addition to regular exercise, you get ongoing help from a psychologist or a therapist if you are suffering from these condition for an extended period of time.

Now back to exercise…

Insulin receptors

 As mentioned earlier type II diabetes is often due to the result of obesity BUT it can also be a result of insulin resistance, this is important. Insulin resistance is why some non-obese people are diagnosed with Type II diabetes; these patients release normal or high level of insulin but there body does not respond to it. Exercise will benefit both groups

For patients that are just too big, exercise will benefit them from a mere size in reduction alone but exercise has also been shown to increase insulin sensitivity. This means the body can use the insulin already being secreted more effectively, like metformin, during and well after exercise. In addition exercise stimulates a non-insulin dependent glucose transport mechanism which allows your cells to take up glucose, and use it for energy, whether insulin is available or not.

For type I and severe type II diabetics on multiple medicines be wary of hypoglycaemia (low blood sugar levels) during exercise and be ready to treat it if needed. If you suffer from diabetes always speak to a specialist before embarking on any fitness regime.

Cholesterol

Oh the famous statins. One of the most commonly prescribed medicines in the world to control cholesterol, but wouldn’t controlling your diet and exercise do the same. Indeed it would. Contrary to popular belief eating foods high in cholesterol, such as eggs, does not cause an increase in blood cholesterol, but a diet high in saturated fat will.

For those with KNOWN heart disease, statins have a NNT (number needed to treat) score of 83. That means for every 83 people treated with them only 1 persons life will be saved. The NNT of statins to prevent a non fatal heart attack is 39, which is 2.5% succes rate, and to prevent a stoke it is 125 (0.8% success). Remember this is for patients with known heart disease, for patients without known heart disease the statistics are less favourable.

At the end of the day eating too much of anything will add fat to your frame, I prefer to use the word fat instead of weight because fat is where the weight comes from, and obesity has been linked with high cholesterol. How much you eat is a matter of self-control and requires an innate understanding of your metabolism. If you have a low metabolism there’s not point comparing yourself to someone with a high metabolism and stating you only eat as much as him/her, that’s ridiculous. Learn how much your body needs for maintenance and accept your metabolism will drop as you age, adapt your diet accordingly WITHOUT comparing yourself to others.

try consuming less saturated fats and more unsaturated fats, particularly monounsaturated fats

Of course for those in the know, you may have read about the emerging data no longer supporting the link between saturated fat consumption, cholesterol and heart disease. To them I’d say “slow down!” Nothing is for certain but the debate sure is interesting. I would not recommend a diet high in saturated fats that for sure but you do not need to avoid fat like the plague. Instead try consuming less saturated fats and more unsaturated fats, particularly monounsaturated fats. This once again is a topic that will need its own article so watch out for that.

In terms of exercise well that has been shown to reduce cholesterol. It works by:

  1. Stimulating enzymes involved in moving LDLs (bad cholesterol) from the blood (and blood-vessel walls) to the liver where it is converted to bile and excreted. This improves the bad to good cholesterol ratio (LDL:HDL).
  2. Increasing the size of LDL particles making them easier to remove and less likely to accumulate within the lining of heart and blood vessel tissues
  3. Intense exercise has also been shown to increase HDLs

Heart Health

Exercise increases cardiac output by strengthening the muscles of the heart. This means blood can be pumped around the body more effectively and oxygen delivery as a whole is improved. Cardiovascular risk is reduced and blood pressure is lowered. While lung capacity is not directly increased, the ability to transport oxygen better means exercise tolerance is increased and naturally you will feel less out of breath (compared to if you didn’t exercise regularly)

So can I stop taking my medication?

Not without the approval of your doctor! Whilst incorporating effective diet and exercise plans can improve and reduce the risk of a multitude of conditions it will take at least 3 – 4 weeks to start seeing significant changes. In the meantime you will need to keep taking you medication until your doctor deems you fit enough to come of them.

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Note that not all patients will be able to stop their medication but most patients will benefit from a better diet and regular exercise programme. How effective and whether you will be able to stop some/all you medication is at least partly dependant on how long the problem has persisted. The longer a condition has been left untreated the more likely the damages are less reversible.

Finally whilst this article has focused on type II diabetes and cardiovascular issues, diet and exercise can also reduce your risk of cancers, improve asthma, improve eczema and a number of other common conditions. So before your medication starts pilling up, ask yourself, what lifestyle changes have I made to help myself?

You always have a choice. If you choose not to do anything…well that in itself is a choice.

Related Article: 5 Simple Food Choices for Long Term Health Results

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About Author

Mehmet is a qualified pharmacist and lover of shorts, whatever the season. Whilst his background is in science his interests are in fitness, music and entrepeneurship. He is the founder of Gym Meals London and believes quality food, an active lifestyle and regular stretching is the obvious secret to good health.

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