ANTACIDS ARE NOT SAFE
Medscape, a highly read conventional medical newsfeed, reports that the most popular article of the month among readers was the one reporting that proton pump inhibitors (PPIs) were linked to a rise in heart attacks. PPIs are medications like omeprazole (Prilosec), pantoprazole (Protonix), dexlansoprazole (Dexilant), esomeprazole (Nexium) and lansoprazole (Prevacid). They are prescribed for a variety of complaints, especially acid reflux and indigestion. Millions of people are on these medications, sometimes for decades. It can be very hard to stop these medications, because stopping them may cause rebound heartburn (though I have my tricks).
How do PPIs cause heart attacks? Scientists are not sure, but it could be because we need the acid in the stomach for a number of reasons, and one of them is to use a substance made by mouth bacteria and turn it into a very important substance called nitric oxide, that protects blood vessels.
Far fetched, but, it’s only a start.
IBUPROFEN IS NOT SAFE
Today the FDA put out a warning that NSAIDs, well-loved drug category reducing pain and inflammation, also likely increase heart attacks and strokes. This category includes ibuprofen (Advil, Nuprin, Motrin), naproxen (Aleve, Naprosyn), and many others. Almost everyone has at least tried something from this category, or taken it for a week or more to manage an injury, and millions take it most days to manage chronic pain. So what are doctors supposed to do with patients’ pain?
Interestingly, the regular use of NSAIDs can cause heartburn, and I have often seen patients started on PPIs because of their NSAID, sometimes preventatively. I am not looking forward to the study about what the combination does to your heart attack risk.
In case you thought you would turn to acetaminophen (Tylenol), remember that it worsens asthma and impairs detoxification by reducing your levels of glutathione. It has also been connected to asthma development in babies and to ADHD in the children born to women who used it during pregnancy. All of these are associations, but they are not reassuring.
STATINS ARE NOT SAFE
What about statins? Everyone should be on one, right? Well they cause diabetes. They were thought to cause a little diabetes, but it turns out they cause more diabetes than originally thought. So how is it that they can still be beneficial? After all, another study this month tells us that a significant number of patients have a sudden decline in cognitive function after starting statins. Researchers are not sure if this is a real effect of the drug or some sort of research distortion, but it sure could be real.
DIABETES IS WORSE THAN WE THOUGHT, EVEN WELL-TREATED
Yesterday saw the publication of a study showing that diabetics have an accelerated decline in cognitive function, even when treated. So maybe those people who had heart attacks and were placed on statins are living longer but living with cognitive decline?
AND LET’S NOT FORGET
This month the Cochrane Collaboration, a highly respected European group that reviews research on therapy and prevention, declared that there was no good evidence that water fluoridation prevents dental caries.
This is the same group that pointed out that influenza vaccination is probably not worthwhile for the vast majority of people.
And more recent research suggest that whooping cough vaccination (not lack of vaccination) is a cause of disease resurgence.
Does this leave anything for the average doctor to do that will actually work, and won’t make the patient worse? How about preventative tests that aim to detect cancer?
CANCER IS NOT AS WE THOUGHT
This week, we also had the report on an enormous study comparing breast cancer incidence and mortality across US counties with high and low mammography rates. If mammography saves lives then the counties with high mammography rates would have had fewer breast cancer deaths, and fewer larger tumors. But that is not the case. Mammograms do find many more small cancers, but these may not be cancers that would have become noticeable over time. We know this because counties with a high rate of mammography did not have a lower rate of large tumors. Therefore mammograms do not prevent small tumors from turning into large tumors.
Nor did counties with high mammography rates have lower breast cancer mortality. So mammograms do not save lives.
But these counties did have higher breast cancer incidence rates. So really all mammography does is cause more women to have to undergo cancer treatment. Overall, lives are not saved. I am NOT talking about false positive scares. This is full-fledged chemotherapy, lumpectomy or mastectomy and/or radiotherapy; and then more medications like tamoxifen; and long-term side effects like heart failure and cognitive decline from chemo and immune system anomalies from radiotherapy.
THE PRICE TO PAY FOR PEACE OF MIND
It appears that what really happened is that some women gained reassurance at the expense of other women going through a diagnosis of breast cancer (either invasive breast cancer or DCIS), and undergoing dangerous chemotherapy and disfiguring and painful removal of a body part. Women that were going to die, died anyways (the mortality didn’t change). UNLESS-- what we are seeing is a lot more real breast cancer than before—but no one is admitting to that.
The following concept is now gaining favor: that cancer does not always proceed from small to large in predictable fashion. I know it makes no sense but it is true: cancer sometimes starts small and explodes very fast. Sometimes it starts small and regresses back to nothing. Sometimes it progresses the way we used to think, from small to large to widespread.
HERE’S WHAT I THINK
The concept of better living through chemistry is backfiring. Chronic disease prevention through surgery will also not work. There’s that devil once again, in the details. The idea that you could continue with your previous lifestyle, the one that brought on the heartburn, joint pain or headache, high cholesterol (which may not even be harmful cholesterol) or high glucose, or maybe even cancer—the idea that a pill could make it just fine to continue with that lifestyle—that has turned out to be WRONG. Doctors can’t save you from a symptom without giving you a disease, which may be worse.
What we need to do is to find and fix the underlying cause.
For some people, it’s not a choice they made. The underlying cause is toxins, or immune dysfunction, or multigenerational trauma. Help may be available for them too. There are worthwhile trade-offs to be found, there is trauma therapy, and immune support.
But for others who have space to improve their lifestyle, to eat healthier, sleep more, exercise more, stress less, focus more on meaning, purpose, community, love, and service, it will actually NOT be very hard to sidestep antacids, anti-inflammatories, statins, and whatever is on those rows and rows of shelves at the drugstore—and diabetes, strokes and heart attacks, and in many cases even cancer.
The work we do to resolve heartburn or reflux, joint pains, headache, cholesterol and glucose issues is the same work that studies suggest leads to a long and healthy life.
INDEED, ALL CAUSE MORTALITY IS SHARPLY REDUCED WITH FRUITS, VEGETABLES, EXERCISE and MEDITATION.
A study from 2012 shows an 8-fold reduction in all-cause mortality in the participants who ate more than 5 portions of fruit and vegetables daily and who were in the fittest subset. A separate study showed a 40% reduction in all-cause mortality with meditation. I would love to see the study that combines diet, exercise and meditation. And the study that further measures the effect of having a strong sense of mission, and a good close-knit group of family or friends.
The skills and practice of functional medicine have helped me squarely focus on the promotion of wellness. My goal is to continue to learn efficient and effective ways to guide my patients to optimal health through natural means.
REFERENCES FOR THE SKEPTIC—bring to your physician and have a conversation!
Proton Pump Inhibitors and Cardiovascular health
NSAIDS and cardiovascular health
Statins risk for diabetes—March 2015
Statins affect memory
Water fluoridation not proven to prevent cavities
Influenza shots probably not worthwhile in most people
Whooping cough vaccination spreads disease
Mammography and cancer rates in US counties
Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women.