July 1, 2015

My Pills and Me: Less Is More

Cleaning out my medicine cabinet

One of my big concerns these days is the overuse of pills -- supplements and prescribed meds -- by patients and doctors. "Less is more" is a favorite mantra whenever I write about medications.

Today we hear a rising chorus from healthcare reformers sounding the "less is more" theme for both medications and also medical treatments. Today, let's discuss the former; soon, we'll discuss the latter.

Dietary Supplements
Until a few years ago, my mantra was "the more, the better" when it came to pills.

The photo above was taken over two years ago when I tossed out my impressive stash of dietary supplements. 

I could no longer ignore the consensus of medical advice from my research and health newsletters. They agree that we get health benefits from all sorts of vitamins and minerals. But they also agree we're better off getting nutritional requirements from food, not pills. A supplement is useful only for people whose diets lack a specific nutrient.

Google "vitamins food or supplements" and you'll see the consensus -- food. For example, ConsumerLab.com poses the question: "Is it better to get vitamins from foods or supplements?"

Here's their answer:
It is generally best to get your vitamins (as well as minerals) naturally from foods or, in the case of vitamin D, controlled sun exposure. For example, recent research on the mineral calcium suggests that it is safest to get your calcium from foods that are naturally rich in calcium than from supplements. Older women who get high amounts of calcium from supplements seem to have a higher risk of kidney stones, strokes, and even a greater risk of dying over periods of time. A small increased risk of death has also been seen in studies of people taking supplements containing vitamin A and beta-carotene compared to those who did not.

Exceptions to the "foods are better" rule are two B vitamins. Ten to thirty percent of older people don't properly digest and absorb natural vitamin B-12 from foods, so it is recommended to get B-12 from a supplement if you are over age 50. Folic acid (vitamin B-9) from supplements and fortified foods is absorbed twice as well as from regular food.
My Dietary Supplements Today

That's it. Just these three supplements:
  • Vitamin D:  Based on my blood work, my geriatrician recommended I take two of these D3 – 1000 mg pills each day. Vitamin D insufficiency is common among the elderly. It is an established risk factor for osteoporosis, falls and fractures. Studies suggest that cereals and other foods cannot be fortified enough to provide enough vitamin D for the elderly without exceeding the safe limits for children.
  • 5-HTP:  I was using this serotonin booster even before my Parkinson's diagnosis. It helped me deal with three common non-motor side effects of Parkinson's: insomnia, depression and constipation. I belatedly realized the carbidopa that dramatically increases levodopa's bioavailability does the same thing with 5-HTP's serotonin. So as I increased my doses of carbidopa-levodopa, the concomitant  increase from the supplement's serotonin resulted in dangerous blood pressure spikes. Now I take only half a 50mg pill (the lowest dose available) at bedtime, which seems to work.
  • Curcumin:  I posted a full recap on curcumin a few days ago.
This post would never end if I tried to list and discuss all of the supplements I've tried. Name a popular supplement, and there's a very good chance I've tried it.

Prescription Medications

Yep. That's it.  Just two prescription medications:
  • Carbidopa levodopa : This is the gold standard medication for Parkinson's. Not long ago, I switched from the regular carbidopa-levodopa to the extended release variety. (Click here for that report.) Then recently my neurologist gave me a prescription for rytary, a new extended release pill, but my insurance may not cover it. I also wonder if it really could be better than what I'm taking now... an issue I'll discuss tomorrow.
  • Fluticasone Propionate:  This is a nasal spray for my runny nose.
My Recent Cutbacks in Prescription Meds
Most doctors would agree that "less is more" should be the mantra for their patients when it comes to dietary supplements... but not necessarily when it comes to meds they prescribe.

Increasingly, our healthcare system is faulted for over-medication and over-treatment. Back in July 2012, I wrote a series of posts about the book Are Your Prescriptions Killing You? by Armon Neel. He's a consulting geriatric pharmacist who received the 2010 achievement award from the American Society of Pharmacists.

A consultant to nursing homes, Dr. Neel is an expert on the perils of medicating the elderly, and statistics support his conviction that many common geriatric complaints can be cured simply by getting patients off their "geriatric" drugs.

No More Lipitor or Other Statins
Reading his book, I wondered whether I still needed to treat high cholesterol with statins, drugs he places "among the least effective and most dangerous drugs on the market." He says he stops these drugs for all his older patients "because they are invariably at the root of nearly all their problems." Neel is particularly opposed to prescribing statins for men 80+ who show no sign of heart disease. That's me.

(Click here for full discussion of Neel's warning for those of us 60+ to "stay away from statins at all costs.")

No More Blood Pressure Meds
My decision to discontinue my blood pressure (BP) medications -- I'd taken them for years -- wasn't a result of reading Neel's book. He doesn't advocate doing away with BP meds for the elderly. But he does say "very very few doctors are prescribing hypertension drugs appropriately -- at least, not when it comes to their older patients."

My decision to stop these meds came from my research. Among other findings, an independent group of experts, based on a review of the medical research, recently concluded that  most people 60+ don't need BP meds until their levels hit 150/90.

Some authorities now argue that anyone 80+ without cardiac problems can stop taking BP medication. One study even found that high blood pressure in people 85+ predicts longer survival. (A recent echocardiogram resulted in heart-health readings above average for this 86-year-old.)

So I stopped taking BP meds about a year ago.

When I told my doctors about the BP spikes I'd been experiencing during my levodopa treatment "off" periods, they all urged me to start taking the pressure pills again. So I did.

But I argued that basic hypertension was not the problem; instead -- I felt sure -- it was the gaps in levodopa's effectiveness. Recent developments suggest that my assessment was correct. Click here for that report.

With the recent change in my levodopa medication, my BP numbers are lower than they were when I was popping those BP pills.

Less IS more.

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