When diet and exercise aren't enough...

Published on Thursday, 16 February 2012

I think this is of the most cruelly deceptive phrases in modern advertising. Firstly, no one wants to change their diet. Secondly, exercise takes time and effort and, at least at first, is quite unpleasant. Taking a pill is ridiculously easy to do.  So essentially this advertising phrase applies to everyone with high blood pressure, high cholesterol, metabolic syndrome, adult-onset diabetes or other "lifestyle-related" diseases for which there are profitable pharmaceuticals (or "alternative" treatments, for that matter). It should really be "when diet and exercise don't seem appealing...". Now look at it from the doctor's point of view: with only a few minutes to visit with you, and after so many years of failure at encouraging patients to eat a healthier diet and get more exercise, the appeal of getting those cholesterol or blood pressure numbers down with a pill is unquestionably apparent. But everything has a cost. While cholesterol lowering drugs such as the statins have demonstrated measurable long-term benefits for people with very high cholesterol combined with heart disease and other cholesterol-related ailments, there are many side effects including some very serious ones. People with high cholesterol but no other current risk factors may benefit just as well or better from even modest reductions in dietary cholesterol and cholesterol-raising foods (sugars and pure starches contain little or no cholesterol but can contribute to higher serum LDL cholesterol levels). Some people are averse to taking FDA-approved pharmaceuticals, instead opting for "alternative" preparations and herbs. While some "alternative" treatments may work, few if any have been rigorously tested to eliminate bias and verify effectiveness. Beware of quacks selling easy fixes. Even if these "treatments" have no side effects, they may also have no beneficial effects. The actual "side effect" of such treatments is that you may not be doing anything at all to treat a life-threatening disease. That's no better than taking a pill that may cause liver damage while actually fixing the primary problem. There are also plenty of research and claims about various foods such as soy (which probably doesn't), oats (which does appear to help almost as much as some drugs in some cases) and other foods that may help lower cholesterol.  Just keep in mind that there are no easy fixes. You can't have steak, eggs and hash browns with white bread for breakfast and hope downing a glass of pomegranate juice will help. Actually, because of the sugar in the juice, it may do the opposite. The reality is that proper diet and exercise are almost always enough. Even for those who have a family history of the disease (it just means your threshold for getting the disease is lower).  Diet and exercise are not easy, so start out small and work your way into them. Find a support group or club for encouragement. Get your spouse or family to join you. It doesn't mean you can never enjoy an omelet or a juicy burger and fries ever again, it just means you have to make these foods more of a treat rather than a staple of your diet. Perhaps the question you might want to ask yourself (and your doctor) is "what do I need to do to make changing my diet and increasing my physical activity easier and less daunting?" Wouldn't that be better than taking a drug for the rest of your life that may help but may also cause you other problems down the line? Wouldn't it be better than taking a bunch of untested, unverified "treatments" that may only make you feel better psychologically while delaying your actually getting better?