Thou Shalt Not Try to Outsmart Me
Medical researchers and their groupies – early adopters, thoughtleaders, those easily influenced or whatever you want to call them – never seem to learn that when you try to outsmart Mother Nature or Our Heavenly Father, whichever appeals more to your world view, you usually get your hand slapped.
When I was a resident (1981-1984), I got penalized if I didn’t offer postmenopausal women estrogen-progesterone replacement therapy because it seemed obvious that if women with endogenous estrogen didn’t get many strokes or heart attacks and women without estrogen did, all we needed to do was make up for God’s or Mother Nature’s oversight in not keeping the estrogen coming after age 50.
Then the Women’s Health Study in 2000, almost 20 years later, showed that women on Prempro had more strokes, blood clots and heart attacks, and more breast cancer on top of that, than women who accepted the natural order of things – menopause with all its symptoms and inconveniences.
The same things has happened with osteoporosis – more subtrochanteric femur fractures after five years of Fosamax than in untreated women.
A simple thing like hypertension has played out similarly: People who take certain third tier blood pressure medicines, like alpha blockers, don’t have the benefit of lowering blood pressure that you might expect; those medications actually increase risk of death from cardiovascular causes.
The typical blood sugar targets that have been drilled into our heads, hemoglobin A-1 C under 7%, have been found to be detrimental to older patients who are more sensitive to low blood sugars than younger patients, so now we have a hemoglobin A-1 C target of 8% for older folks (thank goodness, especially for those with classic late onset diabetes).
And even my own affliction, gastroesophageal reflux, has a downside when you rely entirely on medications instead of lifestyle measures for management; escalating proton pump inhibitor doses are now known to increase the risk of iron and vitamin deficiencies, osteoporosis, pneumonia and C. difficile infections.
Just like prednisone and Humira work brilliantly when you feel like you have do decrease autoimmunity, rather than say “what it is making the immune system overreact” (gluten, artificial food additives and antibiotics in the food chain), reaching for medications instead of asking “what is my body/God/Mother Nature trying to tell me” sooner or later might come back to haunt us.
We must always ask: “Is this a symptom caused by unhealthy lifestyle choices that need to change rather than medicated with more or less risky medications” or “Is this an aging manifestation normal enough to make medications unnecessary” or “Is this premature aging and possibly worthy of intervention?”
Aging phenomena that happen to everybody, such as osteoporosis, are perhaps, just possibly, better left alone, at least as far as drugs go, but certainty a subject for lifestyle exploration and intervention?
Which makes me think of all the hype about “Low T” (testosterone). Isn’t that the estrogen story all over again? I guess time will tell…
One after another, your posts hit home for me. I’m 73 years old. For the past 6 years, my a1C has tested in pre-diabetes level. The first time it happened I went to the diabetes doctor, great doctor, Dr. Ruiz. I told him that I wanted to make lifestyle changes although I already ate at least 80% healthy. However, I’m a carb eater, mostly fruits, vegetables, whole grains and nuts. I do like my cookies and quickbreads but I make my own so that I can sub in some wheat flour, oat/wheat germ, olive oil for butters, etc. So he gave me diet info, I checked out some books from the library, and I joined an app called LoseIt, not to lose weight but by buying the paid version, it tracked my carbs, protein, fats and fiber from the foods I entered each day. Yay! (I will admit to being a poor protein eater which is well tracked in that App.) So, I cut back on carbs and ate even “better” carbs, had the a1C test again and it was even higher! Dr. Ruiz gently suggested Metformin but I wasn’t giving up. I had already read that if one’s blood doesn’t turn over as fast or as slow as the test tests to, one’s results can be falsely high or low. Also, at that point, NM where I live, did not have one certified lab that ensured that an a1C test was accurate. So I asked Dr. Ruiz if I could test myself the way diabetics do, with a glucose meter and finger pricks. I wanted to find out what I was eating that was causing the a1C level. He agreed and gave me a Contour glucose meter and finger pricker and I bought a 3 month supply of strips to use with it. I pricked my finger upon rising (fasting) and 2 hours after every meal and once in awhile if I’d had a dessert late. Although my fasting “norm” is 103-105, every single after meal prick was normal, not even in pre-diabetes territory. The great thing about the meter is that it came with an App that I sent the readings to and it produced a report for me. It showed that there were no “manual” entries. When I saw him again, with another high a1C number, I gave him the report. He was stunned and said that if I had given him these numbers hand written on a form he had provided, he wouldn’t have believed me. He then asked me if he could test me in his office…he had a machine that produced the a1C number. I said sure thing. Well, on his meter, I was normal. He apologized and said if he had put me on Metformin it could have dropped my blood sugar too low, That was in 2017. In 2022 I did the finger prick thing again for 2 weeks to satisfy my PCP that my over 100 fasting glucose number didn’t mean I was pre-diabetic. Now with a new PCP and a 6.1 a1C, the highest I’ve ever had, I did the finger prick thing again for 2 weeks and again, aside from a 103 average fasting glucose reading, all other readings are in the green zone. Since then, I also found that the newest “normal” accepted a1C for people over the age of 65 is fine up to 6.4 or 6.5. I warned her that my a1C tests high on the regular a1C tests and that I have proof that I’m not likely to become a diabetic in my lifetime. She has not sent me any notes after getting my bloodwork but I do have that new 2 week glucose meter repot to provide as well as my past reports if she so desires. (I’m also old enough that in the “olden days” any fasting glucose reading under 115 was considered normal. Then they changed it to under 100.
So, a very long comment, my apologies. But I do care about my health. I do have some heart issues that I monitor and that have been managed for years, mostly avoiding known stress factors. For the most part I try to eat healthy, I walk at least a mile each morning with my dog, I do chair yoga in the early evenings. As I age, I realize that it’s even more important to take care of myself in order to enjoy the time I have left. This post of yours, added to other posts that have been spot on in my opinion, convinced me to become a supporting member of you on Substack. I’m not sure when you will be notified of my subscription, but I would love to have that free copy of your book that is offered to subscribers as well. I have shared some of your posts on FB (well received by my friends). This post will be shared as well. One of my friends had her femur shatter when she was on Fosamax and had a rod in her leg for a long time. Another one of those supposedly good drugs that may not be such a good idea.