Pills or lifestyle?Published 4.22.2016
This will probably wind up being a bit of a rant, but it's a topic that interests me, both intellectually and personally through family and friends. Changes in diet and lifestyle can have a profound effect on health, but only if they are adhered to.
A study finds that lower blood pressure results in less CVD but more side effects because the lowering was done via drugs. Of course it was done via drugs, changing diet and lifestyle is much more difficult and most people decline to even try. But what is easy is filling a prescription and popping a pill— although even that can be too difficult. Beyond remembering to take them, the problem with popping pills is that they can interact within the body causing side effects, which is exactly what happened to subjects in the study. So yes, lowering blood pressure via drugs worked, but then the question become are the side effects (or to a lesser extent the extra effort to take them) worth the benefits?
The same risk reward argument occurs about the cholesterol lowering drugs known as statins. I'm not going to go into the controversy over whether or not cholesterol is causative in cardio vascular disease (CVD) because that's a different topic, but it is a marker that has shown an association with the disease. Populations with naturally low cholesterol levels have lower CVD rates, so it wasn't a crazy thought to think that lowering cholesterol via drugs would lower CVD risk. And statins do lower cholesterol levels— but they also have side effects. Diet and lifestyle changes can lower CVD risk and even reverse artery blockage. Doctors Ornish and Esselstyn have shown this to be true.
However, to get the benefit, both doctors prescribe a diet, and in Ornish's case a lifestyle, that is very different from how the typical American lives. And most people, even after being diagnosed, do not want to change what they do and how they do it, and so they don't. Instead they pop a pill and go to regular appointments with multiple specialists to record their health's deterioration. No one gets out alive, but it's hard not to be struck by the fact that so little of modern medical treatment results in actual cure.
Statins lower cholesterol, but do not reverse CVD. Drugs for type 2 diabetes control blood glucose, but only slow, not stop the course the disease. Type two diabetes (T2D) of course is a disease that can be completely reversed with diet and lifestyle changes. Reversal means that the person can pass an oral glucose tolerance test WITHOUT prior preparation or eat a potato without sending their blood glucose into diabetic levels. This means that a very low carbohydrate high fat (LCHF) diet does not reverse T2D, but I've noted that often enough recently to not repeat it now.
Diet and lifestyle changes always come down to adherence. If you make changes that you can adhere to the rest of your life, then the good effects will accrue over time— and they don't dissipate. Popping pills comes down to adherence too, of course. If you don't take the medicine it can't have an effect. But it's my observation (and please note this is anecdotal, I'm not any kind of medical professional) is that drugs taken for chronic conditions only work for a certain time, and then the effects seem to tail off. I don't know if that's because the body's chemistry adapts, I just know that progression always seems to be higher dosage, or more drugs added to the cocktail. Eliminating prescriptions takes effort on the part of the patient (or his advocates).
Walking the talkNow that I'm done ranting, I think will give a brief personal update and admit that I have not been "walking the talk" as it were for a while now in terms of my own adherence to changed lifestyle habits. There are multiple excuses I could offer, but the bottom line is that I've seen some markers slide as a result of changes in choices I've made recently. I don't know yet if my blood markers have changed along with the physical markers, but I will know early in May when I have my annual physical. The only good news to note is that I have continued to limit the amount of adult beverage, which has been the boon it was expected to be. I realize that statement in cryptic, but that's the limit of how much I'm willing to put out on the internet. The marker changes aren't huge, but the trend is not my friend.
What this means is that I have once again sat myself down for an assessment of what and how much I'm eating and drinking as well as how much I'm moving. While those aren't the only terms in the energy balance that matter, they are the ones I can control. Not changing much, just returning to what I found worked for me, and what I was comfortable with.
But that begs the question why, if I was comfortable with them, did my habits change? The answer to that comes down to changing circumstances in my life— some of which I control and some I do not. I'm still exercising as much as I had been, it's really in the NEAT department where I've slacked off. NEAT, as I've often written, stands for non-exercise activity thermogenesis and basically includes the energy expended to move, except for deliberate exercise. NEAT encompasses most human movement in other words, and is mostly ignored or written off as "genetically determined." Bollocks. Whether or not I fidget might come down to genetics, but whether or not I stand or sit while writing these words is a choice.
As it happens I am pedaling at my bike desk as I write this, but if I wasn't doing that I'd be standing. I choice to stand or pedal while I work rather than sit at a traditional desk. I do still use my beloved treadmill desk, but not as often as I used to. I've mentioned but not explained this fact previously here, and I'm afraid that's all I'm going to this time as well.
In terms of intake, our social life has expanded over the past six months, and our intake of pub and restaurant fare for dinner has as well. The result has been a higher weekly caloric intake resulting in a higher weight set point. Really not hard to explain, and certainly not unexpected. However, I've reached the top end of my preferred weight range, which means something's got to change. And so it will.
This isn't rocket science— nor is it some hormonal or endocrine horror show. It's simply me eating a bit more and moving a bit less and so becoming a larger sized human. I will move a bit more and eat a bit less, and let my weight settle back to a lower weight.
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