[ryaxnb]

Well I thought I'd rant (and ask for opinions) about "stupid medicines": One-a-day pills that treat problems that aren't there or could be treated permanently: anti-cholesterol medications, lack of research into blood pressure treatment that's permanent, not enough vaccines, and Restless leg syndrome, not to mention Alli.

1. These medicines are chosen because they are "one-a-day": That means you take one-a-day for the rest of your life/till problem goes away for other reasons. Don't you see the problems here? Medicines have side effects, interact with other medicines/foods, cost a lot, etc.. which is all well and good when you need them or they are treating problems temporarily (e.g. most Pain medicines), but my personal belief is that if more research were done, they could cure or prevent such problems as heart attacks, clots, and AIDS without continuous medicines.
2. Cholestrol medicines deserve special treatment: These are stupid, stupid, stupid. Very little evidence is there that high cholesterol links to heart attacks, and you can lower cholesterol with proper diet anyway. But patients are too lazy to diet. Under the guise of "family/genetics influence" (which could also be treated with diet, but studies haven't proved this cause no one has tried a study with low-carb diets, and besides patients are too damn lazy to diet, even in studies that tell them to,) they market to patients who don't want to diet. They recommend in small print "In conjunction with proper diet..."; of course no one who takes these medications actually uses proper diet (generalization) so so much for that. So they take statins, the most effective medication, which have so many horrible side effects it's not even funny (they almost killed my grandma.) Furthermore, they lower a value that isn't even conclusively proven to effect heart attacks significantly. Oops.
3. Weight-loss pills. When will people learn that to lose weight, you need to Eat Right?! Alli and similar won't help much unless done on a proper low fat diet (they say so in small print on the packaging, but the marketing doesn't let you know that,) but that, when followed through, will fix most people's weight problems anyway. There are also low-calorie and low-carb diets, and balanced special diets; any reasonable diet will generally cause weight loss if followed; it's just a matter of which one's easier. Also, many try extreme diets (e.g. less then 18% fat, less than 1500 calories, only one food, only one brand of foods) in an attempt to diet faster. Any diet that claims more than 1-2 pounds a week is unhealthy, generally speaking. And very hard to follow.

[subego]

Maybe I'm confused here, but I think what they are touting with "one-a-day" is "as opposed to 3 or 4 times a day".

They've cooked up a 24-hour time release system, so you don't have to be constantly popping pills to maintain the proper levels of the drug.

Not that I think continuous medicine is any great shakes or anything, but I'd have to say that if you are going to take it, having to take it once is better than having to take it multiple times.

[ryaxnb]

Originally Posted by subego 

Maybe I'm confused here, but I think what they are touting with "one-a-day" is "as opposed to 3 or 4 times a day".

They've cooked up a 24-hour time release system, so you don't have to be constantly popping pills to maintain the proper levels of the drug.

Not that I think continuous medicine is any great shakes or anything, but I'd have to say that if you are going to take it, having to take it once is better than having to take it multiple times.

Maybe I have the semantics wrong, (I think a better name would be "continuous") but I think I have the facts right.

[turtle777]

Originally Posted by ryaxnb 

3. Weight-loss pills. When will people learn that to lose weight, you need to Eat Right?!

Oh, I see why this goes to the PWL.

Yeah, what you claim there ("just eat right" is unpatriotic. Amaraca would not be Amaraca if people took responsibility for their eating habits.

-t

[subego]

Originally Posted by ryaxnb 

Maybe I have the semantics wrong, (I think a better name would be "continuous") but I think I have the facts right.

Got ya.

I thought for a second you had a problem with the "once" part, but you're taking issue with the "day" part.

If that makes sense.

[BRussell]

I agree ryaxnb. It's terrible and it's one of the things that makes medicine so expensive. Most of the new drugs being created and marketed today are no better than existing (cheaper, often generic) drugs, according to the research. But they want those massive profits, and so they advertise them on teevee and doctors are getting pressure to prescribe them, and insurance companies are getting pressure to pay for them. It's the health outcomes that matter, not how new and trendy (and expensive) the treatment is!

[lpkmckenna]

Originally Posted by ryaxnb 

Well I thought I'd rant (and ask for opinions) about "stupid medicines": One-a-day pills that treat problems that aren't there or could be treated permanently: anti-cholesterol medications, lack of research into blood pressure treatment that's permanent, not enough vaccines, and Restless leg syndrome, not to mention Alli.

Restless leg syndrome is a real condition.

[RAILhead]

Originally Posted by ryaxnb 

Well I thought I'd rant (and ask for opinions) about "stupid medicines": One-a-day pills that treat problems that aren't there or could be treated permanently: anti-cholesterol medications, lack of research into blood pressure treatment that's permanent, not enough vaccines, and Restless leg syndrome, not to mention Alli.

Did you mean Ali?

[ghporter]

Examples please? There is a huge body of evidence that high levels of serum cholesterol, particularly low density lipoprotiens, contribute to atherosclerosis, a leading cause of myocardial infarction, stroke, kidney failure, etc. Eating right and exercising at least moderately are both great ways to control your weight-much better than either pills or special diets-but they can only do so much about serum cholesterol which, as the Vitorin ad says, comes both from what you eat and what your body is programmed by genetics to do.

The stupidest "medicines" are those that promise "drastic weight loss today!" and offer instant results for people who can't be bothered to just eat less and walk more. I find it disgusting to see extremely overweight people cruising the mall parking lot endlessly just so they can get a parking spot within 50 feet of the door, instead of using one of the many open spots 150 or more feet from the door. No handicapped tag or plate, no apparent problem with locomotion, just "I'm too lazy to park that far away." It's not that the medicines are stupid, it's that many people are, and Barnum's Law applies today as much as it did 130 years ago. Bright people are always ready to take advantage of stupid people who want something for nothing. When it's about taking their money without giving them anything in return, it's called "fraud" or "a scam." When they get something that isn't really what they need, it's called "marketing."

[Person Man]

Originally Posted by ryaxnb 

1. These medicines are chosen because they are "one-a-day": That means you take one-a-day for the rest of your life/till problem goes away for other reasons. Don't you see the problems here? Medicines have side effects, interact with other medicines/foods, cost a lot, etc.. which is all well and good when you need them or they are treating problems temporarily (e.g. most Pain medicines), but my personal belief is that if more research were done, they could cure or prevent such problems as heart attacks, clots, and AIDS without continuous medicines.

There is plenty of research being done in those fields, and it's not as easy to "cure" those illnesses as you think. Take AIDS, for example. Being HIV positive used to mean that you were going to die. Plain and simple. Now, with the anti-HIV drugs people can live a long life without even developing AIDS. Sure, they have to take the medicines continuously, but those pills have turned what was a terminal condition into a chronic, manageable condition. Yes, they have side effects, but most people will take the side effects over dying any day. Finding a cure for HIV/AIDS is still the ultimate goal, and maybe someday people taking the medicines will be able to stop them. But we aren't at that point yet.

2. Cholestrol medicines deserve special treatment: These are stupid, stupid, stupid. Very little evidence is there that high cholesterol links to heart attacks, and you can lower cholesterol with proper diet anyway.

WHOA! There is PLENTY of evidence to show that high cholesterol contributes to the risk of heart attacks. I suggest you look at the Framingham Heart Study and all the related studies that have been done using their data. There is even evidence that some statin drugs (but not all) can actually *reduce* plaque build-up in the blood vessels.

But patients are too lazy to diet.

I agree that *many* (but not all) patients are "too lazy to diet." Perhaps they can control their blood pressure and cholesterol by diet alone, perhaps not. But this is a major reason why the guidelines for treating cholesterol usually start with a six month trial of diet and exercise before starting a medicine, unless the patient is diabetic or has already had a heart attack, where the studies have shown that using a statin reduces the risk of having another heart attack.

Under the guise of "family/genetics influence" (which could also be treated with diet, but studies haven't proved this cause no one has tried a study with low-carb diets,

I beg your pardon? There are PLENTY more (than the four I linked to) studies done on low carb diets and cholesterol where those came from. Don't comment on something you clearly don't know anything about, and don't claim that "no one has tried a study with low-carb diets" because I just proved you wrong with a simple Medline/PubMed search.

and besides patients are too damn lazy to diet, even in studies that tell them to,) they market to patients who don't want to diet. They recommend in small print "In conjunction with proper diet..."; of course no one who takes these medications actually uses proper diet (generalization) so so much for that.

They don't just "market drugs to patients that don't want to diet." But I'm not defending direct-to-consumer advertising, either. I don't think ANY direct-to-consumer advertising of drugs should be done, because people come into my office telling me "they know what's wrong with them," and then when my examination and testing shows something other than that, they tell me "I'm wrong."

The only exception to direct-to-consumer advertising are those commercials where they don't promote any specific drug and instead urge people to "talk to their doctor" about things like erectile dysfunction, restless leg syndrome (which DOES exist), etc. Then patients come in to talk about things but they aren't asking for a specific drug, which allows me to determine if drug therapy is even necessary (I like to try non-drug things first before reaching for the drugs).

So they take statins, the most effective medication, which have so many horrible side effects it's not even funny (they almost killed my grandma.) Furthermore, they lower a value that isn't even conclusively proven to effect heart attacks significantly. Oops.

Make up your mind. First you call statins the "most effective medication," then you say that they aren't "conclusively proven to effect heart attacks significantly." Again, there are PLENTY of studies out there that show a reduction in heart attacks and strokes in people taking them.

Not to minimize what happened to your grandmother, but for every case like her, I can point to probably hundreds of thousands of patients taking statins with no major problems. I'm not saying "no side effects." ALL medicine has side effects. You have to balance the side effects with the therapeutics effects. If the risks of taking the medicine outweigh the benefits of giving it, then you don't prescribe the pill. Unfortunately it is impossible to tell beforehand whether a pill will cause a given side effect in a patient, and how bad it will be.

3. Weight-loss pills. When will people learn that to lose weight, you need to Eat Right?! Alli and similar won't help much unless done on a proper low fat diet (they say so in small print on the packaging, but the marketing doesn't let you know that,) but that, when followed through, will fix most people's weight problems anyway. There are also low-calorie and low-carb diets, and balanced special diets; any reasonable diet will generally cause weight loss if followed; it's just a matter of which one's easier. Also, many try extreme diets (e.g. less then 18% fat, less than 1500 calories, only one food, only one brand of foods) in an attempt to diet faster. Any diet that claims more than 1-2 pounds a week is unhealthy, generally speaking. And very hard to follow.

I agree with you here, as well. Unfortunately, we as a society have become used to "quick-fixes" and diet pills promise that, but they don't fulfill it by a long shot. Also, NONE of the diet pills are intended to be used indefinitely. You use them for a few months at a time, if at all. I don't use any diet pills except Xenical/Alli (same medication), and only as a way to teach people how to eat properly. You only take the pill with a fatty meal, and after a few episodes of diarrhea, people quickly learn what high fat foods to avoid.

Just avoid the fad diets, stick to a calorie-controlled, *healthy* diet and exercise program, and the weight will come off. And you're right about the "lose no less than 1-2 pounds a week."

One other thing. About restless leg syndrome. It is a real condition that affects many people. It was not something "created by the drug companies to sell more medicine." The medicine that is used to treat it is used primarily to treat Parkinson's disease. The fact that it treats restless leg syndrome was a "side effect" discovered during the studies for Parkinson's. Then they did studies to directly look at the restless leg syndrome effect.

That being said, studies have also shown that low iron levels in the blood can also lead to restless leg syndrome, and those same studies have shown that treating the iron levels can lead to symptoms disappearing. Ferrous sulfate is available over the counter and is EXTREMELY cheap. This is why I always test iron levels first. I only use the other medicines when the iron levels are normal and they're still having symptoms. Many insurance companies require you to look for and treat low iron before reaching for the other medicines.

This is another case where direct-to-consumer advertising can either harm or help. Commercials that say "This is restless leg syndrome. Talk to your doctor to see if he can help you," without mentioning specific drugs are helpful. Ones that say "This is restless leg syndrome. Ask your doctor if Requip is right for you," aren't.

[cjrivera]

Well put, Person Man. I was going to type out something similar (but not as eloquently) but you pretty well summed it up.

[olePigeon]

Colloidal Silver Details
Bio-Alternatives Nutritional Supplements
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[Person Man]

Originally Posted by olePigeon 

Colloidal Silver Details
Bio-Alternatives Nutritional Supplements
"Real Colloidal Silver Information Without Misleading Fuzzy Science!"

You too can look like Papa Smurf! Just take colloidal silver for many years!

[smacintush]

Originally Posted by ghporter 

Examples please? There is a huge body of evidence that high levels of serum cholesterol, particularly low density lipoprotiens, contribute to atherosclerosis, a leading cause of myocardial infarction, stroke, kidney failure, etc. Eating right and exercising at least moderately are both great ways to control your weight-much better than either pills or special diets-but they can only do so much about serum cholesterol which, as the Vitorin ad says, comes both from what you eat and what your body is programmed by genetics to do.

I don't know what he was referring to, and I'm not gonna deny what you say, but there is as of yet no connection between lowered cholesterol via the new medications, and lowered incident of heart attack.

As far as the topic in the broader sense, I would say that I agree 100%…but I would also add that we as individuals don't have to participate. So what's the problem? No one is mandating the use of Lipitor or anything else.

[smacintush]

Originally Posted by lpkmckenna 

Restless leg syndrome is a real condition.

There are plenty of Physicians that would disagree with you.

I also think that the broader point it that those who do have what you would call RLS with severe and frequent enough symptoms are fairly rare. The pharmaceutical companies would like us to believe that it is more common and more severe than it is. There are, I believe, plenty of people who would have minor symptoms that may not even be diagnosable as RLS, that would still get medication for it either by pressuring their doctors or by the doctors' tendency to dole out medications to placate their patients.

[BRussell]

Originally Posted by smacintush 

As far as the topic in the broader sense, I would say that I agree 100%…but I would also add that we as individuals don't have to participate. So what's the problem? No one is mandating the use of Lipitor or anything else.

True, but to the extent that worthless, expensive pills get put on the "covered" list for insurance because of advertising, we all do pay when our premiums are more than they really should be.

[smacintush]

Originally Posted by BRussell 

True, but to the extent that worthless, expensive pills get put on the "covered" list for insurance because of advertising, we all do pay when our premiums are more than they really should be.

That's true, I hadn't looked at it that way.

[olePigeon]

Originally Posted by BRussell 

True, but to the extent that worthless, expensive pills get put on the "covered" list for insurance because of advertising, we all do pay when our premiums are more than they really should be.

I've noticed that some major health care providers are starting to cover Chiropractic. Absolutely ridiculous that my premium goes up so people can essentially go buy some miracle tonic.

Chiropractic is not certified by any medical board. Anyone who believes that any ailment can be cured simply by adjusting the spine is retarded. Sorry if I offend anyone who sees a chiropractor, but it's 100% placebo. The only merit Chiropractic might have is in therapeutic massage, but then you can go see a certified massage or sports therapist instead of a snake oil peddler.

My sister sees a chiropractor, of course, she also thinks we never landed on the moon.

[smacintush]

I don't know, I'm a fan of placebo. I've said it before: I'll take real results from the placebo effect over real results from ingesting some chemical compound any day.

That being said, no I don't think it should be covered either.

[olePigeon]

Placebo is not a bad form of treatment. There are studies that show a direct link between a healthy mindset and a healthy body, there's no doubt about it.

For anyone who sees a chiropractor for a "bad back" or whatever other joint is troubling you, here's the secret: Cavitation.

When you crack your knuckles or any other joint, you release a small pocket of air that is quickly filled with synovial fluid. If you continuously crack the joint, the condition will worsen (though with an immediate, although temporary, release of tension.)

Here's the trick: Stop cracking your joints. You will suffer mild stiffening of the joint for a short while, but then it will go away. So will the "need" to crack the joint. That is all a chiropractor is doing.

I'd also like to remind people that a chiropractor is not certified by any board of medicine. You can not become a medical doctor in the field of chiropractic. One of the biggest problems associated with chiropractic is actually stroke. When some quack is "adjusting" your back and neck, they can pinch or even sever the vertebral artery to your brain, causing a stroke and even death.

I can't stress enough how important it is to top feeding these people. Go see a proper and licensed physical therapist if you're having problems.

[olePigeon]

Here's a history on chiropractic. It'd make L. Ron Hubbard proud.

Chiropractic - Wikipedia, the free encyclopedia

[lpkmckenna]

Originally Posted by smacintush 

There are plenty of Physicians that would disagree with you.

Really? Who?

[maxintosh]

If you're 100 lbs overweight taking cholesterol meds is ridiculous.

However, I train hard 3-4 hours 4 times a week and jog 5 miles 3-4 times a week as well (1 day of rest). To be modest, I'm in great freaking shape. I eat low-fat, lean meats, all whole grains, plenty of oatmeal, take my tablespoon of flaxseed oil and pop the fish oil as well. And yet, every time my cholesterol gets checked, it's higher, and it's been really high for a few years now. My good cholesterol is better than it used to be but my bad cholesterol remains sky-high and climbing.

I am not convinced high cholesterol = heart attack for most people, although my grandfather did drop dead of a heart attack way before I was born, which concerns me. And I'm not on cholesterol meds, yet... I'm only 23 and am going to keep an eye on it for a few years.

One of my friend's mother is a doctor and she says she has never met a patient that is able to significantly greatly their cholesterol with diet and exercise. I think the NY Times even did a piece on how difficult it is for most people to actually do that recently, and it's not always lack of will.

[Person Man]

Originally Posted by smacintush 

There are plenty of Physicians that would disagree with you.

I also think that the broader point it that those who do have what you would call RLS with severe and frequent enough symptoms are fairly rare. The pharmaceutical companies would like us to believe that it is more common and more severe than it is. There are, I believe, plenty of people who would have minor symptoms that may not even be diagnosable as RLS, that would still get medication for it either by pressuring their doctors or by the doctors' tendency to dole out medications to placate their patients.

No, restless legs syndrome IS a real, well-described syndrome in the literature. It was NOT made up to sell drugs. If you read what I wrote above carefully, you'd see that I said that the majority of cases can be treated by correcting iron deficiency, which can be done cheaply and with something available over the counter.

[Person Man]

Originally Posted by smacintush 

I don't know what he was referring to, and I'm not gonna deny what you say, but there is as of yet no connection between lowered cholesterol via the new medications, and lowered incident of heart attack.

There is plenty of evidence in the medical literature that lowering cholesterol can lower the incidence of heart attacks. But not all the cholesterol medications are equally as effective at doing so.

[ryaxnb]

Originally Posted by ghporter 

Examples please? There is a huge body of evidence that high levels of serum cholesterol, particularly low density lipoprotiens, contribute to atherosclerosis, a leading cause of myocardial infarction, stroke, kidney failure, etc. Eating right and exercising at least moderately are both great ways to control your weight-much better than either pills or special diets-but they can only do so much about serum cholesterol which, as the Vitorin ad says, comes both from what you eat and what your body is programmed by genetics to do.

IMHO, it's simply not a good risk ratio. We haven't even proven that statins cure heart attack more effectively than diet and exercise, but they are prescribed all the time.

And of course, I see those annoying ads... these are not the people, these are the ads manipulating the people. They purposely put pretty background images out and use the guy with the most monotonic voice ever when talking about the side effects, reasons not to take it, etc. No one listens, and the small print is so small and/or fast-talked that no one could anyway.

[ryaxnb]

Originally Posted by Person Man 

There is plenty of research being done in those fields, and it's not as easy to "cure" those illnesses as you think. Take AIDS, for example. Being HIV positive used to mean that you were going to die. Plain and simple. Now, with the anti-HIV drugs people can live a long life without even developing AIDS. Sure, they have to take the medicines continuously, but those pills have turned what was a terminal condition into a chronic, manageable condition. Yes, they have side effects, but most people will take the side effects over dying any day. Finding a cure for HIV/AIDS is still the ultimate goal, and maybe someday people taking the medicines will be able to stop them. But we aren't at that point yet.

True, true. Don't you think not enough money is being spent on the cures though?

I beg your pardon? There are PLENTY more (than the four I linked to) studies done on low carb diets and cholesterol where those came from. Don't comment on something you clearly don't know anything about, and don't claim that "no one has tried a study with low-carb diets" because I just proved you wrong with a simple Medline/PubMed search.

Allow me to define low-carbohdyrate: Ketosis must kick in. Did ketosis kick in in these studies? The first one looks to be on the right track, but what the heck is it studying anyway? You haven't proved that ketosis makes LDL go down and "good cholesterol" go up in a statistically significant sample of patients yet. And even if you did , that wouldn't matter because my argument works just as well without that point last I checked.

They don't just "market drugs to patients that don't want to diet." But I'm not defending direct-to-consumer advertising, either. I don't think ANY direct-to-consumer advertising of drugs should be done, because people come into my office telling me "they know what's wrong with them," and then when my examination and testing shows something other than that, they tell me "I'm wrong."

The only exception to direct-to-consumer advertising are those commercials where they don't promote any specific drug and instead urge people to "talk to their doctor" about things like erectile dysfunction, restless leg syndrome (which DOES exist), etc. Then patients come in to talk about things but they aren't asking for a specific drug, which allows me to determine if drug therapy is even necessary (I like to try non-drug things first before reaching for the drugs).

I agree.

Make up your mind. First you call statins the "most effective medication," then you say that they aren't "conclusively proven to effect heart attacks significantly." Again, there are PLENTY of studies out there that show a reduction in heart attacks and strokes in people taking them.

AFAIK only one statin has been proven to lower Heart Attacks. I'd love to be corrected.

Not to minimize what happened to your grandmother, but for every case like her, I can point to probably hundreds of thousands of patients taking statins with no major problems. I'm not saying "no side effects." ALL medicine has side effects. You have to balance the side effects with the therapeutics effects. If the risks of taking the medicine outweigh the benefits of giving it, then you don't prescribe the pill. Unfortunately it is impossible to tell beforehand whether a pill will cause a given side effect in a patient, and how bad it will be.

Is Your Doctor in Denial? - washingtonpost.com
People are saying, that statins cause more side effects then you think. Doctors won't admit it sometimes; my Grandma's doctor didn't know about the side effects at all, and brushed off her complaints that were to some of the most common statin side effects.

I agree with you here, as well. Unfortunately, we as a society have become used to "quick-fixes" and diet pills promise that, but they don't fulfill it by a long shot. Also, NONE of the diet pills are intended to be used indefinitely. You use them for a few months at a time, if at all. I don't use any diet pills except Xenical/Alli (same medication), and only as a way to teach people how to eat properly. You only take the pill with a fatty meal, and after a few episodes of diarrhea, people quickly learn what high fat foods to avoid.

High fat foods can be good for health! Monounsaturated fats are good. Does Alli block monounsaturated fats? How about Saturated fats? The only ones that really need blocking are Trans fats and polyunsaturated fats; you can have a healthy egg meal 3 times a week and still fit in to a diet.

Just avoid the fad diets, stick to a calorie-controlled, *healthy* diet and exercise program, and the weight will come off. And you're right about the "lose no less than 1-2 pounds a week."

Calorie-controlled, huh. What's the evidence that the body works like a machine? Ask for 1500 calories in and something is bound to happen. People will "forget" to count; they'll have days off. Or the body will just go into starvation mode if they're being fed real low amounts (~1200 cal or less) and those are usually recommended when calorie-controlled methods don't work at ~1600 calories (and they often don't.)
My personal recommendation would be either Weight Watchers or South Beach. South Beach if you go for low-carb, low-fat combos, Weight Watchers if you want to stick with what's known through countless studies to work, but costs a lot and requires you to eat less as you go on.

[ryaxnb]

Originally Posted by olePigeon 

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Bio-Alternatives Nutritional Supplements
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Yes, Bio-alternatives for serious (non-cold) style diseases are dangerous and they suck. Your Point?

[Person Man]

Originally Posted by ryaxnb 

Allow me to define low-carbohdyrate: Ketosis must kick in. Did ketosis kick in in these studies?

Ketosis has nothing to do with lowering cholesterol.

AFAIK only one statin has been proven to lower Heart Attacks. I'd love to be corrected.

Nothing has been "proven." But there really is only one that has enough data to show that it is most effective at reducing risk of heart attacks, and it still has a few years to go before it becomes generic. The others do lower the risk, but not by as much.

Is Your Doctor in Denial? - washingtonpost.com
People are saying, that statins cause more side effects then you think. Doctors won't admit it sometimes; my Grandma's doctor didn't know about the side effects at all, and brushed off her complaints that were to some of the most common statin side effects.

Don't lump me in with other doctors. I take every one of my patients' complaints seriously. If a patient asks me, for example, whether the muscle aches they have are caused by their statin, I tell them to stop the statin and see if it goes away. If it does, restart the medicine and see if it comes back. If it does, then it's probably the medicine, and I either lower the dose or switch to something else. I also monitor liver function very closely and stop statins if anything seems wrong.

Still, the majority of patients taking statins aren't having many problems with them. If the side effects were as bad as some of the stuff you find online would have you believe, the FDA would have them off the market. Yes, I know that side effects are underreported. But not all muscle aches are signs of a serious issue. I get people who say, "I have a few aches from this medicine, but they don't bother me at all." If the patient is diabetic and there are no signs of muscle damage, and the patient doesn't mind their muscle aches, then the benefits of the medicine outweigh the risk of taking it.

The risk to benefit ratio is different for every patient.

High fat foods can be good for health! Monounsaturated fats are good. Does Alli block monounsaturated fats? How about Saturated fats? The only ones that really need blocking are Trans fats and polyunsaturated fats; you can have a healthy egg meal 3 times a week and still fit in to a diet.

Yes, certain fats are good, but most high fat food that the average American eats is usually high in the bad fats and not enough of the good.

Calorie-controlled, huh. What's the evidence that the body works like a machine? Ask for 1500 calories in and something is bound to happen. People will "forget" to count; they'll have days off. Or the body will just go into starvation mode if they're being fed real low amounts (~1200 cal or less) and those are usually recommended when calorie-controlled methods don't work at ~1600 calories (and they often don't.)

I'm talking about maintaining a negative calorie balance to lose weight. You can do it with 1200 calories under a closely supervised medical program or you can be sensible about it. When I say "calorie controlled," I mean relative to what the average person eats, which is a lot more than what they really need. See below.

My personal recommendation would be either Weight Watchers or South Beach. South Beach if you go for low-carb, low-fat combos, Weight Watchers if you want to stick with what's known through countless studies to work, but costs a lot and requires you to eat less as you go on.

Yes, but you don't NEED the South Beach diet or Weight Watchers to lose weight. Just eat a well balanced diet and don't eat too much and get plenty of exercise. Let me illustrate. The average person who is overweight probably eats WAY more than they need. Like 2500-3000 calories. Ask most people how much they eat, and they underestimate how much they take in (for example, many people don't consider soda pop to be "food." I pointed out to one young woman who drank four 20 ounce bottles of regular pop a day, that she was getting an extra 600 calories a day that she didn't need). Once you ask these people to keep a food diary (if it goes in your mouth, it gets written down), they are usually surprised at how much they're actually getting. For many people, raising their awareness is enough to get them to cut back.

An example will demonstrate my approach, which is very common sense. Let me go through the calculations and discussion I have with a typical patient who comes to me to lose weight. For this example, we'll say a 25 year old woman who weighs 200 pounds and is 5 feet 4 inches tall (BMI of 34.3). She doesn't exercise at all.

It takes 3500 extra calories above what your body needs to gain one pound of weight. So, if you eat 500 extra calories a day, after seven days, you will weigh one pound heavier.

How much should she weigh? I don't use ideal body weight, as it is usually on the low end for most people. My example patient's ideal body weight would be 122 lbs, which gives a Body Mass Index (BMI) of 20.9. Normal range BMI is about 18-24.9. I try to shoot for the middle of normal range, which produces more "realistic" numbers for most people. So let's pick a BMI of 23, which for her would be 135 lbs. If she weighed 140 her BMI would be 24, which is still in normal range. Anything above 145 would be overweight, and anything above 174 would be obese.

Ok. Let's make the target 135 lbs. She needs to lose 65 lbs to get there.

How much energy is her body using just to stay alive? (What is her Basal Energy Expenditure?) Using her current age, height and weight, we use the Harris-Benedict equation and get 1707 calories a day. Multiply it by an "activity correction factor," which for a sedentary person is about 1.1, and you get 1878 calories. Rounded up, it would be 1900. So, if she only ate 1900 calories a day, she would maintain her weight at 200 pounds.

If she ate 1400 calories a day, she could lose a pound a week. That's a bit unrealistic for most people. So, let's split the difference between exercising and eating. The current recommendations for physical activity are an hour a day on most days of the week.

So, I would tell her to burn 250 calories a day by exercising, and eat 1650 calories a day, which is much more doable. This doesn't take nutrients or dietary composition into account. She could still lose weight by eating 1700 calories a day.

You don't need to "induce ketosis." Yes, that produces a dramatic weight loss at first, which then slows down over time. But it won't get you there any faster than going slow and steady. This has been studied.

So, I tell my patients to keep a food diary, eat less, and exercise more. "Wait a minute doc, that sounds like work!" Yes, you have to work at it. And it can be done without following any sort of special diet. Just make sure you eat a balanced diet. (Balanced according to the food pyramid).

Oh, and most adult females are supposed to eat between 1600-1800 calories a day (usual dietary recommendations) and most adult males are supposed to eat between 1800-2000 calories a day. 1500 is not "calorie controlled."

[Person Man]

One other thing. If everyone did what they were supposed to and maintained healthy habits, we wouldn't need a lot of the so-called "lifestyle drugs," such as cholesterol medicines, high blood pressure pills, etc. But human nature being what it is, the drugs are a necessary evil. Every time I put a patient on a new drug, they ask me how long they have to take it. My answer is usually the same. "Indefinitely." I don't say "forever," and I don't say "temporarily," because "temporary" to a patient is a lot shorter than it really is.

When they ask me what I mean by that, I say that if they are able to do what it takes to get healthy and stay healthy, they may be able to stop the drug, provided that they haven't lived an unhealthy lifestyle so long that they have permanent damage.

So, if an overweight 30 year old comes in and is found to have high blood pressure, starting them on a blood pressure pill may be the wake-up call they need to lose weight and exercise more. Then they might not need the blood pressure pill any more.

But, if an overweight 55 year old who has had a heart attack and bypass surgery comes in, chances are that they've gotten so bad that they likely need to be on cholesterol and blood pressure medicines for life. But does that mean they should give up? No. To the extent that they are still able to improve their health situation, they should. They may not be able to stop all their medicines at that point, but they can still take steps to reduce the amount of medicine they need. (For example, 2 blood pressure medicines instead of 5. 10 mg of Lipitor as opposed to 80 mg.)

It's far easier to prevent damage from occurring in the first place than it is to manage it after the fact. But as long as people think that "it'll never happen to me," and "why should I do the hard work it takes to maintain health when there's a pill I can take if a problem develops," doctors will always have work to do.

[BRussell]

hey personman, my wife the RD who thinks most doctors' idea of nutrition is to pop some good healthy pills, would be quite impressed with that post. You sound just like her.

[Monique]

Pills are a good way for doctors to process as many people as possible and making more money. Except in some rare cases they are not useful. Changing your lifestyle has greater benefits than popping pills.