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The Doctor Game with W. Gifford Jones, M.D.

What you should know about 'pre-diseases'

 Samuel Johnson once remarked, "Nothing sharpens the wit so much as the knowledge you're going to be hanged in the morning."

 Today, doctors can predict when medical endings will happen and what can be done to prevent them. But too many patients are using the wrong prescription to treat "pre-disease" problems.

 In the past, doctors could inform patients they had diabetes, hypertension or a fractured bone. Today, they've moved a notch higher and often are able to predict these ailments before they strike. But this ability has pitfalls.

 What's the negative? It's the possibility of being over-treated for a number of common diseases. For instance, blood studies can now tell patients they have "pre-diabetes." And studies show that people with pre-diabetes usually develop full-blown diabetes within 10 years.

 So it was as predictable as night follows day that pharmaceutical companies would develop a drug to treat this condition. And since it's today's custom to solve every problem with a pill, there's a ready market for this medication.

 What happened? A drug called rosiglitazone (Avandia) was found to decrease blood sugar levels and reduce the risk of diabetes. But as I've mentioned repeatedly in this column it's rare that patients get something for nothing. And it takes time to discover the bad news. But last year the news arrived. The FDA (Federal Drug Administration) restricted the use of Avandia. It appeared to increase the risk of heart attack and stroke.

 The pill route will never be the ideal way to treat pre-diabetes. This problem, like several others, can be prevented by lifestyle changes. It's not the easy route but the best one. This means first buying a scale and a calorie book and start losing weight. Concentrate on a diet rich in fruits and vegetables, choose low-fat dairy products, decrease the amount of saturated fat, cut back on salt, get off the couch and limit alcohol consumption.

 High blood pressure is another problem for millions of North Americans. Like too much air in a tire, this excess pressure often results in stroke, heart failure or death from coronary attack. Today's trend is to label many patients with the diagnosis of "pre-hypertension" and use medication to decrease the risk of its complications. On the surface this seems to be a logical approach.

 But does it work? Consumer Reports on Health reports two studies that show anti-hypertension drugs can decrease the risk of full-blown hypertension. But it adds that one study was funded by the maker of the drug. In the other instance, the authors of the study had financial ties to the pharmaceutical company. It's getting harder and harder to get unbiased reports these days.

 Dr. Laura Svetkey, director of the Duke University Hypertension Center in Durham, North Carolina, says the risks and benefits of using medication in pre-hypertension patients are largely unknown. She stresses the best treatment is lifestyle intervention, the same advice as for pre-diabetes.

 Following a bone density test many patients are told they have osteopenia, the forerunner of full-blown osteoporosis (brittle bones). Drugs can slowly help to build stronger bone, but not without a price. This medication has been associated with inflammation of the esophagus (food pipe), unusual fractures of the femoral bone and on rare occasions, degeneration of the jaw bone, a very serious complication as there's no treatment for this condition.

 Pre-osteoporosis for many patients is best treated by muscle-strengthening exercise, adequate amounts of calcium, vitamin D and vitamin K2 that puts calcium into bone where it's needed.

 Knowing you have a "pre-disease" is of great benefit for patients who decide it's time to get serious and prevent the full-blown disease. But it's highly unlikely the pill approach will ever be the right prescription.

 North Americans, prodded by both pharmaceutical companies and often physicians, have developed "pillitis." It's a bad habit as they're often exchanging one poison for another. No one has stressed to them that all these pills have to be metabolized by the liver and excreted by the kidneys. Nature did not intend that these organs should handle so much medical garbage. And many are failing.

 See the website http://www.docgiff.com. For comments, info@docgiff.com.



posted on 07/26/11
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