Whether or not one need to take their prescription medication forever is a question I get almost daily. As a pharmacist, it’s clear that individuals are often torn between wanting to be independent and not wanting to rely on medication for the rest of their lives. It’s a valid concern considering that many prescription medications come with potential side effects and may have long-term health implications.
However, the answer to this question is not a simple yes or no. It depends on several factors such as the type of medication, the underlying health condition, and the individual’s response to treatment.
Type of medication
Certain medications are meant for short-term use while others require lifelong management. For example, antibiotics are usually prescribed for a specific period of time to treat an infection and once the infection clears up, the medication can be stopped. However, for chronic conditions such as diabetes, high blood pressure, and asthma, medications are necessary for long-term management. This is because these conditions cannot be cured but can be controlled with the help of medication.
Underlying health condition
The duration of prescription medication also depends on the underlying health condition being treated. Some illnesses may require continuous medication while others may only need to be managed for a certain period of time. It’s important to discuss with your healthcare provider about the duration of treatment for your specific health condition.
One factor to consider is whether or not the underlying health condition driven by a genetic component? For example, type I diabetics have a genetic defect that reduces their ability to secrete insulin. In these instances there is a high chance that prescription medicine, insulin in the case of type I diabetics, will always be required.
If on the other hand, one is suffering from a chronic condition, one that can be categorised as a lifestyle disease , perhaps not.
What’s a lifestyle disease?
These are conditions in which the condition MAY be a result of poor lifestyle.
Examples of lifestyle diseases include type 2 diabetes, hypertension, high cholesterol, acid reflux, and obesity. While these conditions may also have a genetic component, they are also heavily influenced by lifestyle factors such as diet, exercise, and stress levels.
Consequently, whether or not those diagnosed with a lifestyle disease need to take their medication forever depends on their ability to make lifestyle changes. This includes following a healthy diet, being physically active, managing stress levels, and avoiding unhealthy habits such as smoking or excessive alcohol consumption.
In addition to lifestyle changes, there are also other non-medication treatment options available for certain conditions. For example, physical therapy may be used to manage chronic pain instead of relying on pain medication. Some mental health disorders can also be managed through therapy and counselling rather than solely relying on prescription drugs.
Importance of medication adherence
Regardless of the underlying health condition, it is crucial to adhere to prescribed medication regimens. Failure to do so can lead to serious consequences including worsening of symptoms, disease progression, and even death.
Moreover, non-adherence can also result in increased healthcare costs as well as decreased quality of life for the individual. For those with chronic conditions, medication adherence is essential for managing their condition and preventing further complications.
Finding a balance
Finding a balance between lifestyle changes and medication adherence is key in managing chronic diseases. By making positive lifestyle changes it’s possible to restore health, providing irrepressible damage hasn’t already been done.
In my previous post, ‘How big do you really want to get? – Muscle Talk’, I quite plainly wrote there exists a correlation between our physical condition and the effort we put into it. Let me repeat. I am not suggesting those with a genetic condition are at fault, neither am I suggesting that everything that happens to someone is a direct consequence of something they did. I am however suggesting, the choices we make or do not make, can have a significant impact on our health.
The Type II Diabetes Example
Metformin is a medication used for type II diabetics, it increases the body’s ability to utilise insulin and is often the first drug given to type II diabetics. One of my university lecturers hammered into us that type I diabetics tend to thin whilst type II diabetics tend to be, larger.
While type I diabetes is a genetic/autoimmune condition (for the majority of cases), a type II diabetic typically becomes diabetic due to their physical condition. It’s true, some are unlucky enough to be in a position whereby they are genetically pre-disposed, but most are just fat; plus just because you’re more likely to get something doesn’t mean it’s guaranteed; there are still ways to reduce the risk.
You can’t change the cards you are dealt, but you can change how you play them.
Enough insulin for a healthy size, not enough for the plus size
Generally speaking, it’s not that type II diabetics do not produce sufficient insulin. It is that their bodies have become insulin resistant due to excess fat tissue. In addition, the more body fat someone has, the higher their blood glucose levels will be as the body struggles to regulate it with the insulin it is able to produce, even when it increases insulin production.
It’s a vicious cycle. The more you eat (and don’t burn), the fatter you get, the less sensitive your cells become to insulin, the more insulin you need to produce, the fatter you get… and so on it goes. This is why type II diabetes is often referred to as a lifestyle disease.
As one gets bigger and bigger the amount of insulin required to service the increasing size also increases, and this is where the problem starts. Soon you do not have enough for your size and your blood glucose cannot be adequately controlled. So what does your doctor give you? Metformin of course
Metformin helps the body better utilise the insulin that is being secreted and all of a sudden the diabetes is under control. Well done! But has the problem gone away? No, effectively we’ve just painted over the cracks, eventually that structure will crumble. As time passes the pancreas will have a hard time keeping up, eventually slowing down and secreting less.
In response, doctors will once again prescribe something else. This time the medication not only increases the uptake of insulin by cells, but also the volume of insulin secreted by the pancreas. Great! But has the problem gone away?
Ultimately, the body can produce only so much insulin. There is a maximum output and this needs to be respected. If the body is set to run on maximum for too long, it will eventually give up, and at that point the only option is insulin injections. This is why it’s important to maintain a healthy lifestyle and manage weight, as this can help prevent or delay the onset of type II diabetes.
Is Your Medication a Crutch?
I can think of only a few reasons so important that your health needs to suffer. If your house was about to fall down do you really think getting to work on time would be you biggest concern. Will getting that new widescreen TV matter if you have no wall to hang it?
Smoking increases you risk of heart attack, stokes, cancer, respiratory problems and more, yet it’s not uncommon to find patients being treated for these conditions regularly smoking. Are they victims?
What if your marriage was falling apart, would you not invest time into repairing the damage before it completely disintegrates? There is a point of no return and once its crossed there’s only so much that can be done. Like most problems, the longer you leave it the worse it gets, and the more effort will be required to resolve it.
Exercise does a lot more than just burn calories
The benefits of exercise extends beyond weight loss, and beyond muscle building too. Excluding the benefits it has on our physical appearance (vanity), exercise also changes us from within.
Endorphins
Countless studies have shown that those who exercise regularly benefit from a positive mind-set, a boost in mood and lower rates of depression. This effect is not only related to the increased self-confidence, which comes from an improved body image, but also from the release of endorphins. Endorphins are the body’s self-secreting antidepressants, no prescription needed.
Endorphins are released as a direct result of exercise and interact with receptors in the brain, they have been shown to:
- Produce an analgesic effect (a.k.a painkiller) by reducing the brains perception of pain
- Improve mood
- Reduce stress and anxiety – which are contributing factors to high blood pressure
- Improve sleep
Endorphins are the body’s self-secreting antidepressants
Professionally I’m saddened by the way prescription antidepressants are being used within our healthcare system, though they certainly have their place in therapy. Anxiety, depression and sleep disturbances are often conditions accompanied with a minefield of psychological issues that need resolving with the help of a professional, not you’re GP. For the most part these patients need psychological help from someone willing to listen for more than a 5 minute consultation.
Insulin receptors
Exercise also helps improve our insulin sensitivity by increasing the number of insulin receptors in our body. Insulin receptors are important because they allow glucose to enter into our cells, where it is used for energy. When we are physically active, our muscles require more energy and therefore need more glucose. This increased demand for glucose triggers the production of more insulin receptors to help transport glucose into our cells. This is important because it means our body can more efficiently regulate blood sugar levels and prevents the onset of conditions such as diabetes.
In addition, regular exercise has been shown to increase the sensitivity of these insulin receptors, making them more responsive to insulin. By exercising regularly and maintaining a healthy weight, individuals with diabetes can improve their insulin sensitivity and better control their blood sugar levels. This means the body can use the insulin already being secreted more effectively, during and well after exercise. In addition exercise stimulates a non-insulin dependent glucose transport mechanism which allows your cells to take up glucose, and use it for energy, whether insulin is available or not.
Type I and severe type II diabetics on multiple medicines must be vigilant of hypoglycaemia (low blood sugar levels) when exercising. We recommend those with diabetes always speak to a specialist before embarking on any fitness regime.
Cholesterol
Oh the famous statins. One of the most commonly prescribed medicines in the world to control cholesterol, but wouldn’t controlling your diet and exercise do the same. Indeed it would. Contrary to popular belief eating foods high in cholesterol, such as eggs, does not cause an increase in blood cholesterol, but a diet high in saturated fat does.
For those with KNOWN heart disease, statins have a NNT (number needed to treat) score of 83. That means for every 83 people treated with them only 1 persons life will be saved. The NNT of statins to prevent a non fatal heart attack is 39, which is 2.5% success rate, and to prevent a stoke it is 125 (0.8% success). Remember this is for patients with known heart disease, for patients without known heart disease the statistics are less favourable.
At the end of the day eating too much of anything will add fat to your frame. How much you eat is a matter of self-control and requires an innate understanding of your metabolism. If you have a low metabolism there’s not point comparing yourself to someone with a high metabolism, that’s ridiculous. Instead you should find out what works for your body, and stick to it. You can consult a registered dietician who can help create a meal plan tailored to your specific needs if needed.
try consuming less saturated fats and more unsaturated fats, particularly monounsaturated fats
The link between saturated fat consumption, cholesterol and heart disease is complex and still debated among experts. However, a diet low in saturated fats and high in monounsaturated fats has been linked to lower levels of “bad” LDL cholesterol, and a reduced risk of heart disease. Monounsaturated fats can be found in foods like olive oil, avocados, nuts and seeds.
In addition to dietary changes, regular exercise can also help control cholesterol levels
Exercise has also been shown to reduce cholesterol. It works by:
- Stimulating enzymes involved in moving LDLs (bad cholesterol) from the blood (and blood-vessel walls) to the liver where it is converted to bile and excreted. This improves the bad to good cholesterol ratio (LDL:HDL).
- Increasing the size of LDL particles making them easier to remove and less likely to accumulate within the lining of heart and blood vessel tissues
- Intense exercise has also been shown to increase good cholesterol (HDLs)
Heart Health
Exercise increases cardiac output by strengthening the muscles of the heart. This means blood can be pumped around the body more effectively and oxygen delivery as a whole is improved. Cardiovascular risk is reduced and blood pressure is lowered. While lung capacity is not directly increased, the ability to transport oxygen better means exercise tolerance is increased and naturally one will feel less out of breath (compared to if you didn’t exercise regularly)
So can I stop taking my medication?
Not without the approval of your doctor! Whilst incorporating effective diet and exercise plans can improve and reduce the risk of a multitude of conditions it will take at least 3 – 4 weeks to start seeing significant changes. In the meantime you will need to keep taking you medication until your doctor deems you fit enough to come of them.
Note that not all patients will be able to stop their medication but most patients will benefit from a better diet and regular exercise programme. How effective and whether you will be able to stop some/all you medication is at least partly dependant on how long the problem has persisted. The longer a condition has been left untreated the less likely it will be.
Finally whilst this article has focused on type II diabetes and cardiovascular issues, diet and exercise can also reduce your risk of cancers, improve asthma, improve eczema and a number of other common conditions. So before your medication starts pilling up, ask yourself, what lifestyle changes can be incorportated into your daily habits?
You always have a choice. Choosing to do nothing is a choice.
Related Article: 5 Simple Food Choices for Long Term Health Results
