Dear Dr. Roach: Do meds for high blood pressure, cholesterol and diabetes lose their efficacy if the patient is noncompliant with diet? My partner thinks a meal of wings, French fries, cake and ice cream is OK as long as he takes a statin, Glucophage and Norvasc. I think the meds will eventually become ineffective. Your thoughts?
W.G.
The best scenario here is to eat well, keeping fried foods (like wings and fries), high-sodium foods (like wings and fries) and concentrated sweets (cake and ice cream) at a low level, on top of taking your medication as properly prescribed. Medication can partially counteract the effects of a bad diet, but a really bad diet will cause harm no matter how much medication a doctor provides. It’s not that the medications lose efficacy; it’s like trying to put out a house fire with a squirt gun.
I don’t know whether your partner’s doctor has told him about the sort of diet he should have. I have certainly had patients, like your partner, who continue to eat poorly, counting on their medicine to help them, despite receving earnest and repeated advice from me. Getting help from a registered dietician or nutritionist, diabetes nurse educators, health coaches, their partner and others can certainly help reinforce the message. It isn’t the information alone that gets people to change their behaviour. Correcting bad habits is hard, and requires time and effort.
When people really do dramatically change their diet (especially in combination with regular moderate exercise), both they and their doctors are often surprised to see how much less medicine they need and how much better they feel.
Dear Dr. Roach: I’ve noticed that I feel hungry a few minutes after I take ibuprofen, even though I am careful to take it with food to avoid an upset stomach. Can you explain why this is?
J.S.B.
The stomach holds extremely strong acid and requires protection to keep the stomach lining from being damaged. Some of that protection is medicated by a class of compounds called prostaglandins, which, among other actions, increase local blood flow, secrete mucin (to protect cells) and bicarbonate (to reduce the acid that does get through the protective mucin barrier), and help repair any damage that is done.
Ibuprofen, like all nonsteroidal anti-inflammatory drugs and aspirin, works by reducing the enzyme that starts production of prostaglandins and other compounds that transmit pain. However, they also reduce the protective stomach prostaglandins, leaving the stomach vulnerable to the ill effects of acid. Sometimes this causes symptoms — a burning or gnawing pain is the most frequent I hear. I conjecture that some people may find the symptoms after taking ibuprofen similar to the sensation you get when you are hungry. Other people have no symptoms but, nonetheless, can still receive damage in the stomach, including gastritis and ulcers.
The first step to avoiding NSAID-induced stomach damage is to use these drugs infrequently, especially if you get symptoms from them or have a history of proven damage due to them. There are medications to reduce the risk, such as antihistamines (like famotidine); proton-pump inhibitors (omeprazole and others, all of which reduce acid production); and misoprostol, which works on the prostaglandins.
Finding and treating the stomach infection Helicobacter pylori can also be considered as a preventive for people who are about to start a course on NSAIDs. People who have been on NSAIDs for a long time are at a lower (but not zero) risk of developing stomach damage, although older age is associated with a greater risk.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
