What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know

9 DRUGS CANNOT OVERCOME A POOR DIET OR AN UNHEALTHY LIFESTYLE

“Let your food be your medicine and
let your medicine be your food.”

—Hippocrates

THERE IS AN EVER-GROWING appreciation of the role of diet in determining our level of health. It is now well established that certain dietary practices cause, and others prevent, a wide range of diseases. In addition, more and more research indicates certain diets and foods offer immediate therapeutic benefits. Yet despite these advances, rarely are patients with diet-related diseases given the dietary information that could lead them to better health. Instead, people with diabetes, high blood pressure, and many other diet-related diseases are immediately placed on drug regimens. And what the drug companies won’t tell you and your doctor doesn’t know about these drug regimens is that they ultimately cripple our body processes and shorten our lives. As startling as that statement may seem, it is nonetheless irrefutable.

Natural medicine may not provide all the answers for every person with type 2 diabetes or high blood pressure, but there is no way around the fact that no drug provides all the benefits a person can achieve through diet, lifestyle, and key natural medicines. Although drugs may be necessary in some cases, they simply cannot replace the many advantages produced by diet and lifestyle.

METABOLIC SYNDROME—AN AMERICAN EPIDEMIC

It is estimated that about 60 million adults in the United States meet the criteria for metabolic syndrome. This cluster of signs and symptoms includes:

Central obesity (excessive fat tissue in and around the abdomen) as demonstrated by a greater waist-to-hip ratio.
Low levels of HDL cholesterol—less than 40 milligrams per deciliter (mg/dL) in men and less than 50 mg/dL in women.
Fasting blood triglycerides of 150 mg/dL or more.
Elevated blood pressure (130/85 mm Hg or higher).
Insulin resistance (the body can’t properly use insulin or blood glucose), as demonstrated by the presence of prediabetes (glucose levels between 101 and 125 mg/dL)
Elevated uric acid levels (above 8.3 mg/dL).

Originally referred to as “syndrome X” by the endocrinologist Gerald Reaven, M.D., of Stanford University, metabolic syndrome is a serious health issue because people who have it are at increased risk of coronary artery disease, other diseases related to plaque buildup in artery walls (e.g., stroke and peripheral vascular disease), and type 2 diabetes. The presence of four or more of the above criteria is associated with a 2.5 times greater risk of a heart attack or stroke, and a nearly 25 times greater risk of diabetes.

Metabolic syndrome, prediabetes, hypoglycemia, increased insulin secretion, and even type 2 diabetes can be viewed as different facets of the same disease having the same underlying dietary, lifestyle, and genetic causes. The human body was simply not designed to handle the amount of refined sugar, white flour, salt, saturated fats, and other harmful food compounds that many people in the United States and other western countries consume, especially when such a diet is combined with a sedentary lifestyle. The result is that a metabolic syndrome emerges—elevated insulin levels, obesity, elevated blood cholesterol and triglycerides, and high blood pressure. “Metabolic syndrome” is the label modern medicine has chosen to ascribe to a condition caused by poor dietary and lifestyle choices. It seems rather silly for medical researchers to be spending millions of dollars on the development of drugs (presumed to be “magic bullets”) to address these problems, when they could be prevented at far less cost, and far more effectively, by teaching people how to choose a healthier diet and lifestyle. It is highly unlikely that there will ever be a drug to replace the important dietary and lifestyle factors on which the human body lives and thrives.

Fast-Food and Insulin Resistance

Given the relationship between obesity and the incidence of type 2 diabetes, researchers sought to assess the association between fast food, weight gain, and insulin resistance in a study called Coronary Artery Risk Development in Young Adults (CARDIA). The results showed that those participants who frequented fast-food restaurants more than two times per week at the start of the study and at the 15-year follow-up put on an extra 10 pounds and had an approximately 200 percent greater increase in insulin resistance than participants who ate at fast-food restaurants less than once a week at baseline and follow-up. These findings demonstrate that fast-food is strongly linked to weight gain and insulin resistance.1

METABOLIC SYNDROME IS A GOLD MINE FOR THE DRUG INDUSTRY

Patients with metabolic syndrome are a virtual gold mine for the drug industry. Typically, these patients are on very extensive (and expensive) drug regimens to try to address the many facets of this syndrome. Here is a typical list of drugs prescribed for patients with the metabolic syndrome, as well as for many patients with type 2 diabetes:

Lopid (gemfibrozol)—a drug designed to lower triglycerides, but it is also associated with potentially serious side effects.
Lipitor—a statin drug used to lower LDL cholesterol levels.
Altace—an ACE inhibitor drug used in the treatment of high blood pressure.
Avandia or Actos—potentially dangerous drugs used to lower blood sugar levels. Doctors prescribe these drugs because they are told that the drugs will help reduce the risk of atherosclerosis as well.
Metformin (glucophage) is prescribed because doctors are told that it will reduce the risk of type 2 diabetes in patients with the metabolic syndrome. What the doctors don’t know is that moderate exercise is twice as effective in achieving this goal (as discussed below).
Nexium—an acid-blocker drug. It is often prescribed to deal with some of the gastrointestinal side effects produced by some of the other drugs.

Do these drugs really benefit the patients? That is highly debatable, given their side effects, interactions, and failure to address the real issues underlying metabolic syndrome as well as type 2 diabetes. Nonetheless, as the drug industry tries to expand its market, there is a tremendous push to get doctors to prescribe these multidrug regimens for all patients with metabolic syndrome and type 2 diabetes as early as possible.

OBESITY IS THE BIGGEST THREAT TO AMERICA’S FUTURE

The drug industry and the conventional medical community have played a significant role in another serious epidemic in the United States—obesity. The drug companies offer their little pills for the treatment of diabetes, prediabetes, and metabolic syndrome in an attempt to overcome the effects of obesity, dietary excess, and an inactive lifestyle.

Conventional Wisdom Once Again Proved Wrong

Patients with type 2 diabetes have been medicated in an attempt to achieve very tight control of blood sugar. It would seem to make sense that if you can improve the control of blood sugar levels, there will be a decrease in the complications of diabetes, and in mortality from diabetes. Although this practice became the unofficial gold standard of care, it had never been properly tested. That led the National Heart, Lung, and Blood Institute (NHLBI) to develop a study of approximately 10,000 patients with type 2 diabetes and either heart disease or two risk factors for heart disease. This study, named the ACCORD trial, was stopped prematurely because there was a higher rate of mortality from heart attacks in the patients being treated to achieve normal blood sugar control with a target for hemoglobin A _1C (HbA _1C, an indicator of blood sugar control) of less than 6 percent compared with those for whom the target was 7.0 percent to 7.9 percent.

Researchers and various medical experts scrambled to explain these results to the press, but the explanation seemed clear to me. To achieve the desired goal, these subjects were given higher dosages of drugs known to be associated with promoting heart disease. The results are not really surprising in light of the known issues with diabetes medications as well as some of the other drugs used in the trial (see the list on Chapter 9 for an idea of what these patients were probably taking).

Each year obesity-related conditions cost more than $100 billion and cause an estimated 300,000 premature deaths in the United States. Although terrorism, environmental pollution, and dwindling natural resources certainly put the future of our nation in peril, a very strong case can be made that the obesity epidemic is the most significant threat to the future of the United States as well as other nations. In 1962, the proportion of obesity in America’s population was at 13 percent. By 1980 it had risen to 15 percent, by 1994 to 23 percent, and by 2004 to one out of three, or 33 percent. Approximately 65 million adult Americans are now obese—more than the total populations of Britain, France, or Italy. And there is no end in sight. This trend is still rising rapidly. In particular, the percentage of children who are obese is rising at an alarming rate.

OBESITY AND HEALTH

Can you be healthy and fat? No. According to a recent study by the RAND organization, obesity is more damaging to health than smoking, high levels of alcohol consumption, and poverty.2 Obesity affects all major bodily systems—heart, lungs, muscle, and bones. The health effects associated with obesity include, but are not limited to, the following:

Metabolic syndrome—Approximately one-third of overweight or obese people in the United States have metabolic syndrome.
High blood pressure—Additional fat tissue in the body needs oxygen and nutrients in order to live, so the blood vessels are required to circulate more blood to the fat tissue. This increases the work of the heart because it must pump more blood through additional blood vessels. More circulating blood also means more pressure on the artery walls. Higher pressure on the artery walls increases blood pressure. In addition, extra weight can raise the heart rate and reduce the body’s ability to transport blood through the vessels.
Diabetes—Obesity, particularly abdominal obesity, is the major cause of type 2 diabetes. Obesity can cause resistance to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, the body’s blood sugar level becomes elevated. Even moderate obesity dramatically increases the risk of diabetes.
Heart disease—Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people compared with those who are not obese. Coronary artery disease is also more prevalent because fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood flow to the heart can cause chest pain (angina) or a heart attack. Blood clots can also form in narrowed arteries and cause a stroke.

Cancer—In women, being overweight contributes to an increased risk of various cancers, including cancer of the breast, colon, gallbladder, and uterus. Men who are overweight have a higher risk of colon and prostate cancers.

Joint problems, including osteoarthritis—Obesity can affect the knees and hips because of the stress placed on the joints by extra weight. Joint replacement surgery is commonly performed on damaged joints, but it may not be an advisable option for an obese person, because the artificial joint has a higher risk of loosening and causing further damage.

Sleep apnea and respiratory problems—Sleep apnea, a condition in which people stop breathing for brief periods, interrupts sleep throughout the night and causes sleepiness during the day. It also causes heavy snoring. Respiratory problems associated with obesity occur when added weight at the chest wall squeezes the lungs and restricts breathing. Sleep apnea is also associated with high blood pressure.

Psychosocial effects—In a culture where the usual ideal of physical attractiveness is to be overly thin, people who are overweight or obese frequently suffer disadvantages. Overweight and obese persons are often blamed for their condition and may be considered lazy or weak-willed. It is not uncommon for overweight or obesity to result in having a lower income or in having few or no romantic relationships. Disapproval of overweight people may progress to bias, discrimination, and even torment.

Obesity Defined

The simplest definition of “obesity” is an excessive amount of body fat. Obesity is distinguishable from “overweight,” which refers to an excess of body weight relative to height. A muscular athlete may be overweight yet have a low percentage of body fat. Given this distinction, it is obvious that using body weight alone as an index of obesity is not entirely accurate. Nonetheless, a simple measure known as body mass index (BMI) is now the accepted standard for classifying individuals with regard to body composition. The BMI generally correlates well with a person’s total body fat. It is calculated by dividing a person’s weight in kilograms by his or her height in meters squared. The mathematical formula is weight/height² or kg/m². You are not likely to actually calculate your BMI, so here is a simple table. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.

Body Mass Index

A BMI between 25 and 29.9 indicates overweight. Obesity is defined as a BMI of 30 or greater. To put BMI in perspective, a woman five feet four inches tall with a BMI of 30 is about 30 pounds above her ideal body weight. Obesity is not a matter of simply being a few pounds overweight. It reflects a significant amount of excess fat. There is one more calculation that is important—your waist size. The combination of your BMI and your waist circumference is very good indicator of your risk of all the diseases associated with obesity, especially the major killers: heart disease, stroke, cancer, and diabetes.

Risk of Associated Disease According to BMI and Waist Size

BMI	Classification	Waist Less Than or Equal to 40 Inches (Men) or 35 Inches (Women)	Waist Greater Than 40 Inches (men) or 35 Inches (women)
18.5 or less	Underweight	—	NA
18.5–24.9	Normal	—	NA
25.0–29.9	Overweight	Increased	High
30.0–34.9	Obese	High	Very high
35.0–39.9	Obese	Very high	Very high
40 or greater	Extremely obese	Extremely high	Extremely high

ABDOMINAL OBESITY—A KEY COMPONENT OF METABOLIC SYNDROME AND INSULIN RESISTANCE

Abdominal obesity is highly associated with metabolic syndrome, insulin resistance, elevated inflammatory markers, high cholesterol, high triglycerides, high blood pressure, dyslipidemia, and hypertension. It is much more strongly linked to these conditions than body mass index is. So, apparently it is not how much you weigh, but rather where you store your fat, that determines your risk of cardiovascular disease.

Abdominal fat tissue was previously regarded as an inert storage depot; however, the emerging concept describes adipose tissue as a complex and highly active metabolic and endocrine organ. Fat cells secrete adipokines, hormonelike compounds that control insulin sensitivity and appetite. As abdominal fat accumulates, it leads to alterations in adipokines that ultimately promote insulin resistance and an increased appetite, thereby adding more abdominal fat. Fortunately, reduction of abdominal fat through dietary means and increased physical activity can reestablish insulin sensitivity and reduce appetite.

To determine your waist circumference, locate the upper hip bone and place a measuring tape around the abdomen (ensuring that the tape is horizontal). The tape should be snug but should not compress the skin. If your waist circumference is (for a man) greater than 40 inches or (for a woman) greater than 35 inches, there is no need to do any further calculation, as this measurement alone has been shown to be a major risk factor for both CVD and type 2 diabetes. If your waist circumference is less than these values, you need to determine your waist-to-hip ratio. To do this, measure the circumference of your waist as before and the circumference of your hips at the greatest protrusion of the buttocks. Divide the waist circumference by the hip circumference. A waist-to-hip ratio above 1.0 for men and above 0.8 for women increases the risk of developing CVD, type 2 diabetes, high blood pressure, and gout.

Measure the circumference of your waist: _____
Measure the circumference of your hips: _____

Divide the waist measurement by the hip measurement: waist/hip = _____ (this is your waist-to-hip ratio)

DIABETES—A MAJOR CONSEQUENCE OF OBESITY

Diabetes is one of the biggest drains on our society’s resources—both financial and human. The total economic toll of diabetes in the United States alone is more than $100 billion dollars annually. To put this in perspective, the average annual cost of health care for a diabetic is approximately $12,000, whereas the cost for an adult without diabetes is about $3,000. Diabetes is responsible for more than 30 million visits to doctors each year, and for a total of about 15 million days of hospitalization for diabetes-related issues. In addition to an earlier death, diabetes carries significant risks of serious complications such as blindness, a need for dialysis, and limb amputation.

A Diabetes Primer

Diabetes is divided into two major categories: type 1 and type 2. Type 1 diabetes is associated with complete destruction of the beta cells of the pancreas that manufacture the hormone insulin. Individuals with type 1 diabetes will require lifelong insulin to control blood sugar levels. About 5 to 10 percent of all diabetics are type 1.

In type 2 diabetes insulin levels are typically elevated, indicating a loss of sensitivity to insulin by the cells of the body. Approximately 90 percent of individuals categorized as having type 2 diabetes are obese. Obesity greatly reduces the sensitivity of cells to the hormone insulin.

Prediabetes is a condition that occurs when a person’s blood glucose levels are higher than normal (>101 mg/dL), but not high enough for a diagnosis of type 2 diabetes (>126 mg/dL). There are almost as many people in the United States with prediabetes (about 16 million) as there are with type 2 diabetes (18 million).

The major complications of diabetes are as follows:

Heart disease and stroke—Adults with diabetes have death rates from cardiovascular disease about two to four times higher than adults without diabetes.
High blood pressure—About 75 percent of adults with diabetes have high blood pressure.
Blindness—Diabetes is the leading cause of blindness among adults.
Kidney disease—Diabetes is the leading reason why people need to go on dialysis, accounting for 43 percent of new cases.
Nervous system disease—About 60 percent to 70 percent of people with diabetes have mild to severe nervous system damage. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
Amputations—More than 60 percent of lower-limb amputations in the United States occur among people with diabetes.
Periodontal disease—Almost one-third of people with diabetes have severe periodontal (gum) disease.
Pain—Many diabetics have chronic pain due to conditions such as arthritis, neuropathy, circulatory insufficiency, or muscle pain (fibromyalgia).
Depression—This is a common accompaniment of diabetes. Clinical depression can often begin years before diabetes is fully evident, and it is difficult to treat in poorly controlled diabetics.
Autoimmune disorders—Thyroid disease, inflammatory arthritis, and other diseases of the immune system commonly add to the suffering of diabetics.

DIABETES—WHAT THE DRUG COMPANIES WON’T TELL YOU AND YOUR DOCTOR DOESN’T KNOW

Type 2 diabetes is an entirely preventable disease, even if it’s in your family. If you have type 2 diabetes, in most cases, you can eliminate the need for drugs and normalize blood sugar levels by achieving your ideal body weight. In Chapter 1, I stated that the current treatment of type 2 diabetes is absurd. The research is quite clear—oral medications to treat type 2 diabetes do not alter the long-term development of the disease. The drugs are quite effective in the short term, but they create a false sense of security and ultimately fail starting a vicious circle in which they are prescribed at higher dosages or in combination with other drugs, leading to increased mortality. That is right; the long-term use of these drugs is actually associated with an earlier death, compared with control groups of diabetics who are not being given the drugs. The major categories of these oral diabetes drugs are:

Alpha-glucosidase inhibitors: acarbose (Precose); miglitol (Glyset)
Sulfonylureas: acetohexamide (Dymelor); chlorpropamide (Diabinese, Insulase); glimepiride (Amaryl); glipizide (Glipizide, Glucotrol); glyburide (Diabeta, Micronase); repaglinide (Prandin); tolazamide (Tolinase); tolbutamide (Orinase)
Biguanide type (non-sulfonylureas): metformin (Glucophage)
Sulfonylurea/metformin combination: glyburide + metformin (Glucovance)
Insulin-response enhancers: pioglitazone (Actos); rosiglitazone maleate (Avandia); troglitazone (Rezulin)
Insulin-production enhancers: repaglinide (Prandin); nateglinide (Starlix)

The most widely prescribed of these drugs is metformin (Glucophage). Metformin is a drug with a profile that is generally more favorable than the other oral diabetes drugs for most type 2 diabetics requiring medication. Although studies have found that metformin alone shows a decrease in heart attacks and all diabetes-related deaths, it does not work at all in about 25 percent of cases and tends to lose its effectiveness over time.3 When it does lose effectiveness, it is usually combined with a sulfonylurea. On their own, these drugs are of limited value, and there is some evidence that sulfonylureas actually have harmful long-term side effects. For example, in a famous study conducted by the University Group Diabetes Program (UDGP), it was shown that the rate of death due to a heart attack or stroke was 2.5 times greater in the group taking tolbutamide (a sulfonylurea) than in the group controlling type 2 diabetes by diet alone. Though newer sulfonylureas are considered safer than tolbutamide, there still remains considerable concern regarding their effects on the heart.⁴ In addition, sulfonylureas promote weight gain, thereby fighting against the diabetic’s necessary efforts to lose weight. The combination of metformin with glyburide or gliblencamide, like taking a sulfonylurea alone, actually increases premature mortality.⁵

The thiazolidinediones are the newest class of oral diabetes drugs. Like pioglitazone (Actose) and rosiglitazone (Avandia), these drugs appear to be extremely dangerous. The first drug in this class, Rezulin (troglitazone), was removed from the market because of widespread deaths due to liver failure. Pooled results from 42 different studies with Avandia found a 43 percent increase in the number of heart attacks and a 64 percent increased risk of dying from heart disease in patients taking it, compared with type 2 diabetics given a placebo.⁶ In addition, both Actose and Avandia are also associated with significant weight gain. Although these drugs may have some benefits in lowering blood sugar levels, it is clear that the side effects outweigh the benefits.

PREVENTING DIABETES IN HIGH-RISK INDIVIDUALS

Several large, well-designed trials have shown that lifestyle and dietary modifications can be used effectively to prevent type 2 diabetes. That fact has not dissuaded drug companies from sponsoring studies attempting to show prevention of diabetes with their drugs. The goal is to tap into the prediabetes market. Since there are almost as many Americans with prediabetes as with type 2 diabetes, drug companies can double their profits from oral diabetes drugs if they can persuade doctors to prescribe them for people with fasting blood sugar levels between 101 and 125 mg/dL (anything over 126 signifies diabetes). The drug companies are very quick to point out their drugs do seem to produce a preventive effect, but they fail to tell the doctors that the degree of prevention achieved by drugs pales in comparison with the effectiveness of diet and lifestyle. For example, consider one of the most celebrated studies. The drug companies’ sales reps tell doctors that in this study metformin reduced the incidence of diabetes by 31 percent, but they fail to tell the doctors that walking for 30 minutes a day five days a week reduced the incidence by 58 percent.7 Clearly, the lifestyle intervention was significantly more effective than metformin.

HUNGER-FREE FOREVER

The most important goal in the effective treatment of type 2 diabetes (as well as of metabolic syndrome and high blood pressure), in the overwhelming majority of cases, is achieving ideal body weight. To help in that goal, Dr. Michael Lyon and I developed the Hunger Free Forever plan to make effective, permanent weight loss a reality. Our program utilizes exciting scientific breakthroughs to stabilize blood sugar levels, improve the action of insulin, normalize appetite, and help people enjoy a high degree of satiety. This simple approach makes it easy to reach and maintain body weight goals.

Satiety is defined as the state of being full or gratified to the point of satisfaction. Research has shown that humans eat to achieve satiety and those who are overweight have more food cravings and resist satiety even after eating adequate amounts of food. Our program uncovers the reasons for these cravings and this resistance to satiety, and it provides keys to restoring normal appetite control. We have found it to be successful whether someone wants to lose five pounds or 200 pounds.

If you have struggled to achieve your ideal body weight, if you have tried various diets only to end up weighing more than when you started, if you feel that when you simply look at food it magically winds up on your thighs, or if you always feel hungry and never feel satisfied, then I strongly encourage you to read our book Hunger Free Forever for detailed information. But to get started, please see Appendix C, The Hunger Free Forever Program.

Soft Drinks Linked to Metabolic Syndrome

The frequent consumption of soft drinks, whether regular or diet, is associated with obesity and increased risk of metabolic syndrome and diabetes. A team of researchers at Harvard analyzed consumption of soft drinks in more than 6,000 individuals participating in the Framingham Heart Study.8 Their results are astounding. Drinking one or more soft drinks per day was associated with several conditions.

	Increased
Component of the metabolic syndrome	risk
Increased waist circumference	30%
Elevated blood sugar	25%
High blood pressure (≥135/85 mm Hg or on treatment)	18%
High triglycerides	25%
Low HDL cholesterol	32%
Overall incidence of metabolic syndrome	44%

Presumably individuals who drink soda, with sugar or without, tend to have a greater intake of calories, consume more saturated and trans fats, consume less fiber, and have a more sedentary lifestyle. And, despite the fact that diet soda has zero calories, the findings are not entirely surprising, because previous studies on diet soft drinks have linked them to weight gain and high blood pressure. Diet sodas are thought to lead to a stronger dietary preference for sweeter foods, as well as to disrupt appetite control.

HIGH BLOOD PRESSURE

Each time the heart beats, it sends blood coursing through the arteries. The peak reading of the pressure exerted by this contraction is the systolic pressure. Between beats the heart relaxes, and blood pressure drops. This lower reading is referred to as the diastolic pressure. Blood pressure readings are in millimeters (mm) of mercury (Hg). A normal blood pressure reading for adults is 120 (systolic)/80 (diastolic). Readings above this level are a major risk factor for heart attack and stroke. High blood pressure can be divided into the following categories:

Prehypertension (120–139/80–89)

Borderline (120–160/90–94)

Mild (140–160/95–104)

Moderate 140–180/105–114)

Severe (160+/115+)

More than 80 percent of patients with high blood pressure are in the borderline-to-moderate range. Because most of these cases can be brought under control through changes in diet and lifestyle, it can be concluded that 80 percent of the prescriptions for high blood pressure are ill-advised. In fact, in comparisons of cases of borderline to mild hypertension, many nondrug therapies such as diet, exercise, and relaxation have proved superior to drugs. Here is another important point: several well-designed long-term clinical studies found that people taking diuretics, beta-blockers, or both not only experienced unnecessary side effects, but also had an increased risk of heart disease. Keep in mind that the reason why high blood pressure is treated is to reduce the risk of heart disease and strokes. Although the newer classes of drugs, the calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors, appear to be safer and to have fewer side effects, they are also not without problems.

ANTIHYPERTENSIVE DRUGS

The four major categories of drugs that lower blood pressure are diuretics, beta-blockers, calcium channel blockers, and ACE inhibitors. Here is a brief description of each drug, followed by current recommendations for the drug treatment of high blood pressure.

Diuretics

To lower blood pressure, diuretics reduce the volume of fluid in the blood and body tissues by promoting the elimination of salt and water through increased urination. In addition, diuretics also work to relax the smaller arteries of the body, allowing them to expand and increase the total fluid capacity of the arterial system. The net result of diuretics is lower pressure due to reduced volume in an expanded space. Thiazide diuretics are by far the most popular type—they are often the first drug used in treating mild to moderate high blood pressure. Examples of thiazide diuretics include:

bendroflumethiazide (Naturetin)
benzthiazide (Exna, Hydrex)
chlorothiazide (Diuril); chlorthalidone (Hydone, Hygroton, Novo-Thalidone, Thalitone, Uridon); cyclothiazide (Anhydron)
hydrochlorothiazide (Apo-Hydro, Diuchlor H, Esidrix, Hydro-chlor, HydroDIURIL, Neo-Codema, Novo-Hydrazide, Oretic, Urozide)
hydroflumethiazide (Diucardin, Saluron)
methyclothiazide (Aquatensen, Duretic, Enduron)
metolazone (Diulo, Mykrox, Zaroxolyn)
polythiazide (Renese)
quinethazone (Hydromox)
trichlormethiazide (Aquazide, Diurese, Metahydrin, Naqua, Trichlorex)

Some of the side effects of thiazide diuretics are light-headedness, higher blood sugar levels, higher uric acid levels, aggravation of gout, and muscle weakness and cramps caused by low potassium levels. Decreased libido and impotence are also reported. Less frequent side effects include allergic reactions, headaches, blurred vision, nausea, vomiting, and diarrhea.

Thiazide diuretics also cause a loss of potassium, magnesium, and calcium from the body. All these minerals have been shown to lower blood pressure and prevent heart attacks. The drugs also raise cholesterol and triglyceride levels; increase the viscosity of the blood; raise uric acid levels; and increase the stickiness of the platelets, making them likely to aggregate and form clots. All these factors may explain why thiazide diuretics may actually increase the risk of dying from a heart attack or stroke. Thiazide diuretics also have a tendency to worsen blood sugar control, so they are difficult to use safely with diabetics.

Beta-Blockers

Beta-blockers produce a reduced rate and force of contraction of the heart, as well as relaxing the arteries. In addition to high blood pressure, beta-blockers are also used in treating angina and certain rhythm disturbances of the heart. Because heart function is reduced with beta-blockers, there is a decreased need for oxygen and angina is relieved. In the long term, however, this inhibition of heart function can lead to heart failure. Beta-blockers have fallen out of favor because they are not effective in reducing cardiovascular mortality, and they have been shown to increase the risk of developing diabetes by about 30 percent.

Beta-blockers produce some significant side effects in many patients. Because cardiac output is reduced in a more relaxed arterial system, it is often difficult to get enough blood and oxygen to the hands, feet, and brain. This results in the typical symptoms described by users of beta-blockers, such as cold hands and feet, nerve tingling, impaired mental function, fatigue, dizziness, depression, lethargy, reduced libido, and impotence. Beta-blockers also raise cholesterol and triglyceride levels considerably. This may explain some of the negative effects in the clinical studies, which failed to demonstrate any significant benefit of beta-blockers in reducing mortality due to cardiovascular disease.

It is extremely important not to discontinue a beta-blocker suddenly. Stopping this medication suddenly can produce a withdrawal syndrome consisting of headache, increased heart rate, and a dramatic increase in blood pressure.

Examples of beta-blockers include:

acebutolol (Acebutolol, Sectral)
atenolol (Atenolol, Senormin, Tenormin)
bisoprolol fumarate (Zebeta)
carteolol (Cartrol, Ocupress)
metoprolol succinate (Toprol-XL)
metoprolol tartrate (Lopressor)
nadolol (Corgard)
propranolol (Betachron, Inderal, Pronol)
pindolol (Visken)
penbutolol sulfate (Levatol)
timolol maleate (Blocadren, Timoptic)

Calcium Channel Blockers

Calcium channel blockers, along with ACE inhibitors, have taken over the top spots in the drug treatment of high blood pressure because they are better tolerated than diuretics and beta-blockers. Although calcium channel blockers have been shown to lower the risk of stroke, they carry the same increased risk for heart attacks as the older approach (diuretics and beta-blockers).

Calcium channel blockers work (as the term implies) by blocking the normal passage of calcium through certain channels in cell walls. Since cal cium is required in the function of nerve transmission and muscle contraction, the effect of blocking the calcium channel is to slow down nerve conduction and inhibit the contraction of the muscle. In the heart and vascular system, this action results in reducing the rate and force of contraction, relaxing the arteries, and slowing the nerve impulses in the heart.

Although they are much better tolerated than beta-blockers and diuretics, calcium channel blockers still produce some mild side effects, including constipation, allergic reactions, fluid retention, dizziness, headache, fatigue, and impotence (in about 20 percent of users). More serious side effects include disturbances of heart rate or function, heart failure, and angina.

Examples of calcium channel blockers include:

amlodipine (Norvasc)
diltiazem (Cardizem CD, Cartia, Dilacor Xr, Diltia Xt, Tiazac)
felodipine (Plendil)
lacidipine (Motens)
lercanidipine (Zanidip)
nimodipine (Nimotop)
nisoldipine (Sular)
nitrendipine (Cardif, Nitrepin)
nicardipine (Cardene, Carden SR)
nifedipine (Adalat CC, Procardia XL)
verapamil (Calan, Covera-Hs, Isoptin, Verelan)

Angiotension-Converting Enzyme (ACE) Inhibitors

The ACE inhibitors prevent the formation of angiotensin II, a substance that increases both the fluid volume and the degree of constriction of the blood vessels. An ACE inhibitor relaxes the arterial walls and reduces fluid volume. Unlike the beta-blockers and calcium channel blockers, however, ACE inhibitors actually improve heart function and increase blood and oxygen flow to the heart, liver, and kidneys. This effect may explain why ACE inhibitors are the only antihypertensive drugs that appear to reduce the risk of heart attacks. Unfortunately, they do not reduce the risk of strokes.

The newer ACE inhibitors are generally well tolerated but have many of the same side effects as the other antihypertensives, including dizziness, light-headedness, and headache. The most common side effect is a dry nighttime cough. The ACE inhibitors can also cause potassium buildup and kidney problems, so potassium levels and kidney function must be monitored.

Examples of ACE inhibitors include:

benazepril (Lotensin)
captopril (Capoten)
captopril/hydrochlorothizaide (Capozide)
enalapril maleate (Vasotec, Renitec)
fosinopril sodium (Monopril)
lisinopril (Lisodur, Lopril, Novatec Prinivil, Zestril)
perindopril (Coversyl, Aceon)
quinapril/magnesium carbonate (Accupril)
ramipril (Altace, Tritace, Ramace, Ramiwin)
trandolapril (Mavik)

Current Drug Treatment of High Blood Pressure

For many years the drug of first choice for high blood pressure was a thiazide diuretic alone or in combination with a beta-blocker. As mentioned earlier, because of a lack of effectiveness in reducing the cardiovascular death rate, and because of side effects noted in numerous studies, this approach has somewhat fallen out of favor. Currently, the most commonly used medication is a diuretic alone or in combination with newer medications de signed to relax the arteries, such as calcium channel blockers and ACE inhibitors.

A diuretic or any of these other drugs alone is referred to as a “step 1” drug. Thiazide diuretics are still the most popular step 1 drug but may soon be displaced by calcium channel blockers or ACE inhibitors. Beta-blockers are not suitable as step 1 drugs, owing to their known side effects. A step 2 approach uses two medications; a step 3 approach uses three; and a step 4 approach uses four. Physicians are instructed to use single therapies before using combinations of medicines. Of course, they are also instructed to utilize nondrug therapies first, but that rarely occurs.

HIGH BLOOD PRESSURE—A RATIONAL APPROACH

Although medical textbooks state that the cause is unknown in 95 percent of cases, hypertension is closely related to lifestyle and dietary factors, which have a direct effect on the health of the arteries. Important lifestyle factors that may cause high blood pressure include stress, lack of exercise, and smoking. Dietary factors include obesity; a high sodium-to-potassium ratio; a low-fiber, high-sugar diet; high intake of saturated fat; low intake of omega-3 fatty acid; and a diet low in calcium, magnesium, and vitamin C. These same factors are also known to promote hardening of the arteries (atherosclerosis) and impair the ability of the kidneys to regulate fluid volume and control blood pressure. In addition, it is important to rule out heavy metal toxicity as an underlying factor in high blood pressure (see Chapter 2 for more information).

Achieving ideal body weight is the most important dietary recommendation for those with high blood pressure. However, overweight people who lose even a modest amount of weight experience a reduction in blood pressure that can significantly reduce the need for antihypertensive drugs.

Dietary Approaches to Stop Hypertension

Two very large studies have shown quite clearly that diet can be effective in lowering blood pressure. These studies, the Dietary Approaches to Stop Hy pertension (DASH), tested a diet that was rich in fruits, vegetables, and low-fat dairy foods, and low in saturated and total fat. The first study showed that a diet rich in fruits, vegetables, and low-fat dairy products can reduce blood pressure in the general population and in people with hypertension.9 To be effective, the original DASH diet did not require either sodium restriction or weight loss—the two traditional dietary tools to control blood pressure. The second study from the DASH research group found that combining the original DASH diet with sodium restriction is more effective than either the DASH diet or sodium restriction alone.¹⁰

In the first trial, the DASH diet produced a net blood pressure reduction of 11.4 and 5.5 mm Hg systolic and diastolic, respectively, in patients with hypertension. In the second trial, sodium intake was also restricted. The most common form of sodium is sodium chloride, which is table salt (Fast foods; processed meats, such as bacon, sausage, and ham; and canned soups and vegetables are all examples of foods that are generally very high in sodium.)

Many studies have shown varying success rates with a sodium-restricted diet in the treatment of high blood pressure, but the DASH diet with the lower sodium level led to a mean systolic blood pressure that was 11.5 mm Hg lower in participants with hypertension. These results are clinically significant and indicate that a sodium intake below 1,500 mg daily can lower blood pressure significantly and quickly. As a point of reference, 1 teaspoon of table salt contains 2,300 mg of sodium.

The reason why many studies using sodium restriction alone failed to lower blood pressure is that in order to be effective sodium restriction must be accompanied by a high potassium intake.¹¹ Since the best way to boost potassium levels is to increase the intake of fruits and vegetables, that may explain why the results were so good in the second DASH study. Most Americans have a potassium-to-sodium ratio of less than 1:2, meaning that they ingest twice as much sodium as potassium. For optimal health, the research indicates that we should be consuming five times as much potassium as sodium (5:1). The easiest way to achieve this ratio is to avoid prepared foods and table salt, and to use potassium chloride salt substitutes, such as the popular brands NoSalt^® and Nu-Salt^®, instead. You can find these products right next to the sodium chloride salts at your local grocery or health food store.

Avoid Junk Food and Hidden Sources of Empty Calories

According to the third National Health and Nutrition Examination Survey, which studied eating habits among 15,000 American adults, one-third of the average diet in this country is made up of unhealthy foods, including potato chips, crackers, salted snack foods, candy, gum, fried fast food, and soft drinks. These items offer little in terms of protein, vitamins, or minerals. But they do have lots of empty calories in the form of sugar and fat. Here are guidelines for making healthier eating choices:

Read labels carefully. If sugar, fat, or salt is one of the first three ingredients listed, the product is probably not a good option.
Be aware that certain words appearing on a label—such as sucrose, glucose, maltose, lactose, fructose, corn syrup, or white grape juice concentrate—mean that sugar has been added.
Look not just at the percentage of calories from fat, but also the number of grams of fat. For every 5 grams (g) of fat in a serving, you are eating the equivalent of 1 teaspoon of fat.
If a snack doesn’t provide at least 2 g of fiber, it’s not a good choice.
Keep an eye on the sodium content. If a package lists more than 10 percent of your total sodium allowance per serving, the product is not a good choice.

Special foods for people with high blood pressure include celery; garlic and onions to lower cholesterol; nuts and seeds, or their oils, for their essential fatty acid content; cold-water fish such as salmon and mackerel, or fish oil products concentrated for the omega-3 fatty acids EPA and DHA; green leafy vegetables and sea vegetables for their calcium and magnesium; whole flaxseeds, whole grains, and legumes for their fiber; and foods rich in vitamin C, such as broccoli and citrus fruits.

Other Recommendations to Lower Blood Pressure

Caffeine, alcohol, and tobacco should be eliminated. Stress reduction techniques, such as biofeedback, meditation, yoga, deep breathing exercises, and regular aerobic exercise may offer some benefit in lowering blood pressure without the use of drugs. For example, RESPeRATE is a computerized biofeedback device approved by the FDA for reducing stress and lowering blood pressure. It works by analyzing your breathing pattern to create a personalized melody that it transmits to earphones. The goal is to synchronize your breathing to the melody that you hear through the earphones—about 10 breaths a minute, with particularly long exhalations. The theory behind RESPeRATE is that many people with high blood pressure have increased activity of the sympathetic nervous system—the part of your nervous system that controls blood flow. Slow, deep breathing reduces this activity, allowing blood pressure to return to normal. Studies of people with high blood pressure who use RESPeRATE as directed report an average decrease in blood pressure of 14 mm Hg. For more information, see RESPeRATE (www.resperate.com)

The most effective natural product for lowering blood pressure is a purified mixture of small peptides (proteins) derived from muscle of the fish bonito (a member of the tuna family). Basically, these peptides work to lower blood pressure by inhibiting ACE (angiotensin converting enzyme). This enzyme converts angiotensin I to angiotensin II, which is a compound that increases both the fluid volume and the degree of constriction of the blood vessels. If we use a garden hose as a model to illustrate the pressure in your arteries, the formation of angiotensin II would be similar to pinching off the hose while turning up the faucet full blast. When the formation of this compound is inhibited, anti-ACE peptides relax the arterial walls and reduce fluid volume. Anti-ACE peptides exert the strongest inhibition of ACE reported for any naturally occurring substance available.

Three clinical studies have shown that anti-ACE peptides from bonito (daily dosage 1,500 mg) significantly lower blood pressure in people with high blood pressure (hypertension).12 Anti-ACE peptides appear to be effective in about two-thirds of people with high blood pressure—about the same percentage as many prescription drugs, but without the side effects. The degree of to which blood pressure was reduced in these studies was quite significant; typically, pressure was reduced systolic by at least 10 mm Hg and diastolic pressure by 7 mm Hg in people with prehypertension and borderline hypertension. Greater reductions will be seen in people with higher initial blood pressure readings.

Anti-ACE peptides do not appear to produce any side effects, according to human safety studies. The typical daily dosage is 1.5 grams (g), but even at a daily dosage of 30 g not a single subject in safety studies experienced any side effect—not even the dry nighttime cough so typical with the ACE inhibitor drugs.

THE IMPORTANCE OF SLEEP

No one would disagree that sleep is absolutely critical to human health; after all, sleep is the period of time when the body and mind are recharged. But does the quality of sleep have anything to do with the likelihood of developing obesity, type 2 diabetes, or high blood pressure? According to recent scientific studies, the answer is definitely yes.13, ^14, ^15, ¹⁶ Sleep plays a prominent role in regulating hormones, including the hormones that in turn regulate blood sugar levels. Sleep deprivation has been shown to lead to impaired insulin action and multiple metabolic disturbances consistent with obesity and type 2 diabetes. It now appears that in addition to causing daytime drowsiness, mood and memory disturbances, impotence, and car wrecks, sleep disorders also promote insulin resistance and cardiovascular disease. In case you missed it, see Chapter 8 for Seven Tips for a Good Night’s Sleep.

The sleep disorder that is especially stressful to mechanisms controlling blood sugar is sleep apnea (characterized by brief interruptions of breathing during sleep), but even snoring is linked to poor blood sugar control. In an analysis of data from 70,000 female nurses followed for 10 years, occasional snoring was associated with a 41 percent increase and regular snoring was associated with a twofold (100 percent) increase in the frequency of developing type 2 diabetes. This increased risk occurred irrespective of body weight, indicating that snoring is an independent risk factor for type 2 diabetes.¹⁷

NASAL STRIPS, THROAT SPRAYS, AND SURGICAL OPTIONS TO RELIEVE SNORING

If you have watched a professional football game anytime since the mid-1990s you probably noticed that many of the players wear nasal strips. These adhesive strips mechanically open the nasal passages. The most popular brand is Breathe Right^®. The strips were invented by Bruce Johnson in 1991. Bruce had always had trouble breathing through his nose, especially at night. Besides suffering from an array of allergies, Bruce has a deviated septum, a structural abnormality of the nose that constricts airflow through one nostril. This combination left his nose chronically congested and made sleeping through the night quite difficult. Lying in bed one night in 1988, he wondered, “Why not try opening the nasal passages mechanically from the outside of the nose?” His answer, after three years of development, took the form of a spring-loaded adhesive strip that he placed across the bridge of his nose to open it up. The device relieved his congestion and improved his sleep quality dramatically. He soon received a patent for his invention, and he brought his product to market in 1992.

Since that time, several clinical studies have confirmed what Bruce experienced himself—dilating the nasal passages can dramatically improve sleep quality and relieve snoring.18, ¹⁹ However, this is not a cure-all. A variety of factors can contribute to snoring—body weight, alcohol, smoking, sleeping on your back, age, climate, and allergies—but the most common causes are related to airflow disruption through the nose, the throat, or both.

In the clinical studies, about half of the subjects experienced a significant benefit, but the other half did not. These results led to the development of Breathe Right^® Throat Spray, a product designed to help people who snore as a result not of impaired nasal airflow but rather of loose tissue in the throat. This natural product contains an essential oil blend from wintergreen, peppermint, anise, and clove oil that tightens the throat tissue and reduces irritation. It seems to help many snorers sleep better. Some people experience the best results when they use both products. For more information on these products, see www.breatheright.com.

For severe snoring due to airway disruption through the throat, ultrasound-assisted uvulopalatoplasty appears to be a good option. It has replaced other surgical techniques because it has produced better results with fewer complications, such as bleeding or charring (the latter occurs with the use of lasers or electrosurgery). The procedure involves the use of sound waves to basically damage the tissue of the back of the throat, causing excessive soft tissue from the back of the throat and from the palate (the roof of the mouth separating the mouth from the nasal cavity) to tighten up and eliminate the loose tissue that causes snoring or sleep apnea in many people.

SLEEP APNEA MUST BE TREATED

First described in 1965, sleep apnea owes its name to a Greek word, apnea, meaning “want of breath.” The pauses in breathing are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often lead to excessive daytime sleepiness and may be associated with an early-morning headache. Approximately 18 million Americans are thought to suffer from sleep apnea.

Early recognition and treatment of sleep apnea are important because this condition is associated not only with an increased risk of obesity, type 2 diabetes, and high blood pressure, but also with severe daytime fatigue, irregular heartbeat, heart attack, and stroke, as well as a loss of memory and other intellectual capabilities. For many patients with sleep apnea, their bed partners or family members are the first to suspect that something is wrong, usually from the patients’ heavy snoring and apparent struggle to breathe. Coworkers or friends may notice that a patient falls asleep during the day at inappropriate times (such as while driving a car, working, or talking). The patients themselves usually do not know they have a problem and may not believe it when told. It is important for them to see a doctor if they snore heavily or if a sleep partner has noticed periods of interrupted breathing during sleep. Sleep apnea should also be considered in anyone with signifi cant daytime drowsiness or changes in intellectual function. Sleep apnea can be properly diagnosed only by a sleep disorder specialist and usually only in a sleep laboratory. Home testing equipment may also be provided through a sleep disorder specialist. The American Academy of Sleep Medicine (www.aasmnet.org) certifies specialists and sleep laboratories and, if appropriate, a referral to one of these centers should be sought from your physician.

Sleep apnea is most often caused when an excess amount of fatty tissue accumulates in the airway and causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. This narrowing of the airways results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea. In some cases sleep apnea occurs even if no airway obstruction or snoring is present. This form of sleep apnea is called central sleep apnea and is caused by a loss of perfect control over breathing by the brain. In both obstructive and central sleep apnea, obesity is the major risk factor and weigh loss is the most important aspect of long-term management. People with sleep apnea experience periods of anoxia (oxygen deprivation of the brain), with each episode ending in arousal and a reinitiation of breathing. Seldom does the sufferer awaken enough to be aware of the problem. However, the combination of frequent periods of oxygen deprivation (20 to several hundreds of times per night) and the greatly disturbed sleep can greatly diminish the quality of life and lead to some very serious problems, including diabetes! Sleep apnea needs to be taken seriously, and it should always be treated.

Weight loss is also a critical part of the successful management of sleep apnea. Beyond that, the most common treatment of sleep apnea is the use of nasal continuous positive airway pressure (CPAP). In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or if it is used improperly. The CPAC equipment is readily available and can be obtained with a doctor’s prescription. It takes quite a while to get used to CPAP, but this method usually works well. In fact, I have had many patients who feel that they have been given a new lease on life with it.

Sleep Deprivation and Weight Gain

Sleep deprivation increases hunger and slows down metabolism, thereby promoting weight gain. The underlying mechanisms include:

Increasing the level of cortisol, thereby promoting increased appetite, a craving for sugar, and weight gain. An elevated cortisol level also interferes with proper utilization of carbohydrates, leading to an increase in the storage of body fat and insulin resistance, a critical step in the development of obesity and diabetes.
Elevating ghrelin and reducing leptin. Ghrelin is an appetite-stimulating hormone released mostly by the stomach. When ghrelin levels are up, people feel hungry. Leptin is a hormone, released by fat cells, that promotes a feeling of satiety.

In population studies, a dose-response relationship between short sleep duration and high body mass index (BMI) has been reported across all age groups. This observation alone indicates that sleeping more may help with weight loss. A very detailed analysis from the Wisconsin Sleep Cohort Study, a large sleep study that has been going on in Wisconsin for more than 15 years, provides even more insight.20 The participants have been filling out questionnaires about their sleep habits, have kept sleep diaries, and have occasionally spent a night in the laboratory, where researchers studied their sleep in more detail. After sleeping overnight in the laboratory, the participants gave blood samples, which were tested for levels of leptin and ghrelin. What the researchers found is that habitual or acute short sleep duration produces low leptin and high ghrelin levels, a powerful recipe for an increased appetite and for a craving for carbohydrate-rich foods, including cake, candy, ice cream, pasta, and bread.

FINAL COMMENTS

My key point in this chapter is that drugs cannot compensate for the effects of diet and lifestyle. Diabetes and high blood pressure are very serious conditions that must not be ignored. Unfortunately, treatment with current drugs simply provides drug companies with very good customers for a relatively long time. Remember that the main goal is achieving ideal body weight. To help you with that goal, I recommend following the Hunger Free Forever program described in this chapter and detailed in Appendix C. Beyond that, I recommend several dietary, lifestyle, and supplement strategies designed to help improve the action of insulin and normalize blood sugar levels. These recommendations are detailed thoroughly in How to Prevent and Treat Diabetes with Natural Medicine (which I cowrote with Dr. Lyon). This book is a source of information and guidance for anyone with either type 1 or type 2 diabetes. Appendix D on Backmatter provides additional information and a summary of recommendations for individuals with metabolic syndrome, diabetes, and high blood pressure.

Regular physical exercise is an especially important therapy for metabolic syndrome, type 2 diabetes, and obesity. In fact, there are considerable data to show that physical inactivity is a major cause underlying these conditions. It is especially important to include exercise in a weight loss program, for the following factors:

Exercise increases the sensitivity of our cells to insulin.
When weight loss is achieved by dieting without exercise, a substantial portion of the total weight loss comes from lean tissue, primarily as loss of water.
When exercise is included in a weight loss program, there is usually an improvement in body composition due to a gain in lean body weight, and in turn to an increase in muscle mass and a decrease in body fat.
Exercise helps counter the reduction in basal metabolic rate (BMR) that usually accompanies dieting alone.
Exercise increases BMR for an extended period of time following the exercise session.
Moderate to intense exercise may have a suppressing effect on the appetite.
People who exercise during and after weight reduction are better able to maintain the weight loss than those who do not exercise.