Turn Off The Faucet

Dr George Cho MFSc CEP ND
Clinic Director, Pathways Lifestyle Medicine Clinics / Medical Director, Lifestyle is Medicine / Certified Exercise Physiologist, Cleveland Clinic Canada

One day my father came home after a visit with his doctor about his high cholesterol. When asked how the visit went, he showed my twin brother and I a bottle of tablets and said: “The doctor said to take these.” I asked him for how long. To which he replied, “For life.” I followed up by asking if there was any in-depth discussion during the doctors’ visit regarding diet. Not surprisingly, he answered in the negative. 

 
Band-aid solutions

My father’s experience is not a unique one. I am quite sure you know many individuals who have been told that they had to take such and such a drug “for life.” This would not be such a bad thing if it was not for the fact that so many drugs come with negative, very bothersome side effects. The practice of medicine is supposed to bring whole-person healing. However, the story for many individuals is that to manage one sickness, they have to start enduring another sickness brought on by the drugs they are taking. 

Another issue is that many of today’s pills, tablets and injections actually act more like surface band-aid solutions. These merely impede a disease process without actually dealing with the underlying cause. They often just treat symptoms without getting at the deeper roots of the disease.

Let’s take my father’s case as an example. The drug he was prescribed that day was Crestor (Rosuvastatin). Crestor is mainly used to address high cholesterol levels (1).  Dealing with elevated cholesterol levels is important because cholesterol build-up can lead to plaque formation in the blood vessels, which can then result in something more serious like  advanced coronary artery disease and heart attack. (2) The way that Crestor works is by acting on  an enzyme in the liver called HMG-CoA reductase (3). This enzyme is important for the formation of cholesterol in the body. So, by inhibiting this enzyme (HMG-CoA reductase), Crestor is impeding the production of cholesterol (3). But notice: Crestor does not address why the cholesterol was high in the first place. It is  a superficial solution. Like how a band-aid merely covers the problem without addressing the cause, many drugs address symptoms with no effect on why the disease process and symptoms even started. For my father, the issue is not with his HMG-CoA reductase. This enzyme was never the underlying issue, so by taking Crestor, the cause of my father’s problems are not being dealt with. This is why my father was told to take those tablets for life. If a band-aid is your only solution, then it has to be left on for life. Similarly, if symptom-masking drugs are our only solution, then these drugs indeed need to be taken for life as well.   

Just mopping symptoms

This issue of merely addressing symptoms and risk factors without addressing causes is well illustrated by the picture of an over-flowing sink. Imagine somebody at home forgot to turn off a faucet resulting in water spilling all over the floor. In this situation, would it be any good to just mop the floor? Obviously not! Yet this is precisely the experience of many patients. So much of the tablets, injections and pills we are taking, whether synthetic or even natural, are merely mopping up symptoms without addressing the root problem,  the faucet (spilling out a very poor lifestyle) was not turned off.

Doctors Mark Hyman, Dean Ornish and Michael Roizen stated it very well in their wonderful paper on lifestyle medicine, when they said:

“Disregarding the underlying causes and treating only risk factors is somewhat like mopping up the floor around an overflowing sink instead of turning off the faucet, which is why medications usually have to be taken for a lifetime.” (4) 

Turn off the Faucet

So what would be turning off the faucet? What is the cause of diseases today? Well, in part one, we determined that much of our chronic diseases today are the result of poor lifestyle habits (5).  The World Health Organization estimates that by 2020, about two-thirds of our diseases will be lifestyle-related. (6) So, if poor lifestyle is a major cause,  then surely a good lifestyle must be part of the solution. In other words, lifestyle must be part of our medicine, and the good part is: good lifestyle habits often come with only positive side-effects.

This is not to say that pills, tablets, injections, and surgeries do not have a role to play in medicine. They most certainly do. A lot of what they do has been helpful and has  saved many lives. These modalities will always have a part in medicine, but they should not have a monopoly on medicine. 

We have come to a time when addressing the root cause through addressing lifestyle habits is  a medical imperative. This means that we need to redefine medicine. The concept that lifestyle is medicine must be engrained in the psyche of every one of us.

Conclusion

During that conversation with my father, my brother and I were able to share with him about one of the major causes of high cholesterol: a high animal and processed food diet. His doctor was not going to talk much about his cheese, milk, eggs and meat, but we did. I am glad to say that we have seen shifts in the way that our father has been eating over the years. He is eating less animal foods, exercising more and intentionally trying to live a healthier life.  Like you, we did not want to see our father’s health decline further, so we shared with him many of the lifestyle habits that could potentially reverse and also prevent diseases in the future. 

Nobody really wants to see their loved ones suffer from diseases and take medications for life. However, in order to effect change, we need to change our focus, a shift from merely addressing symptoms, to addressing causes, and for many of us, lifestyle is the major cause and thus also the main solution to our health problems. We need to turn off the faucet of poor lifestyle habits and turn on the faucet of healthy ones.

References

1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;ll:llll–llll. DOI: 10.1161/CIR.0000000000000625. 

2. Vallegjo-vaz, A et al. low-density liproprotein cholesterol lowering for the primary prevention of cardiovascular disease among men with primary elevations of low-density lipoprotein cholesterol levels of 190 mg/dL or above. Circulation. 2017;136:1878 – 1891

3. Smith MEB, Lee NJ, Haney E, Carson S. Drug class review: HMG-CoA reductase inhibitors (statins). Update 5. http://www.phsu.edu/drugeffectiveness/reports/final.cfm

4. Hyman, M., Ornish, D & Roizen, M. Lifestyle Medicine: Treating the causes of disease. Alternative therapies. Nov/Dec 2009: 15 (6). 12-14

5. Murray C et al. The State of US Health, 1990 – 2016. Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018; 319 (14): 1444-1472 

6. Egger, G & Egger, S. Lifestyle Medicine: The Australian experience. Am J lifestyle medicine. 2011;l 6 (1):  26-30