My Year in Review

The past twelve months have not been amongst my favorites. In fact, to use the scientific term, they have pretty much sucked. That, however, was the past twelve. Like someone who missed New Years because of a coma and has now awakened, I presently feel free to resolve to have a better year this time around.

On February 17th of 2009, they discovered I had severe high blood pressure, and the fun began. A good percentage of my blood pressure problem was real, but an equal percentage was what’s called “white coat hypertension,” which is an exaggerated blood pressure response to being in a doctor’s office. At least 20 percent of the population suffers from white coat syndrome, which means that, despite all the ranting by public health officials about the dangers of undiagnosed hypertension, literally tens of millions of people are taking blood pressure medications they don’t need.

It’s been quite a ride, and everything that I’ve discovered along the way has made me wary of the medical system. I’m a member of Kaiser Permanente, a large HMO, which has some benefits; they have a wide-ranging system, and also keep all their records electronically so that anyone anywhere can pull them up with the touch of a button. But Kaiser also makes system-wide policy decisions that are based on research that, although it has been adopted by government panels as best practice, is around twenty years out of date and considered ridiculous or even dangerous by scientists engaged in current research.

The systems first response was to put me on medication. (As the doctor in Urgent Care told me as she wrote the prescription, “You should count on taking these for the rest of your life. People always say they’ll make diet and lifestyle changes, but I’ve never seen anyone do it.” Good attitude, huh?)

When I complained to my primary physician about side effects from the first drug (an ACE inhibitor), he responded by adding two more—a beta-blocker and a thiazide diuretic. He also—without asking how much salt I ate—ordered me to cut down on salt.

Now, I was losing weight at a good clip, and also exercising. In particular, I was doing a lot of Bikram Yoga, which is a strenuous practice done in a room heated to 104 F. So if there was anyone in the world who didn’t need a diuretic, and who needed higher salt intake, it ws me. But the doctor paid no attention to this, with the result that I passed out after one class, and had a mild seizure at home on another occasion (because of natropenia, or lack of sodium).

Now, many people take beta-blockers, and get nothing but benefits. But beta-blockers work by suppressing the sympathetic nervous system—and they actually prevent your heart rate from rising much. It’s a godawful feeling, exercising and having your heart refuse to respond. And I’m one of those people who responds to beta-blockers by becoming severely depressed. After only two weeks on them, I was starting my day by getting out of bed and sitting down on the floor and sobbing. Every day I felt worse, and, quite frankly, suicide began to seem like an attractive option compared to going on like that.

And why didn’t I contact my doctor? Because I no longer trusted him in any degree. So I stopped taking the beta-blocker, even though the label warns you that discontinuing the drug abruptly can be dangerous or fatal. To tell the truth, dying from stopping the damn drug seemed more attractive than continuing to take it.

I felt better immediately. Not great, mind you, but as if I might want to live. And I went through the tedious process of changing primary-care physicians, which at Kaiser is sort of like rolling dice. But I got lucky; my new doctor was far more reasonable. When I told him I had stopped the beta-blocker, instead of lecturing me, he remarked that I should have never been on it in the first place, and he promptly took me off the diuretic as well. In addition, he told me that new research showed that only a small percentage of people had their blood pressure increased by salt intake, and that an equal percentage of people had their blood pressure increase when they limited their sodium intake, and that he thought that in most cases the “authorities” were a decade behind the times.

Of course, Kaiser policy is to counsel severely limiting salt. And beta-blockers and diuretics are both considered by Kaiser to be first-line treatments for all cases of high blood pressure.

As it turns out, recent research shows that long-term use of both beta-blockers and diuretics are diabetogenic—that is, in many people (and perhaps everyone, if administered long enough), they cause adult-onset (Type II) diabetes. We are constantly hearing about the epidemic of Type II diabetes, and hear about the need for diet and exercise, but no one seems to want to discuss the fact that the many cases of diabetes are probably the result of years of taking these safe, proven blood-pressure drugs.

Kaiser is so behind the times that they are still focused on cholesterol and LDL cholesterol. It isn’t surprising when Joe Public believes that cholesterol causes heart disease; he’s had that message hammered at him since the 1970s. But Kaiser ought to know better. A recent editorial in Cardiovascular Drugs and Therapy (told you I’d learned a lot in the last year) says that the link between cholesterol and heart disease “…continues in popular folklore and government dietary policies but it seems to have been quietly dropped by most cholesterol-heart researchers.”

Indeed. Part of the confusion is because of the bestselling statin drugs, which lower cholesterol. These drugs have been shown to have some cardiovascular benefits, but it has been conclusively demonstrated that they do create these benefits by lowering cholesterol! (When a non-statin cholesterol-lowering drug, ezetimbe, was recently tested, it dramatically lowered cholesterol…and displayed no cardiovascular benefits whatsoever.) Statins do something beneficial (and also have a huge number of terrible side effects), but these appear to have nothing to do with cholesterol. Some people think that they have a useful anti-inflammatory effect; other researchers have shown that they increase circulating levels of Vitamin D. (The drug companies aren’t enthusiastic about the latter possibility, since it would mean their expensive drugs could be replaced by a cheap, safe vitamin.) But, of course, Kaiser pushes hard for anyone with blood pressure issues to get started on statins, despite the risk of liver damage and memory loss.

So, I'm pretty much in the position of having to ignore my HMO; they seem to know roughly as much about health research as your average TV news anchor. I concentrate on the things I can control. I’ve lost about 60 pounds, and actually gained some muscle; my body fat percentage is now below 12 percent. My blood pressure is generally around normal--unless I have to go to the doctor.

But although I’m healthier, it’s been a drag getting here. Working, or writing, have been nigh unto impossible. I have to get myself into something of a hyper state to do either, and—surprise, surprise!—doing so pushes my blood pressure up.

In the earlier months, an hour or two of working or writing took my blood pressure up into the danger zone. As I’ve gotten healthier, the increases are more moderate, but a good session at the keyboard still takes my blood pressure up to sketchy levels. The solution, I’ve found, is to do the work, but then blow it out of my system by following it with intense exercise. My blood pressure plummets after yoga or a run, often dropping down to 95/60.

It’s been kind of a wasted year, especially from a writing point of view. But that all changes tomorrow. It’s New Years, right?