Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the practical application of health information. Nutrition. Exercise. Diet. Supplementation. I look at the science behind them, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
For the most part, better health is a choice. You can exercise or not. You can eat a good diet or not. You can carry excess body fat or you can lose it. You can smoke cigarettes or not. Your family history (genetics) does have an influence but for most of the degenerative diseases that afflict Westernized countries, the lifestyle people choose determines whether or not they will get a disease. This is especially true for cardiovascular disease (CVD), type 2 diabetes, and some forms of cancer. More people die from those three diseases in Western society than from any others.
Close to 30 years ago, researchers in Britain proposed a solution for reducing CVD by more than 80% they claimed. It was a polypill. After examining the data in large clinical trials, they determined that four risk factors for CVD are important to control: LDL cholesterol, blood pressure, homocysteine levels, and platelet aggregation (clotting). They proposed that a combination of pharmaceuticals and vitamins could be used to control these risk factors and thereby reduce the morbidity rate 80%. The polypill would include:
• A statin drug to lower LDL-cholesterol
• Aspirin to prevent blood clotting
• Folic acid to reduce homocysteine levels
• A diuretic, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACE inhibitor) to lower blood pressure.
These medications, combined in a single pill, would be about one-half the normal dose taken to treat disease. Who would take it? Everyone 55 years old and older. That’s correct: everyone.
The researchers understood that their view would be controversial--there would be years of clinical trials and debate before this polypill was available. But they also made a statement that goes a long way toward explaining why they took this approach. “It should be recognized that in Western society, the risk factors are high in us all so everyone is at risk.” One interpretation of that statement is that people who live in Western society refuse to change their diets, refuse to lose weight, and refuse to exercise--so they must all take medications to lower their risk of disease. It went nowhere for 15 years.
About 5 years ago, the polypill was resurrected and a form was used in a clinical trial.This time, the objective was to see if there would be a difference in the rate of secondary events between subjects who had recent MI’s and who took the polypill and those that took the same medications but as individual pills. The medications used was slightly different than the original concept. They were aspirin, ace-inhibitor, and a statin. After 3 years of follow-up, the subjects using the polypill experienced significantly fewer secondary events, 8.5% versus 11.7%.
Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually. The subjects taking the polypill were more consistent in taking their medications, the all in one pill, than the subjects who took the exact same medications but as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. Whatever the reason, the experimental subjects just took their medication on a more regular basis.
The difference in secondary events was about 3.2% --about 80 fewer events of the total subjects in the study. Taking that to the entire population of a country or the world would reduce deaths and serious future outcomes by hundreds of thousands, if not millions, of people. Moreover, the cost to treat all those people with the polypill might have prevented reoccurring events and would have saved millions of healthcare dollars while improving the quality of life. To be clear, this was a specific population: over 75 years within months of having a heart attack. The benefit could be greater in people who began to take the medication earlier in life to prevent or delay the heart attack to begin with. More research is needed.
I recently listened to a couple of podcasts that were completely unrelated but talked about the same subject: GLP-1 agonists. To review, GLP-1 Receptor Agonists are medications that allow the manufacture of the hormone GLP-1. Without getting technical, GLP-1 helps the body release insulin which can lower hemoglobin A1c levels in diabetics. It also functions to increase satiety so users don’t eat as much and thus lose weight. With that in mind, here is a recap of the conversations.
Obesity is an issue in the US with 70% of the population overweight or obese. In the first discussion, a physician stated that they put their overweight patients on a low dose of a GLP-1 agonist to help get their appetite under control. The objective is to help the individual reduce hunger while transitioning to a higher protein diet. It’s using the pharmaceutical in a way in which it was designed. The result helps the patient lose weight with an exit strategy of adopting a new lifestyle of eating less and moving more.
The second discussion was between a tech expert and a finance expert—neither one in the healthcare field. The tech expert shared a story of how a nurse who weighed over 300 pounds was using the GLP-1 agonist to get to a more reasonable weight to be able to participate in more activities with her family. That lit up the finance expert to say if we were really serious about addressing health, drop the cost of the GLP-1 agonists to an affordable level of about $50 per month or less instead of the current pricing of over $1,000 per month. The pharmaceutical companies would end up increasing sales overall and reduce the number of overweight and obese citizens from 70% by half or more. That would have an effect of saving about half a trillion dollars in healthcare costs or more per year. That would help around 100 million people and probably save even more than his estimate. More than that, the population would be healthier as long as there were also trained on how to make better food choices, cook better and exercise on a regular basis to maintain the weight loss.
Regular listeners must be sitting there thinking that between the polypill and GLP-1 agonists, I’ve changed my approach to getting healthier. Not at all but if people will not eat better, eat less, and move more to adopt a healthy lifestyle, perhaps getting there by using the medication route with an exit strategy for both approaches may provide the boost people need. I can’t fault the researchers for taking the pharmaceutical approach. We have done little in our society to prove that we are willing to change our lifestyles. Each of the risk factors addressed by the researchers can be dealt with through lifestyle changes: exercise, weight loss, and lowering intake of saturated fat and refined carbohydrate. But neither the physician nor the tech and finance experts addressed the issue of lifestyle change because we haven’t demonstrate the willingness to change.
Isn’t it time for us to begin to exercise regularly, eat less and eat healthier, and modify other things in our lifestyle as well? If we don’t, let me ask this: how long will it be before health insurance carriers tell us that if we don’t take the pharmaceuticals, we won’t get health insurance? You don’t think it could happen? With the cost of healthcare spiraling out of control, what makes you think they won’t insist on this form of prevention?
As Americans, we value one thing above all others: freedom. I believe it should be a person’s choice, and perhaps responsibility, to take care of their bodies. All of us need health insurance to cover accidents and other catastrophic events that we may encounter. But if, by taking charge of our personal health, we can reduce our need for treating degenerative diseases, that benefits society in general as well as us personally. I think that’s a noble and worthy goal. If you haven’t started yet, all I have to say is “Let’s go!”
That’s all the time I have for this episode. If you like this podcast, please hit the share button and tell your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
References:
1 Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 326(7404):1419.
2. N Engl J Med 2022;387:967-977, DOI: 10.1056/NEJMoa2208275
