TW/CW: some reference to weight loss, blood sugar/cholesterol numbers, dieting, trauma, mental illness, sexuality, and suicidal feelings/ideation.
I just googled whether doctors get a kickback for prescribing medications, thinking that I was probably being way over-cynical. Go ahead, google it. Tell me what you find. I didn’t even have to finish typing in my question – the search engine populated several potential lines of inquiry along the same concept. Obviously, I’m not even close to the only one wondering that. Short answer is that yeah, in multiple ways, doctors may financially benefit from their relationships with pharmaceutical companies and, yes, also by writing prescriptions. So, there’s that. No accusations here, just awareness of potential realities.
I made an amateur mistake and had my bloodwork done not quite two weeks after my birthday. I’d had pepperoni pizza for my birthday and leftovers after. I’d had cake and ice cream (in small amounts, but still) virtually every day since my birthday. My friend grilled me a steak that week. I’ve been eating more cheese than is ideal. So yeah, it was unsurprising to me that my cholesterol was a little bit high this time (231). It was 218 at my previous visit in October, after my having gotten it down to 167 the last time I’d had bloodwork done in June of 2019. Without asking me at all about my diet/food history or current practices, exercise regimen, or lifestyle, my doctor recommended that I take fish oil capsules (I can’t afford them right now), “work on eating habits,” lose weight, eat more “healthy fats,” and get more exercise. She also threatened to put me on metformin if my A1C had risen to 7.0. When the lab results came in, my A1C had remained at 6.6, which is higher than I’d like, but I’m still figuring out where the line is where I’ll find a balance I can live with. At least my A1C hadn’t risen from my last visit, in spite of my birthday indulgences.
That didn’t stop her from trying to push me onto metformin. After receiving my results, she sent me a note through MyChart telling me that she’d now like to put me on metformin, 500 mg sustained release once a day – and she also recommended I start taking statin drugs. Really?!? What’s the rush for drugs? Seriously. And how about finding out why those numbers may be higher than ideal – and what I plan to do about that? A few simple questions could have made this whole process more beneficial and given me a modicum of faith in this doctor. But that didn’t happen, of course. In my 57 years, I’ve only had one doctor, back in Michigan, who actually listened to me, who took the time to get to know me as a human being, who asked the right questions, and who respected my own decision making about my body. Every other doctor I’ve had has been a major disappointment, making all sorts of ignorant assumptions, and ultimately turning out to be someone that I couldn’t trust with my health and well-being. I’ve gone through many doctors looking for someone I could trust.
Let’s start with my relationship to pharmaceuticals and then move on to what I intend to do naturally to help my blood sugar and cholesterol levels. Over the decades, I have studied side effects of drugs and have also deeply studied nutrition, exercise physiology, and natural health. At 57, I am not on any medications, both because I’m relatively healthy and because I’m scared half to death of pharmaceutical drugs. Yes, I’ve had them when it’s been life or death emergencies – and I am grateful for life-saving treatments, of course. But in general, I avoid them when possible. I’m nearly certain that my diabetes diagnosis happened due to side effects from an antibiotic I was taking for a tooth infection. I felt that drug rip my body apart. I had to stop taking it before I finished the cycle prescribed because my bladder was in such severe pain. Drugs scare me. Period. My likelihood of taking a drug daily for the rest of my life … is very close to zero. I can’t even imagine it.
Right now, I’m feeling pretty healthy. My energy levels are decent. My eyesight is perfect. I don’t have to wear glasses or anything. I only wake up once or twice a night to pee, which is a huge improvement over waking up every hour like I was doing when I was first diagnosed. The numbers that indicate kidney health in my bloodwork are fine. Yes, my A1C and cholesterol are a little elevated, but not alarmingly so. Through diet and exercise, I have gotten them back to perfect, normal levels – and I can do so again – or at least get closer to the ideal levels than I am now. More about that in a minute. Given that the AMA has lowered the ideal levels of both blood sugar (in 1997) and cholesterol (in the 1980’s) within my adulthood lifetime, I’m having a hard time taking these new numbers seriously. If you want to, you can believe that they changed the recommendations because they discovered that the new numbers reflect better health outcomes. My belief is that the new numbers create a significant increase in the number of people diagnosed with diseases, for which they can sell more pharmaceuticals (and more doctor visits). In fact, with the lowered threshold required for diagnosis, how many people who’d previously been deemed healthy, suddenly had a diagnosis that required medical/pharmaceutical intervention? Ca-ching! Here is a good article to read on that.
Have you read about the side effects of metformin or of statins? Or really, any pharmaceutical drugs? They are terrifying to me. Drug commercials on TV are absolutely absurd with their litany of potential deadly side effects to “cure” a condition that is nowhere near as serious as the side effects of the advertised drugs! Why would I trade in a relatively healthy, feeling well, strong and happy body for the plethora of pain and dysfunction promised by any of those drugs? Seriously? And apparently my new doctor hasn’t read the 2018 recommendations from the American College of Physicians, which suggest NOT giving drugs to patients with A1C below 7 percent. That’s me, by the way. Firmly in the category for whom drugs are not recommended.
In fact, let me quote them directly from the article: “ACP’s analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms,” said Dr. Jack Ende, president, ACP. “The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs.”
Let me emphasize these two words: “substantial harms” – so they don’t just slip by without the adequate attention they deserve. So, seriously, in light of this readily available information, WHY is my doctor still trying to push metformin on me? And how the hell am I supposed to trust her judgment about my health? Or frankly, most doctors – because the vast majority seem to have this indoctrination into believing grossly ignorant assumptions about body size and health (accompanied by a complete lack of nutritional knowledge), as well as an alarming predisposition to write as many prescriptions as possible. This country is grotesquely over-medicated and poisoned by the people so many of us are blindly trusting with our health. But, I digress. Let me step off that soapbox (believe me, don’t get me going) and get back to the issue at hand for me. What am I going to do about my blood sugar and cholesterol? (because, I hope it’s obvious by now, drugs are not going to ever be my answer if I can help it).
Let me tell you where I went wrong before – because I did get all of my numbers down to perfect levels – but what I was doing was extreme and ultimately unsustainable for me. I had a program that I did for a little over 18 months – and then I had a (predictable) rebound effect, where I stopped being so strict/careful and my numbers gradually went back up. What does it mean that I was extreme? I’ll tell you: I cut out entire food groups. I went all of that time without consuming any dairy, grains, breads, foods with a high carb content, or alcohol. In other words, no rice, no pasta, no corn, no chips, no potatoes, no pizza – none of my favorite foods like chicken pot pie, nachos and salsa, lasagna, Chinese food, or crusty bread, etc. None. I ate eggs, veggies or 1/2 sprouted grain English muffin with almond butter, and 1/2 grapefruit or an orange, sometimes blueberries or strawberries, with green or herbal tea for breakfast every day. I ate chicken or turkey, occasionally beef, with salad or vegetables for lunch and dinner. I had nuts for snacks. That was it. I was so afraid of diabetes that I didn’t vary at all. Well, I did allow myself a little bit of dark chocolate as long as my numbers stayed perfect. And they did.
I rode my bike 8-12 miles most days, which I enjoy anyway. I’ve always been an athlete and enjoyed being active. I’d already been dancing for a few hours at least 1-2 nights per week, but the more regular exercise seemed to make a difference (it’s hard to tell when you’re doing a bunch of different interventions at the same time which are working – or if it’s a synergistic effect). I was taking a bunch of supplements for blood sugar control and putting cinnamon and turmeric on many of my meals. I was doing “good” on my program, but as time went on, I wasn’t doing so “good” mentally, emotionally, or psychologically. I talked about that in more detail here. The reality for me, that I’m not sure if I’ve talked about before or not, is that I was feeling increasingly despondent about my life. Like, to the point of questioning if I even wanted to live. What was the point? Work to control my blood sugar. Work to make money to pay my bills. Yes, enjoy people and love in a general way … but where was my pleasure?
Yes, I enjoy riding my bike or spending time in nature, etc. It’s not the same level of pleasure as enjoying good food or sexual pleasure, both of which I’d been denying myself that entire time, having decided to take a break from sexual/romantic relationship/s to regain my mental/emotional equilibrium. A denial of pleasure for me is a surefire path to depression. No fun/delicious foods and no sexual connection with anyone else? That is a recipe for disaster for me!
Listen, this seems like a good time for me to come out: I am a foodie and I love sex. Yes, my love for my family and friends gives me a reason to live – but food and sex give me LIFE! And I don’t mean grilled chicken and vegetables, even though I enjoy them sometimes. I mean food. Sharing food with friends and family. Trying new recipes. Drinking wine. Enjoying a cold beer or a hot chocolate. Making a meal that I have a craving for. That almost always includes vegetables, salads, proteins, etc. – but also often includes cheese and/or some form of grains. Shutting the door on all of that was seriously and negatively impacting my will to live.
I can remember being a kid on weekends or in summertime … and the only reason I would get out of bed sometimes is because I’d lie there dreaming about cereal and fruit combinations – and I’d finally get excited and hungry enough to go make myself a bowl to eat. I can’t eat cereal anymore because of my blood sugar issues, which is sad because that was one of my favorite foods. I had a banana almost every day of my life – either in cereal or in a fruit smoothie – up until my diagnosis three years ago. Now I can’t eat bananas. They notably impact my blood sugar, even moreso than the occasional ice cream I now eat again. I haven’t changed that much over all of these years, though. The thought of something pleasurable to eat remains a highly motivating force for me – and whether I’m alone or with friends and/or family, the act of eating my favorite foods allows me to feel a meaningful connection to life. That’s why the super strict program can’t work out for me long-term. I need that connection to life. I need to eat foods that I enjoy – and to be able to partake in the occasional glass of wine or beer when I feel like it.
So now, the task falls to me to find that line. How far can I push it and still have good numbers? I’m honestly not very upset with where my numbers are now, even though I recognize that they could be a little better. I’m willing to make some concessions, such as cut back a little bit on the cheese. Not cut it out. Not make it feel punitive. I know myself well enough to know that when I deny myself anything, the rebound effect is likely to strike – and I will want it more than if I’d just been moderate in my choices all along. I’ve got a long and traumatic history of weight loss dieting, and denying myself foods, behind me. If you don’t realize how harmful dieting is on multiple levels, including psychologically, you may want to read up on the Minnesota Starvation Experiment by Ancel Keys. There are many articles about that study and the psychological impacts of limiting foods to less than the body needs. Those men were eating about three times as many calories per day as many of the diets that I went on. They were losing their minds eating that much more than I allowed myself. What kind of trauma did I inflict on my own psyche? And not just for a six month period, but on and off for decades? I once went 10 days on a fast, drinking only water. I am not kidding at all when I call dieting an eating disorder. I am a recovering dieter, which means that I have some serious triggers around restricting my eating. That makes dietary management of diabetes even more challenging. Not impossible. I can do this. But recommending “weight loss” for me is asinine – and if I hadn’t already dealt with those demons sufficiently, that recommendation could be dangerous for someone with my history.
My new doctor knows none of this, of course. I can’t remember if I even tried to tell her. She doesn’t know that I usually walk or ride my bike an hour a day, but she did recommend that I do more exercise. I’m not even going to comment on that other than to say that the recommendation for adults is at least 150 minutes of activity weekly – or 30 minutes five days a week. I surpass that. By a lot. I am at my set point weight – the weight that my body naturally goes to whenever I’m not centering my entire life around lowering that weight. When I’m active and eating normally (by that I mean, not dieting and not in rebound mode, but just eating in a balanced manner, when I’m hungry, and what I feel like eating), this is where my body goes. I feel good at this weight. Solid. Strong. Comfortable in my body. Healthy. My doctor mindlessly tells me I should lose weight. She clearly has no idea what I need to do for my health – physical, mental, emotional, or psychological. None. That means I’m basically on my own.
The only thing my doctor does for me is the bloodwork that I need to figure out where I am and what I need to do going forward. What I’ve figured out so far is that maybe I went a bit too far with eating foods I had denied myself for too long. Maybe I can still have those foods when I want them, but a little less frequently and reflexively as I was having them this past year. The reality is that I don’t often want or crave a cheeseburger and fries (for example) – until I tell myself that I can’t have that. Then guess what happens? I want it all of the time! My eating became a little disordered again after over 18 months of severe food restrictions. Life restrictions. The reality is that, for me, sometimes a beer and a couple of pieces of pizza are what get me through the day. And when it comes down to it, that is the more essential thing: getting through the day. I’m finding my balance. I’m feeling good. And that matters way more than any numbers. I’m keeping an eye on the numbers – but more than that, I’m keeping an eye on me – and making sure my life needs are met.
I’m going to go jot my doctor a note in MyChart that no, I won’t be taking those medications. I’m still finding my way, but I will find a way to control my blood sugar and cholesterol naturally. And if my numbers stay a little on the high side (where they are now without getting worse), I can live with that.
Disclaimer: Please be advised that I am not a medical professional nor a dietician. This site is not in any way, shape, or form providing any sort of diagnosis, advice, cures, or recommendations for medical or dietary treatments. I am simply sharing my own journey and experiences. Nothing I say is intended to replace proper medical care.