The Non-Medicated Life:
The Economic Benefits

by Dr. Paul E. Lemanski

Editor's Note: This is the 11th in a series on optimal diet and lifestyle to help prevent and treat heart disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the health care system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of western science may reduce the risk of heart attacks, strokes and cardiovascular death.

In the first ten installments of The Non-Medicated Life, informed diet and lifestyle has been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications. For those who are interested in safely avoiding medication or reducing the amount of medication, this efficacy may be enough to motivate change. However, the economic benefits for an individual, and for society, are also significant. The potential of a non-medicated life or of a minimally medicated life for reducing the cost of health care is the focus of this month's Health column.

Medicines are a major portion and the most rapidly growing portion of the health care budget. The average 65-year-old person in the United States takes five prescription medications. Most pharmacy plans charge a co-pay of $20 for a non-generic formulary drug and $10 for a generic drug. Thus, the average 65-year-old will pay between $50 and $100 per month in pharmacy medication costs. For those on a limited or fixed income such costs may make it impossible to take all prescription medications recommended.

Additionally, Americans are taking an increasing number of supplements and non-prescription medications, which also consume health care dollars. Some supplements have been proven to be beneficial (see The Non-Medicated Life: Supplements, February, 2004). Other supplements have no proven benefit. Moreover, the U.S. Food and Drug Administration does not regulate supplements so apart from their efficacy, the potency and purity of supplements is not assured except by manufacturer reputation or when confirmed by outside laboratory testing. Unfortunately, many limited health care dollars are spent on supplements in which the active ingredient has a potency less than advertised, on supplements of no proven benefit or on supplements containing contaminants known to cause harm.

Proposed solutions include increased regulation of the pharmaceutical industry, a greater use of generic drugs, buying multiple months worth of drugs by mail at reduced cost (when this option is provided by a health plan), and purchasing less expensive branded drugs in Canada. Congress has even addressed the need for a prescription drug plan for seniors. What no one seems to be suggesting is safely using less and/or fewer drugs by utilizing diet and lifestyle to reduce one's actual need for medication.

A case in point is prescription drugs for cholesterol lowering. The most widely prescribed class of drugs is a group called statins. Examples of statins would be Lipitor, Zocor, Crestor, Pravachol, Lescol and Mevacor. Statins have been shown in multiple clinical trials to reduce the risk of cardiovascular death, heart attack, stroke, and the need for bypass or angioplasty by 20-30 percent (see The Non-Medicated Life, March 2003). In its 2001 guidelines for physicians, the National Cholesterol Education Program estimated that 30-40 million Americans would require drug therapy. Moreover, one of the more recent clinical trials called the Heart Protection Study proved that individuals at risk with even normal cholesterol might benefit from a statin suggesting the need for a substantial increase in statin use and thus cost.

What no one seems to be suggesting is safely using less and/or fewer drugs by
utilizing diet and lifestyle to reduce one's actual need for medication.

The cost of statins for those with drug coverage is generally about $20 per month. Mevacor also called Lovastatin is a generic statin that may cost only $10 per month. Lovastatin is only of modest strength in terms of cholesterol lowering and is thus not prescribed by physicians as often as the non-generic statins. However, adopting a heart healthy diet and lifestyle in which only 12-15 grams of saturated fat is consumed daily may make the use of drugs unnecessary in some individuals. When used with Lovastatin such a saturated fat restriction would essentially double the power of the drug and allow individuals with less severe elevations of cholesterol to benefit at lower cost. The same strategy of saturated fat restriction may be used for the non-generic stains allowing less of these medicines to be used.

For those wishing to eliminate the cost of statins entirely - and only with the approval of one's physician - a low fat vegan diet (10 percent of total calories from fat) may accomplish LDL reductions similar to statins. Finally, the use of a supplement called red rice yeast that contains the same active ingredient as Lovastatin may be considered, although the cost may actually exceed that of generic Lovastatin. Additionally, the potency and purity of the currently available red rice yeast is not monitored by the FDA and for many brands cannot consistently be assured.

The cost of blood pressure medicines may also be reduced by the adoption of a heart healthy diet and lifestyle. Most individuals require two or even three blood pressure medications to adequately control their blood pressure. Thus, for those with drug coverage, the cost may be $20-60 per month. In those who have high blood pressure and who are significantly overweight the loss of five pounds may reduce blood pressure and the loss of 15-25 pounds may allow blood pressure medicine to be decreased or eliminated. In the CARDIOFIT and NUTRIFIT weight reduction programs at The Center For Preventive Medicine and Cardiovascular Health, blood pressure medicines have been reduced in many and in some cases eliminated significantly reducing medication costs.

Finally, the cost of diabetes medications may be reduced by a heart healthy diet and lifestyle. Most patients with non-insulin dependent diabetes take two to three medications to achieve blood sugar control. Glucophage or Metformin is available in a generic form, which must be taken twice a day for maximal benefit. The cost for most of those with medication coverage is $10 per month. Newer non-generic diabetes medicines such as Avandia, Actos, or Starlix may cost $20 per month. Thus, an individual with diabetes may pay between $10 and $50 per month not including the cost of fingerstick blood sugar monitoring strips. The use of combination medications that contain metformin and a second agent in one pill may help decrease cost.

With the help of a registered dietitian or certified diabetes educator most individuals can adopt American Diabetes Association approved diets, which may allow medication to be decreased. In those with diabetes who are overweight or obese, the loss of 20-25 pounds may dramatically improve blood sugar and allow medication to be decreased or eliminated. In the CARDIOFIT and NUTRIFIT weight reduction programs with average 12-week weight loss in this range, (see outcome data) diabetes medications are reduced in most and in a number of cases eliminated, thereby significantly reducing medication cost.

In summary, prescription and non-prescription medicine as well as supplements represent a large and growing portion of total health care cost. Numerous strategies have been suggested to control these costs, but few have suggested using informed diet and lifestyle to use less and/or fewer medications and thus reduce total health care expenditure. As such, informed diet and lifestyle may be seen as a powerful way to reduce cost as well as risk and help avoid the proverbial bottle of pills to solve an individual's cardiovascular health problems.

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Center for Preventive Medicine & Cardiovascular Health

at Mid-Valley Cardiology 111 Mary's Ave. Suite 3 Kingston, NY 845-339-3663

Main Office 400 Patroon Creek Blvd. Albany, NY 518-618-1100

at Glens Falls Associates in Cardiology 747 Upper Glen St. Queensbury, NY 518-793-1083