Non-Medicated Life: Independence and Health with Advancing Age
Medicines are a mainstay of American life and the healthcare 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, while others may reduce certain types of cancer.
In the first 57 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost. Such benefits become increasingly important as we age and the number of medications prescribed increase and the potential for drug interactions also thereby increases. Even more, however, informed diet and a lifestyle emphasizing daily exercise can help stave off physical frailty and possibly also dementia. Such additional benefits may thereby allow individuals to maintain their independence and health with advancing age in ways that medications alone cannot provide.
By the age of 60 the average person in the United States is taking five medications on a regular basis. To a large extent these medications are treating chronic medical conditions such as hypertension, high cholesterol, elevated blood sugar, gastro-esophogeal reflux disease (GERD) and obesity. In turn these conditions are many times caused by poor dietary composition, excess salt, excess sugar, excess saturated fat, excess calories, a lack of daily exercise and excessive body weight – all that may be addressed successfully for the majority without medication or at least with fewer medications and smaller doses of medication.
Medications have a cost that is both financial and experiential. While generic drugs have decreased medication’s financial burden, generics do not work for all patients, and the cost of even one branded medication may be prohibitive. Moreover, paying for multiple drugs with multiple copayments can place a burden on older individuals especially those on fixed income. Multiple drugs as well as the higher doses required when diet and exercise are not optimal also increase the risk of drug interactions and side effects. Such drug interactions and side effects can degrade the quality of life especially with age.
For example, diuretic drugs are used to treat hypertension and work by increasing the amount of salt the kidneys excrete. Unrestricted intake of salt, however, in a salt sensitive individual may negate the benefit of diuretics for blood pressure control. Moreover, high dose diuretics may also cause potassium depletion, which may cause muscle weakness and heart arrhythmias, and require the use of potassium supplementation and repeat blood tests.
In another example, statin drugs are used to lower cholesterol in the blood. In an individual with high cholesterol, unrestricted intake of saturated fat, however, may raise the LDL or “bad” cholesterol and negate the benefits of statins – or may require higher doses of statins than otherwise needed. Such higher doses may cause muscle pain or muscle weakness not seen at lower doses, and may lead the individual and the physician who cares for that individual, to conclude erroneously that the drug cannot be used at all. The result may be a risk for heart attack and stroke not addressed by either diet or medication.
It is important to emphasize that when heart attack and stroke are avoided not only is mortality reduced, but also morbidity. A stroke for example may be survived, but leave an older individual less functional, and more likely to lose their independence through placement in a nursing home.
In other circumstances the independence and ability of seniors to navigate the tasks of daily living – bathing oneself, feeding oneself, and getting out of a chair or bed to walk – may be compromised by a progressive withdrawal from and avoidance of meaningful aerobic and strength training. Exercise is not just for the young. Exercise is even more important for individuals as we age because it combats frailty – the progressive loss of muscle mass and balance, which exchanges dependence for the independence we all desire. Without exercise, after age 30 an individual will lose 1% of their muscle mass every two years.
In the elderly, it is not unusual to have lost enough muscle mass that the ability to get out of a chair or walk is compromised. Balance and safe ambulation, as well as the ability to recover after stumbling, and thus avoid falling and fractures is absolutely dependent on muscle mass. But maintaining muscle mass requires daily exercise using body weight as the resistance. Even the elderly who have not exercised previously can increase muscle mass with resistance training supervised by physician and physical therapist.
A study at Tufts University done over 20 years ago established that weight training of 80-year-old people could significantly increase muscle mass and functionality. Individuals who through frailty were in wheelchairs or used walkers or canes were more likely to “graduate” to a less dependent device or become device free with weight training. To graduate safely from a wheelchair to a cane is a huge increase in independence for any individual. It is important not just to live longer, but to live better.
Diet and lifestyle also may slow cognitive decline and reduce dementia. Observational studies of physical exercise in older individuals support its use in reducing dementia. From a mechanical sense, exercise contributes to improved vascular flow and function, lowers blood pressure and body weight, and reductions in vascular disease-associated dementia. But less convincing is the evidence for exercise-induced reductions in the incidence of Alzheimer’s disease. From a nutritional perspective, diets which reduce vascular disease, such as a predominately plant-based diet and a Mediterranean diet, have also some evidence to suggest potential benefit in slowing cognitive decline.
In summary, pursuing the Non-Medicated Life as we age may significantly improve our independence and overall health. Minimizing medications we do not need and allowing the use of reasonable amounts and doses of medications we do benefit from can reduce the financial burden of medication, reduce side effects, and preserve quality of life. Working with physicians and physical therapists to help increase both aerobic exercise and muscle mass can improve balance and combat frailty as well as cognitive decline. As such a pursuit of the Non-Medicated Life may avoid the proverbial bottle of pills and help keep us independent and healthy as we age.
Paul E. Lemanski, MD, MS, FACP is a board certified internist with a master’s degree in human nutrition. He is director of the Center for Preventive Medicine of Paul E Lemanski MD PLLC. Paul is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.
**Originally published in Adirondack life magazine