I take 10mg atorvastatin and there is a grapefruit warning on the bottle but it just says to avoid taking it with grapefruit. I don’t even like grapefruit so I’m good.
I know we’re all at anecdotes right now, but my PCP has a variant of this comic laminated and pinned to the wall of her examination rooms:
(note, this is a youngish, 40something female physician which is entirely to her favor in terms of flexibility compared to some old, cranky male doctors I’ve had)
Her first response to me when I was discussing what I wanted and what my health goals were as a newly minted 50 a while back were to go with lifestyle changes, but to keep checking in to make sure that the issues identified were improving. She had no hesitation to prescribe drugs, surgery, or even some (not all) supplements that were USP certified, but kept my opinions and preferences in mind.
I’ve improved all of my numbers by successfully getting back to a good diet and exercise program (which had gone to pot after Covid and then Jan 6!) and she’s very pleased, but she’s still concerned about my my Cholesterol not being where she wants it. I had a follow up last month, and scheduled another for 6 months to see if it keeps moving the way we want, and thankfully I don’t have any other complicating conditions, but she’s ready to prescribe if we don’t see continuing improvement.
BUT, before I do any more bragging - I want to be clear, eating healthy food, finding the time and energy to exercise, and the equipment to do so is many times a sign of privilege or at least comfortable levels of wealth. So is access to a PCP that can take the time to check on you semi-regularly. And of course, also improved by being a early 50’s individual with nothing having reached an uncorrectable stage without help.
I was lucky to have all of the above, others certainly won’t. All power to the options that can be used instead of, or in conjunction with lifestyle changes.
Sort of a false dichotomy these days with GLP-1 agonists. “Lifestyle change” has been largely a failure due to the lack of willpower. But GLP-1 agonists are essentially willpower drugs. They’re what enable lifestyle changes.
After starting Ozempic I lost 14 lbs and now my weight hasn’t varied more than 2 lbs in the last 2 years. I eat whatever I want now - I just want to eat less of whatever it is.
I feel like basically there’s a potential gap between the body’s hunger and the mind’s ability to ignore that hunger. Some of that gap can be overcome with extreme effort, but only within limits. And I think GLP-1 drugs reduce the gap in both directions. They certainly serve to reduce hunger by improving satiety. But they seem to also be effective in reducing addictive behavior completely unrelated to food, like alcohol and gambling. I’m very interested in studies as to why this is.
We’re the products of a couple billion years of evolution, most of which time the problem was too little food rather than not enough. The surprise is not that “willpower” fails so often but that anyone can overcome that legacy and the bodily systems driving us to eat whenever food is available. It’s not so much “lack of willpower” as that the our bodies are designed to hoard calories.
If willpower was enough addiction wouldn’t be nearly the problem it is. Pharmaceuticals are a tool. Used properly they can be extremely helpful. Abuse? Sure, it’s possible, you can mis-use any tool.
I’m hoping we can get past labeling the vast majority of people as “failures” - that’s not helpful.
Thanks for stopping by and dropping our daily dose of ignorant quackery into what was otherwise a reasonable discussion.
Moderating:
Please flag them next time instead of feeding them.
After a post and a mod note like that I’m always left wondering about what was sent to the cornfield….
A cite by a crank to a medical crank site full of “vaccines are poison, big Pharma is trying to kill us all with all their products, etc., etc.” Standard RW conspiracy theory stuff.
But it is enough! The GLP-1 drugs prove it. They don’t alter metabolism or calorie absorption or anything like that. They just make it easier to eat less. It really was “just” CICO all along, and (with rare exceptions) people really just needed to consume fewer calories.
The issue is that for most, the level of willpower to override their appetite is simply too much to sustain. Anyone can hold off a meal for an hour. Most can probably eat less for a week if they set their mind to it. But a year, or a lifetime? It’s too much.
And that’s why the GLP-1 drugs are so effective. They reduce the level of sustained effort to something manageable. It may not quite be zero for everyone–but instead of feeling hungry every waking moment, they feel the normal level of urges.
It’s the policy of elevating “lifestyle change” above all that’s been the failure, not the people. I’m hoping we’ll see a run of drugs that work the same basic way. Not by doing anything directly for the underlying condition, but by addressing the “willpower gap” one way or another.
I’m going to push back here. My statements specific to statins still holds.
A hyper focus on the number of the scale is also inadequate. Losing fat mass, specifically visceral fat mass matters independently, no question, but quality of what is being eaten in those lesser amounts still matters. Cardiorespiratory fitness and adequate muscle mass and strength still matters.
I’m not going to claim that what I’ve said holds 100% in all cases. If a lifestyle change can be achieved easily, or has some sort of bistable nature (where the benefits end up having a self-reinforcing feedback), it’s more likely that it can be sustained. Changes to the composition of a diet, if not the sheer quantity, seem a little more achievable.
If you need the medication to help the willpower then no, willpower is not enough. Not on it’s own. We need to get away from the idea that illness or medical conditions are entirely the fault of the person suffering. Not everyone feels that way, but too many of the non-medical public do.
“Willpower” doesn’t carry any moral weight. Some people use it that way, and some people interpret it that way, but that’s not needed.
Consider it like physical strength. It’s not that hard to carry around a 15 lb backpack all day. On the other hand, most people could probably carry an 60 lb backpack for a short time, but not continuously. If you ask them to do the latter, they’ll fail. If you can make a change so that only the 15 lb pack is necessary, it becomes achievable.
There’s no “fault” here, no moral failing; it’s just a function of obvious physical factors. IMO, what we need to get away from is thinking a failure of will is a moral issue. No one has unlimited willpower, everyone has some, and not everyone has the same requirement to achieve a given state. We should treat people on that basis rather than pretending it doesn’t exist and coming up with invalid theories of weight gain or other health issues.
Is it though? In an environment in which highly obesigenic foods are always around us? I suspect that if people could well control the composition the quantity wouldn’t be as much of a problem in any case.
Anyway. My concern remains. If the mindset is that medication is the answer, then there is less energy spent to the rest of the complete picture. It is a problem.
I meant for cholesterol control, not weight. Adding fish to a diet to raise HDL is achievable. Maybe that means eating fish-and-chips instead of chicken strips. But sustaining a serious calorie deficit seems harder. Low calorie foods are generally low satiety foods as well.
No on the fish and chips as a better choice than chicken strips. And no on the satiety bit. Think Oreos as low satiety with high “hedonic” (pleasure) value. High calorie. An apple? Decent satiety and lower hedonic value. Beans and greens, chock full of fiber and decent protein relatively low calorie, high satiety, moderate hedonic value.
What you wrote gives me the impression, possibly not meant but lived by some, that medication is an alternative to good lifestyle choices for nutrition and exercise. That’s what I am reacting to
The problem is that if someone is used to chicken strips, you (probably) aren’t going to convince them to eat a bowl of broccoli with 1/10 the calories instead. You have to work within people’s capabilities. Lecturing them harder isn’t effective. Certainly one should find all achievable improvements. But I think it’s increasingly clear that this is not sufficient for most.
GLP-1 drugs do nothing unless the diet is actually altered. If the patient makes no change to the type and quantity of foods they eat, it won’t make a bit of difference. The drugs just make it easier to change the diet.
Statins aren’t like that, but they can at least bridge the gap between an achievable diet and a “good” one. Or even turn a good one into a better one!