You may be taking too many drugs. But how can you tell?

variety of multicolored prescription medications on prescription pad

By Dr. Mary James, ND

I don’t know many women who reach mid-life without taking at least one prescription drug. Maybe you’re taking medications for arthritis, heartburn, headaches or allergies. Everybody’s got something, right? And quite a lot of us have more than one “something” going on.

But taking prescription drugs has its own risks.

What drugs do — and don’t do

You go to your doctor with a complaint — typically a bothersome symptom. She will diagnose the reason, sometimes after a lab test, and typically treat you with a prescription drug. This prescription medication — whatever it might be for — works by sending a chemical signal to change the function of certain cells or systems or organs. The drug generally will suppress the symptom. But it doesn’t affect the underlying cause.

Here’s how that works. If you’re having acid reflux, for example, you might take a medication called a proton pump inhibitor (PPI). Because it suppresses an enzyme that naturally makes your stomach produce acid, the drug leads to less stomach acid and less reflux. Or you might take a medication called an H2 blocker that prevents histamine from attaching to receptors in the stomach. The result is the same — your stomach produces less acid.

But neither drug actually addresses the reasons for acid reflux or heartburn in the first place.

If you don’t explore the “why” part of what’s happening in your body, you may find yourself using the medication over the long term. And possibly in increasing amounts because the medication may become less effective as your body adapts to this new input. Not surprisingly, longer-term use increases the odds of developing side effects, many of which are as bad as the original problem. For example, long-term use of PPIs causes vitamin B12 deficiency in many women. Without realizing what’s happening, you find yourself falling into what’s called a “prescribing cascade.”

How does one prescription become many prescriptions?

A prescribing cascade occurs when a medication you’re prescribed for one problem produces side effects that lead to the prescription of another medication.

Let’s say you’ve been taking that PPI for acid reflux for a year or two. One of the unfortunate long-term side effects of PPIs is that it can set the stage for bacterial overgrowth in the small intestine. So your acid reflux may be held back by the PPI. But then you develop bloating and impaired nutrient absorption related to bacterial overgrowth.

You’re then given an antibiotic to reduce the intestinal bacterial load. But this causes diarrhea. If diarrhea is particularly severe, the prescription anti-diarrheal medication, loperamide, may be offered.

You’ve now gone from one medication to treat reflux to three different medications. One for the original problem. Two for the side effects related to treatment.

And with all this, you still haven’t actually resolved the cause of your reflux!

woman taking her prescription medication

What are the long-term effects on your body?

Your body has a different point of view than most doctors. From your body’s perspective, most medications are a problem. Unlike nutrients that help build tissue or maintain function, your body doesn’t welcome drugs. They’re disruptive foreign chemicals — often toxic — so they need to be removed from circulation as soon as possible. Various enzymes in your liver work to break them down and send them off to be excreted in the urine or feces.

But a lot of medications are metabolized by the same liver enzymes, which means they compete for the enzymes’ “attention.” This distracts the liver from its other vital functions and increases its toxic load.

Worse, some of those medications actually inhibit the activity of key enzymes in the liver. This can slow down the whole process of detoxification even more. What is considered a standard dosage for medications that use that slowed-down enzyme can now act like toxic doses in the body. Unfortunately, as we get older, our liver and kidneys already tend to become less efficient. Blood flow in the liver can decline by as much as 40% and in the kidneys by up to 50% by the time we reach the age of 80. So these toxic loads are really burdensome — increasing the odds of side effects.

Ridding ourselves of metabolites from these medications becomes significantly harder. It also means that when other toxic substances enter our system — which happens on a daily basis — our liver and kidneys have a difficult time metabolizing them. This can potentially make us pretty sick.

Keep two things in mind. First, drugs are typically tested in isolation, even though they’re used in combination with other drugs — so we don’t really know how they interact in the body. That’s especially true since about half of all drugs are prescribed “off label” — that is, they’re used for a purpose other than what was originally approved by the FDA. Second, interactions of all substances in the body are unbelievably complex, probably beyond the computing power we have today, even if we had a complete model of how the body works. Which we don’t.

What are your symptoms telling you?

Integrative and alternative doctors advocate a different view of symptoms. While a conventional doctor usually sees the symptom as a problem, we see the symptom as your body telling you, “Something’s not right.” We want to answer the “and why” question first: Why is the symptom happening in the first place? Once the underlying cause of the symptom is identified, we can take care of it, perhaps with less — or no — prescription medication.

Let’s go back to the example of acid reflux: depending on the individual, the underlying problem could be one of many, including:

  • hidden food allergies (which could be why so many women find relief with H2-blockers, which are antihistamines)
  • stress
  • imbalanced gut flora
  • a thinner protective mucus barrier in the stomach
  • not enough stomach acid (yes, you read that right!)
  • Helicobacter pylori infection
  • eating large meals late in the day

That leads us to another reason to avoid the “prescription cascade”: By treating your symptoms without uncovering their root cause, you could inadvertently mask a bigger issue that, untreated, grows worse.

For example, let’s say you have celiac disease and you simply use medications to relieve symptoms of heartburn, diarrhea and bloating. Without uncovering the fact that eating gluten is the foundation of your illness, the long-term consequences can be devastating: chronic fatigue, osteoporosis, anemia and malnutrition, to name a few.

Unfortunately, this is a common pattern in the treatment of chronic disorders. Conventional medicines mostly treat the symptoms, not the underlying conditions that give rise to the symptoms. As a result, the patient ends up with multiple prescription medications, but not optimal health. Symptoms might be temporarily ameliorated, but the underlying disease continues to progress and you’re prescribed more and more drugs over time.

How to avoid being a victim of the “prescription cascade”

Even if you start by addressing your symptoms with a “quick fix” medication, you are more likely to achieve lasting relief and better health by going after the underlying cause of your problem, rather than just treating the symptoms. You’ll also experience less medication, lower costs and fewer long-term complications. Start by getting some help in identifying what your symptoms are saying about what your body needs. If your doctor is too conventional to consider that approach, I suggest finding a practitioner who’s more open-minded and up to date.

Over-medication is recognized by leaders of both conventional and alternative medicine as a genuine problem that leads to worse health outcomes for patients. While we all know that, it’s still hard to change the pattern of symptom-test-prescription-drug. And certainly there are complex cases where a host of medications is what’s best for the patient. But for most of us — it isn’t. And the reality is, your own clear thinking is the best defense.

What are your symptoms trying to tell you? Find out more with our quick and helpful health quizzes.
References

Carr T. Too Many Meds? America’s Love Affair With Prescription Medication. Consumer Reports (September 2017). https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/

Christianson E. 3 Classic Examples of the Prescribing Cascade. Med Ed 101. https://www.meded101.com/3-classic-examples-of-the-prescribing-cascade/

Guo Y, Hu B, Xie Y, Billiar TR, Sperry JL, Huang M, Xie W. Regulation of drug-metabolizing enzymes by local and systemic liver injuries. Expert Opin Drug Metab Toxicol. 2016 Mar; 12(3): 245–251. Published online 2016 Jan 28. doi: 10.1517/17425255.2016.1139574

Pretorius RW, Gataric G, Swedlund SK, Miller JR. Reducing the Risk of Adverse Drug Events in Older Adults. Am Fam Physician. 2013 Mar 1;87(5):331-336.

https://www.webmd.com/heartburn-gerd/news/20131210/acid-reflux-drugs-tied-to-lower-levels-of-vitamin-b-12#1

Last updated on 12/03/2018