Ever since the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial, or ALLHAT, demonstrated in 2002 that low-cost thiazide diuretics performed no worse than an ACE inhibitor or calcium channel blocking drugs (not compared against placebo), thiazide diuretics became regarded as the first choice to reduce blood pressure in people with hypertension. This means that doctors preferentially prescribe drugs such as hydrochlorothiazide, chlorthalidone, indapamide and others before prescribing other drugs such as beta blockers, ACE inhibitors, or ARBs. Less commonly, more powerful “loop” diuretics like furosemide (Lasix) or torsemide (Demadex) are prescribed, especially if congestive heart failure or kidney dysfunction are present. Let’s focus on the much more commonly prescribed thiazide diuretics.
Followers of the Undoctored lifestyle know that you will not find many complimentary comments about the practices of modern healthcare around this neighborhood, but I applaud any effort to save on healthcare costs. Unfortunately, the cost-saving maneuver of preferentially prescribing thiazide diuretics comes with some very serious potential long-term consequences that have not been fully borne out in shorter-term studies. In other words, some of the adverse consequences of taking a daily thiazide diuretic may not show for a decade, effects such as stroke, heart attack, type 2 diabetes, cancer, dementia, and sudden cardiac death. Because thiazide diuretics have been associated with numerous metabolic derangements that lead to such conditions, we should be concerned that short-term reductions in blood pressure, stroke, and heart attack may not necessarily mean that long-term benefits will be experienced.
The list of potential adverse effects of thiazide diuretics is growing. Emerging evidence suggests, for instance, that they:
- May increase risk for a variety of skin cancers, as thiazide diuretics increase photosensitivity, i.e., sensitivity to sunlight. Although the evidence is observational and thereby preliminary, the more than 3-fold increase in squamous cell cancer makes it more likely that this is a genuine association (unlike the much smaller associations seen in dietary observational studies, e.g., 10% increase risk rather than multiples). As is typical in healthcare, rather than just stop the drug and replace with one that does not increase risk for skin cancer or, even better, advise natural methods that are effective for reducing blood pressure, some advocate drugs to reduce skin sensitivity and skin lesions when taking thiazide diuretics.
- Increase insulin resistance that drives risk for multiple diseases including type 2 diabetes, heart disease, cancer, and Alzheimer’s dementia, reflected in higher HbA1c and fasting glucose levels
- Increased activation of the sympathetic nervous system, an effect that has been associated with increased cardiovascular death and other complications. This is actually a sizable effect.
- Increased blood triglycerides and especially liver triglycerides, the process that leads to fatty liver
- Cause urinary loss of potassium and magnesium, not uncommonly to life-threatening levels. Potassium and magnesium therefore need to be monitored and/or supplemented to avoid sudden cardiac death. (Anyone working in emergency rooms, acute care, or coronary care units has seen many such instances, as it is frightfully common, especially among people whose doctors do not monitor such levels.)
- Increased blood levels of uric acid–which can also trigger gout attacks and may increase cardiovascular risk.
- Slow wound healing
There is no question that maintaining healthy blood pressure is a health advantage. Reducing blood pressure with thiazide diuretics has indeed been shown to avoid 2-3 cardiovascular deaths per 100 people over 5 years. But recognize that “placebo” groups consume grains and sugars, fail to correct vitamin D deficiency, do not address magnesium deficiency that is ubiquitous, do not address thyroid status, do not supplement omega-3 fatty acids, and make no effort to cultivate healthy bowel flora that generates the metabolic benefits of butyrate and other bacterial metabolites, i.e., all the basic efforts we make in the Undoctored Wild, Naked, Unwashed program. And, of course, following the Undoctored strategies does not come with increased potential for type 2 diabetes, skin cancer, delayed wound healing or fatty liver, but contributes to reversing these and other conditions including hypertension in the majority.
Also, most of us agree that good hydration is a basic and necessary health practice. How can a dehydrating agent in the form of a diuretic possibly be good for health?
Husband doing to see Nephrologist, BP and afib doing good, but feet swelling. I am afraid of what they will prescribe.
Barbara wrote: «Husband doing to see Nephrologist, BP and afib doing good, but feet swelling. I am afraid of what they will prescribe.»
Since it’s impossible to guess based on screen names, what diet/lifestyle has he been on, and for how long?
And what meds are in use?
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Stopped Eloquis and Metropinole, mostly healthy eating, low sugar, lots of supplements, 72
Barbara wrote: «Stopped Eloquis and Metropinole,…»
Are those spelled correctly? They don’t turn up in search, and I’m not expert enough to guess.
re: «…mostly healthy eating…»
Various consensus and dissident diets are in near-violent disagreement on what that means.
re: «…low sugar…»
The trick is not just near-zero added sugar, but also avoidance of foods that become blood glucose promptly (which is all the grains, for example). HbA1c, triglycerides and NMR Small LDL-P usually tells the tale, as does tracking actual BG.
re: «…lots of supplements…»
Without knowing what those are, here’s no way to guess if there’s benefit or hazard there. The Undoctored program strives to keep the supplement pile small, mainly limited to key modern deficiencies. And what we do take is usually not found on typical retail shelves (due to quality, potency and junk filler issues).
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I also urge anyone facing blood pressure issues to consider a sleep study! There is more and more concern that lots of us no longer breathe properly. It is actually not hard to re-learn good breathing posture, although it IS hard finding health practitioners who consider this factor. If you are not sleeping well, you definitely won’t be recovering well, or staying well, for long.
lia wrote: «I also urge anyone facing blood pressure issues to consider a sleep study!»
Those can be very worthwhile, as most moderns allow far too much into their lives that is toxic to sleep. Here’s a list I put together a while back.
But ponder the next step. If a problem is found, what is the remediation? CPAP is no cure. Sleep meds can presently literal suicidal risks. If there’s any material out-of-pocket on the sleep study, you might as well apply all my free tips first.
re: «If you are not sleeping well, you definitely won’t be recovering well, or staying well, for long.»
Yep.
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My Mom (73 ) was sent to ER in June with chest pain. Heart checked out fine, no blockage, not a heart attack. They put her on Furosemide, metroprolol, Eliquis and potassium and a temporary amount of barbital. They found “old” blood clots in her legs finally on the last day of her 5 day stay. They tested for lung clots, found none but can’t rule out that an old one from her leg may have broken loose andngiven her a PE. She stayed on Eliquis for about 2 months and weaned off due to lack of affordability and side effects. She is now weaning off the Furosemide and metroprolol, due to severe joint pain, weakness, dizziness, cramps, and in our opinion, very low blood pressure like not uncommon to be at 80s over 50-60 something, how can that be safe long term? She does have a wrist tester which may be inaccurate tho. Major issue she’s having now is a return of bad leg swelling again like before her ER visit even with compression stockings after skipping just one half dose of the Furosemide. What can we do to get the leg swelling down for good and keep her off of these terrible drugs? She is typically grain free, maybe an occasional small exposure once in a great while, low sugar, low carb, 139lbs (she used to be 250+ in years past) 5’6″, replacement hips and left knee, trigeminal neuralgia, glaucoma, and has had gallbladder attacks in the past that have all but gone away with the improved lifestyle. Incidentally, it started acting up again while on the meds. Thanks for any help or info you can provide.
LJ wrote: «Major issue she’s having now is a return of bad leg swelling again like before her ER visit even with compression stockings after skipping just one half dose of the Furosemide. What can we do to get the leg swelling down for good and keep her off of these terrible drugs?»
For most people with simple edema, just strictly following the Undoctored or 2014+ Wheat Belly program causes that to recede.
In the wake of all these meds, however, a number of other suspects arise, including but not limited to dysbiosis and liver toxicity. Standard liver function tests might shed some light on the latter.
Dysbiosis, including SIBO and fungal overgrowth, is pervasive today, even for people not being shotgunned with meds. The meds add the problem that they can easily have unappreciated anti-microbial effects. Implementing the gut flora cultivation aspect of the current program is a start in addressing that.
re: «She is typically grain free, maybe an occasional small exposure once in a great while…»
For anyone with undiagnosed celiac disease, or non-celiac gluten sensitivity, periodic cheats suffice to sustain misery.
re: «…She is typically grain free, maybe an occasional small exposure once in a great while…»
Is there yet-another medication in use for that, such as timolol?
re: «…trigeminal neuralgia … gallbladder attacks…»
Getting the gut in order might keep those away.
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Thank you Mr. Niland. What is the timolol question in reference to please?
LJ wrote: «What is the timolol question in reference to please?»
You mentioned glaucoma. This is commonly treated with drugs that lower intraocular pressure, such as Timoptic® (timolol maleate). These agents can have systemic effects, as can their preservatives (which is why Timoptic is available as a preservative-free product “in Occudose®”).
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Ah. She has always done poorly with glaucoma meds, they always gave her heart palpitations. She has managed to stay off of them for years now with lifestyle and diet changes. Her eye doctor who is a glaucoma specialist, also assists by providing as many drug free alternatives as he can, which is amazing to find these days. The only thing she uses is preservative free Oasis tears. She is sustaining what remaining vision is left via these means thankfully.
LJ wrote: «She has always done poorly with glaucoma meds, they always gave her heart palpitations.»
Bradycardia is a listed side effect for timolol (although it’s way down the list of a lot of things that would nice to avoid, including several that suggest it disrupts intestinal microbiome).
re: «She has managed to stay off of them for years now with lifestyle and diet changes.»
That was my experience. I had switched to Timoptic in Occudose in the 1990s due to corneal pitting from the preservative, and the dose I was on became unavailable for a time (plus, that’s not a cheap agent). When I went on the Wheat Belly diet, the pressures normalized on their own.
re: «Her eye doctor who is a glaucoma specialist, also assists by providing as many drug free alternatives as he can, which is amazing to find these days.»
If the pressures begin rising again, be sure to discuss SLT (Selective Laser Trabeculoplasty) with the specialist. A quick zap every few years can often control it without meds.
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