The drugs that help can also hinder
It is a similar story with raised blood pressure, especially for those aged 70 and beyond
When it comes to diabetes, too much of a good thing can be bad for you. Drugs such as metformin are certainly effective at lowering the blood sugar, but when used inappropriately or at too high a dose can cause hypoglycaemia. Currently, compared to a decade ago, an additional 4,000 people every year require emergency admission to hospital with confusion or coma due to this excess lowering of the sugar level. And while this is readily correctable with a glucose infusion, hypoglycaemia predisposes to injuries sustained in road traffic accidents, fall-induced fractures of the hip and disturbances of the heart rhythm, any of which may be fatal.
It is a similar story with raised blood pressure, especially for those aged 70 and beyond. Drug treatment modestly (if very desirably) reduces the risk of stroke, but surprisingly does not appear to improve overall survival.
This anomaly may be because the commonly prescribed thiazide diuretics deplete the body of sodium and potassium – again, causing disturbances of heart rhythm – or the sudden fall in pressure of postural hypotension predisposing to falls, broken hips, etc. These, and other, dangerous effects of overzealous treatment, as mentioned in this column before, almost certainly account for the recent fall in life expectancy, not just in Britain but also, it now appears, in Western Europe and the United States.
The reluctance of medical leaders to address this issue, attributing it rather improbably to the adverse health effects of “austerity”, may be related to their vigorous advocacy of mass medicalisation over many years – such as the near universal prescribing for millions of statins and other widely used drugs.
Dieting drawback
The query from a group of friends all comfortably losing weight on a Slimming World diet but inconvenienced by frequent, especially nocturnal, visits to the loo (“five times is not unusual”) has prompted further accounts. “I pee for England when I restrict my carbs,” writes a lady from Somerset, while another on the very popular 5:2 diet notes she is up “several times during the night” for the two days of the week she is fasting, but sleeps soundly for the remaining five.
Physiotherapist Katie Mann attributes this to the relatively high water content of fruit and vegetables, a common feature of several dietary regimes, and – to suppress the inevitable hunger pains – inadvertently drinking more than the recommended three to four pints daily.
As for a physiological explanation, a regular dieter points out that when weight is lost, the stored body fat “has to go somewhere”, and is metabolised, 84 per cent being expelled from the lungs as carbon dioxide and the remaining 16 per cent as water or other body fluids.
Still, “a small price to pay for seeing those falling figures on the bathroom scales”.
Polio plaudits
Finally, my account last week of the polio eradication programme seriously underestimated its scale, requiring the amazing feat of immunising 450 million children worldwide every year at a total cost of $14 billion (not £9 billion).
And while acknowledging the generous commitment of Bill and Melinda Gates, the main credit, as several correspondents have pointed out, must go to the magnificent Rotary International, who first launched it almost 40 years ago.
The efforts of their 1.3 million members have contributed billions, while being involved in the often delicate diplomacy to ensure the programme can operate in war zones and across international boundaries.
For those who are interested to know more, John Sever, formerly of the National Institute of Health, describes in a recent issue of the Journal of Infectious Diseases, the legacy and future of the Rotary’s Polioplus programme (2017, volume 216, pages S355 to 361), which is available on the internet.