Who Says There’s Really “Prediabetes”?

I want to launch this post with a disclaimer—don’t do what I did. On the other hand, the usual advice—consult with your physician—might be even worse, for the reasons I’ll get to.

After my 2015 stress test (described in last week’s post) I had a very depressing follow-up call with my doc.

“Your ejection fraction has declined to 46 percent,” he said. “That’s not terrible—50 percent is the low end of normal—but you can expect it to continue to decline. When it gets to 30 percent, you will be officially disabled according to Social Security disability rules.”

“So you’re saying I should get my affairs in order.”

“Oh, I don’t know,” he said. “A typical male in his sixties can expect to live four and half years with congestive heart failure, so you’ve got some time.”

That was supposed to cheer me up?

I left my office early that day and went to the Carnegie Library, where I planted myself in the medical section and reviewed everything I could find on all the meds I was taking. As I had told my father, I didn’t think that stopping the meds was going to extend my life—quite the contrary—but I did hope that it might make whatever time I had left more pleasant.

I found that almost all the meds I was on had very little to do with congestive heart failure. Indeed, there is very little that medical science can do about that condition. Back in the 1970s, congestive heart patients lived four years, and 40 years later we are all the way up to four and a half years. Zowie. Where the hell are all the medical science research dollars going?

Like my father, and like the poor 46-year-old in the stress test waiting room, most of the meds I was on were designed to deal with long-term, chronic conditions: blood pressure, cholesterol, diabetes, etc. To see how silly most of this is, let’s quickly look at the brand new disease of “prediabetes.”

Prediabetes is diagnosed when your blood glucose level (that is, blood sugar level) is higher than normal, but not high enough to be considered full-blown diabetes. Maybe you’ve even seen the highway billboards that shout, “86 MILLION AMERICANS, MAYBE EVEN YOU, HAVE PREDIABETES, GUY-STUCK-IN-TRAFFIC.”

Those billboards are sponsored by the Gang of Three: the American Diabetes Association, the American Medical Association, and the Centers for Disease Control and Prevention, and they are omnipresent. That’s because the Gang of Three believes that diabetes is “One of the nation’s biggest public health crises today.”

Uh, hello, we’re not talking about diabetes, we’re talking about prediabetes, which isn’t even a disease. In fact, only about 15 percent of people with “prediabetes” will ever get full-blown diabetes. So (a) why are the national billboards trying to scare everyone to death, and (b) why put 86 million people on a powerful med (metformin) if only 13 million of them are likely to get diabetes?

Here are the answers. (1) Medical science is medicine-crazy. (2) The American Diabetes Association has insisted that prediabetes can only be treated with metformin, giving its manufacturers monopoly profits. (3) By deeming “prediabetes” a disease, the American Diabetes Association gets 86 million more possible donors. In case you’re wondering, no other country in the world considers “prediabetes” to be a disease (or even a word).

There is also an easy way to determine whether someone with an elevated glucose level is likely to progress on to diabetes: check to see how stable their reading has been over the years. My level, for example, has been exactly the same since at least 1974. But when I mentioned this momentous fact to my doc, she replied, “Oh, I don’t think that means anything.”

What she meant by that was, “You see, I’m afraid that if I don’t put you on metformin and you somehow get diabetes, you will sue the hell out of me.” So she and I have, without discussing it aloud, worked out an ideal solution: she prescribes metformin and I throw it in the trash. Problem solved.

And that’s what I did with every single one of my meds, even the ones (very few) that could arguably be said to address congestive heart failure. My idea was to get the hell off everything, see if I felt better, and then gradually begin adding back the most important meds. As it happened, I executed half this plan.

It turns out that you can simply stop taking some meds, but for others you have to wean yourself off slowly. As a result, although I had my stress test in mid-January of 2015, it wasn’t until mid-March that I was off everything. Then, by the end of April, after all those poisons had worked their way out of my body, I felt fantastic. I felt better than I had felt before my heart attack. I felt better than I had felt since I turned 60. I felt like somebody had shot me full of fountain-of-youth germs.

And along the way I had an epiphany. When doctors point out that the side effects of a med they want you to take are “very minor,” they mean specific, known issues with the drug. Maybe it’s muscle pain, maybe its dizziness, upset stomach, “dry mouth.” When my Dad and the 46-year-old I sat beside at the stress test claimed they had no side effects, that’s what they meant—they had none of those things, or at least they weren’t serious.

But the real side effect of over-medication isn’t specific things associated with a particular med, and it isn’t even the (innumerable) problems caused by interactions among all those meds. No, the trouble is a profound sense of being unwell, of being enfeebled, infirm. It’s a lassitude, a feeling that you’re ill, a lack of emotional and physical energy, an inability to do the things you need to do to stay alive—like exercise. Too many meds will kill you faster than congestive heart failure will kill you.

The only way to know whether you are sick because of disease or sick from over-medication is to get the hell off the latter and see how you feel. Which is what I did. Next week we’ll see how that’s worked out (so far).

Next up: Why We Don’t Take Our Meds (Again), Part IV