One of the foundational principles of medicine is, Primum non nicer, a Latin phrase that means “first, do no harm.” No physician wants any harm to come to their patients. But in this day and age, it’s a given that patients may sometimes be injured, even if you practice high-quality, evidence-based textbook medicine.
A frightening revelation that I had a few years ago is how often doctors can cause long-term harm, despite initial short-term benefits. This can be found in almost every area of medicine. These practices are considered “standard of care,” supported by research and top leaders in our field. Here are 5 ways (3 types of medications and 2 types of surgical procedures) doctors are making you gain weight, and eventually, more sick in the long term.
1. Medications that cause weight gain
Many commonly prescribed medications for allergies, diabetes, high blood pressure and depression are known to cause weight. Some of the more common offenders are:
- paroxetine (Paxil) for depression
- fluoxetine (Prozac) for depression, short term weight loss, long term weight gain
- the atypical antipsychotics, such as olanzapine (Zyprexa) and clozapine (Clozaril)
- mirtazapine (Remeron)
- amitriptyline (Elavil, Endep, Vanatrip)
- valproic acid (Depakote) for bipolar disorder
- chlorpropamide (Diabinese and Insulase) for type 2 diabetes
- fexofenadine (Allegra)
- and prednisone.
2. Medications that lower melatonin
Many of the high blood pressure medications that lower sympathetic tone can lower melatonin production by blocking the sympathetic nerve pathways that contribute to melatonin production by the pineal gland. There aren’t many studies on this on humans, but one study on pigs found significantly lower levels when administered Alpha-methyl-p-tyrosine (AMPT), an enzyme blocker that lowers sympathetic activity. Lower levels of melatonin is associated with poor sleep quality.
3. Medications that cause nasal congestion
Medications that lower your blood pressure, by lowering sympathetic tone, can also cause nasal congestion. Since blood flow in your nose is regulated by a delicate balance between the sympathetic (fight or flight response) and parasympathetic (rest, digestion and reproduction) nervous systems, lowering sympathetic tone can cause pooling of blood in your nasal tissues. Nasal congestion can aggravate sleep-breathing problems.
4. Surgery that prevents you from your preferred sleep position
Imagine if you naturally prefer to sleep on your stomach or side, and after surgery, you’re told to sleep on your back. Oftentimes, you don’t have a choice, such as after hip or abdominal surgery. Being prevented to sleep in your normal position will aggravate more breathing problem, especially on your back, since your tongue and throat structures can fall back more easily due to gravity. Again, lack of sleep due to any reason can cause weight gain.
5. Surgery that causes nasal congestion
Nasal surgery is usually done to open your nasal cavity so you can breathe better. However, some surgeons will use nasal packing or splints, which can aggravate #4. Fortunately, nasal packs are temporary and are usually removed within one week. Another common side effect after nasal rhinoplasty is that if your tip is narrowed, your nostril sidewall cartilage may need to be trimmed, potentially weakening the support structures. In most cases, the effect won’t be seen for years, if not decades. The can present at nasal congestion many years later.
Notice that with all these treatment options there will be initial benefits. But over many years, poor breathing and poor sleep will take a toll on your body. Once you start gaining weight, you can get caught up in a vicious cycle of worsening sleep-breathing problems that can potentially cause even more weight gain.
So before you consider taking certain medications long-term, or before you undergo any surgery, think about any potential long-term consequences, related to sleep and breathing. Anything that lowers your ability to breathe will diminish your ability to sleep, leading to a number of various potential health problems.