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Black Box Warning

Posted Jun 14 2010 7:14am

by Barbara Berkeley, MD

As I read today's newspaper over my morning coffee, I was dismayed to see yet another article on the heretofore unknown hazards of a commonly used class of drugs.   A large study of people taking medications called ARBs (which include the blood pressure drugs Cozaar, Atacand, and others) showed that ARBs are associated with an increased rate of cancers in general and lung cancer in particular.  As I practice medicine, I find that people are becoming more and more wary of medications.  We are constantly finding out that drugs have unintended side effects; witness the demise of the enormously popular diabetes med Avandia which turned out to be linked with heart problems or of the anti-inflammatory Vioxx: ditto.  

Fear of medicine can be a problem for physicians.  When I practiced general internal medicine, I often found myself in a battle with patients who did not want to take statin drugs for their cholesterol.  Their rationale was that the drugs weren't "natural".  But statins have been shown to have an excellent safety profile and to provide good benefit.  I had to remind these patients that having arteries clogged with cholesterol plaques wasn't "natural" either.  Worse, it was potentially deadly.  

The problem with medicines is not that they have side effects but that we turn to them too quickly.  As doctors, we don't trust our ability to influence patients to make deep changes in the way they live.  As a result, our recommendations to "exercise more" or "eat healthy" are usually weak at best.  I think we could benefit from a new kind of referral process: one which would send patients to a motivational and educational course that could open their eyes to the power and importance of cleaning up the way they live.  That course would be designed to give very specific guidelines for how to get that job done.

If I were designing the curriculum, my first lesson would be one that equated SAD foods with the drugs we look at so suspiciously.  Most of us have read the package inserts of our medications with great discomfort.  So many possible side effects.  So many unknown hazards. What if the FDA start creating side effect sheets for manufactured foods?    Here's one for doughnuts:

         Doughnuts  (do' nutz)

         A combination of processed flour, sugar, egg, salt finished by deep frying in a large quantity of vegetable oil.

Selected safety information:

Doughnuts are contraindicated in patients who have demonstrated an intolerance to fat (patients with known gall bladder disease or those who may have silent gallstones), and in patients who have a history of elevated cholesterol, coronary artery disease, peripheral vascular disease, diabetes or elevated fasting blood sugar.  Patients should be aware of the potential risks of consuming vegetable oils that are cooked at high temperature, which include the consumption of carcinogenic compounds.  Vegetable oils are also very high in omega 6 fatty acids which promote body inflammation when consumed to excess.  Foods which are high in simple sugars have been shown to elevated insulin levels when consumed chronically.  High insulin levels can lead to hypoglycemia after food consumption.  Chronically high insulin levels are associated with high blood pressure, elevated serum triglycerides, low HDL cholesterol,increased hunger, obesity and adult onset diabetes.

 Most common side effects include: 

        Nausea,  Post prandial hypoglycemia, weight gain, acne, oily mouth-feel, diarrhea, increased hunger levels, carbohydrate cravings, elevated cholesterol, feelings of depression linked to lack of control over food intake.

Black Box Warning: The excessive consumption of doughnuts and other foods which combine high levels of sugar and fat have been linked to obesity, heart disease and an increased risk of many cancers.  These foods should be consumed rarely and with full knowledge that they are harmful to your health. 

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