Good Health

DEAR DR. ROACH: I have a strong history of premature heart disease in my family, and I have been having some unpleasant side effects of blood pressure medicine. I decided to try a completely plant-based diet: grains, vegetables, legumes, fruit, seeds and nuts. After about a month on the new diet, my total cholesterol dropped 44 points to 159, and the other numbers went from borderline to normal, as measured by my cardiologist. My blood pressure, which was often high in the mornings (typically 150+/90), was 118/68 this morning. I’ve only lost about 5 pounds in the past couple of months, and I’m probably still 8-10 pounds overweight. I am pleased with the results, but why didn’t any of my doctors recommend this? — J.S.B.

ANSWER: Diet is a powerful tool for improving overall health, especially heart health. I believe it is underemphasized by most physicians. Changing from a meat-based diet to a mostly plant-based diet often prompts improvements in blood pressure, cholesterol and weight. Your results are better than most, but by no means unheard of.

You haven’t said how you feel, but many people feel more energetic as well. Many others are able to come off of some (occasionally all) of their medications, which of course reduces side effects. Why don’t physicians recommend it? I think it’s a combination of reasons. Some doctors don’t realize how powerful the effects of dietary change can be. A good deal of patients are highly resistant to making changes, so physicians are used to their dietary advice failing.

Also, taking the time to get an accurate diet history is hard, personalizing dietary advice is harder, and writing a prescription is easy. It is not necessary to have a 100% vegan diet like yours to experience a benefit. A mostly plant-based diet has substantial benefits. It’s easier for some people to make incremental changes.

DEAR DR. ROACH: I’ve been taking Viagra for several years, with good results for my wife and me. Recently my prescription drug coverage administrator has begun restricting my access to 12 pills every 30 days. I’ve requested an explanation from the company, without success. My prescription is written by my heart doctor, and he is not aware of any reason to restrict my access to Viagra. Is there some danger in taking Viagra (sildenafil) on a regular basis? The literature supplied with the prescription, from Pfizer, does not indicate a limit on use. I’d appreciate your feedback on this, as it will affect my wife’s and my happiness. — J.R.

ANSWER: The insurance company isn’t worried about your safety: Sildenafil (Viagra) and similar drugs are safe for daily use in most people, and your cardiologist is certainly the right person to make that determination, not your insurance company. Instead, the drug limits are there to save money for the insurance company. People can make up their own minds about whether that is reasonable or not, but it is a near-universal finding now. One way many patients get around this (if they are taking 25 mg or 50 mg) is to get the larger-size tablet and cut it in half (a pill cutter can do this well), since the limit is on the number of tablets, not the number of milligrams.

Readers may email questions to ToYourGoodHealth@med.cornell.edu. © 2020 North America Synd., Inc.

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