Note: This article is an expanded form of a previous blog concerning diuretics. It was written for publication on another website. But, you should read it, even if you have read the earlier blog. I believe it offers valuable information on the proper management of various conditions for which diuretics are commonly, and erroneously, prescribed.
The greatest thing about the Internet is that it allows public debate of issues that would not otherwise be publically debated. For instance, although almost 10 years have passed since 9-1-1, the 911 truth movement is alive and well and growing, and it's all because of the Internet. The JFK truth movement too has benefted greatly from the Internet.
Likewise, the Internet has become a bastion for medical skepticism. Look what happened last year with the supposed swine flu pandemic. Tens of millions of Americans refused to get the swine flu shot. The majority of Americans didn't get it. Where did such skepticism come from? It came from the Internet. And it's not just the swine flu shot. The Internet puts all medical drugs on trial like never before. Do an online search, and you can find a torrent of information about the harms from statin drugs, NSAIDs, acid blockers, arthritis medicines, horse estrogen, and more. I dare say, if you are prescribed a drug, and you don't do an online search about it before taking it, something is wrong with you.
However, there is one class of prescription drugs that has largely escaped critical analysis on the Internet: diuretics. That is about to change. This article makes the case against diuretics and why you should think twice about taking them. And, diuretics are a very widely prescribed class of drugs. Diuretics are considered first-line treatment for high blood pressure, congestive heart failure, kidney failure, cirrhosis of the liver, and edema from just about any cause. You don't like the puffiness around your eyes in the morning? A doctor will give you a diuretic for that too.
We all know what diuretics do- increase the urinary output- but how do they do it? To grasp that, you have to understand how the kidneys work.
Kidney filtration starts with blood passing through a specialized cluster of high-pressure capillaries called a glomerulus. Because of the high pressure, water and disssolved substances are forced out of the capillaries into the capsule that surrounds the glomerulus, called Bowman's capsule. Then comes a long tubular system known as the renal tubule. There, the body reclaims some of the initial filtrate, including about two-thirds of the salt and water, and virtually all of the organic compounds, such as glucose and amino acids. The whole idea is to reclaim the good and leave behind the bad and to get the balance of everything just right. The whole filtering unit is called a nephron, and there are about a million nephrons in each kidney.
Diuretics work by sabotaging the reclamation process so that more of the initial glomerular filtrate reaches the bladder. So, more water comes out, and also more minerals, such as sodium, potassium, and magnesium. There are different kinds of diuretics. For instance, loop diuretics interfere with reabsorption at the ascending loop, whereas thiazide diuretics interfere at the distal convoluted tubule. There are other kinds of diuretics, but those two seem to be the most widely prescribed. Keep in mind that the function of the kidneys is a very delicate and intricate process. It's influenced by multiple hormones, some of which are produced by the kidneys, and some of which are produced elsewhere, such as the pituitary gland and the adrenals. It's influenced by the body's pH, because, among other things, your kidneys work to maintain the proper acid/base balance. It's a vast, complicated, finely-tuned, precision process, and again: it's very delicate. To go in there, as with a sledgehammer, and pharmacologically force changes on this delicate process is certain to cause havoc. You wouldn't try to adjust a wrist watch with a sledge hammer, but they might as well be doing that when they give people diuretics.
So, do diuretics make your kidneys work better? No, they make them work worse. The fluild output goes up but only because the whole discriminatory process has been seriously corrupted. The result is pharmacological dehydration. That's what you get when you take a diuretic. A diuretic adds a layer of pharmacological dehydration to whatever condition you started with. It doesn't address the causes of the original condition. It doesn't normalize anything. On the contrary, it adds another abnormality to the one that already exists. It certainly does not cure, fix, or correct anything. What it does do is camouflage the original condition. So, no matter what disease you started with, you now have two diseases, one naturally occurring, and the other drug-induced. The result of that morbid combination may kinda, sorta look like normal. But, the devil is in the details.
Hey, don't be fooled by appearances! If you, an LRC reader, are smart enough to see through fake economic recoveries, you ought to be able to see through fake medical recoveries. They're both as phony as a three dollar bill. (Or maybe I should say a five dollar bill.)
Just because your swelling goes down a little in response to the diuretic does not mean you are getting better. You, the poor patient, are being deceived by your misguided doctor. The "improvement" is just a trick, a charade, a medical shenanigan. Nobody gets their issues resolved by taking a diuretic. All it does is mask symptoms while putting an additional strain on the body. I suppose it wouldn't matter if it were harmless. But, it is not harmless. It starts a train of evils that reaches far and wide. For example, JAMA reported in 2002 that patients in kidney failure who were given diuretics to "help" their kidneys had a 68% higher death rate!
Being a bicyclist, I like to make an analogy to a bicycle wheel being "out of true." To get that perfect rotation back, a wobbly wheel is placed in a device, and then the spokes are adjusted- some tightened and some loosened until the wheel rotates evenly again. But, you can't go about it willy-nilly. If you don't know what you're doing, and you start cavalierly tightening and loosening spokes to correct a wobble, you can easily create a worse wobble elsewhere. You'd be surprised how easy it is to make a bad wheel worse when trying to fix it- if you don't know what you're doing. You can easily dig yourself in deeper. And that's exactly what happens when you take a diuretic; you're just digging yourself in deeper, making a bad situation worse. You're just complicating your condition and taking your whole biological system further "out of true." And you are setting yourself up for unending medical dependency. So, don't be lured by the prospect of a symptomatic improvement from taking a diuretic. It's not worth it. It will always prove to be meager and temporary. No real good comes from it. I assure you that diuretics never restored anyone to health. It's really just a trap- a deceptive medical trap. The list of potential side effects from diuretics is long: headaches, weakness, faintness, nausea, vomiting, stomach upset, muscle cramps, etc. etc., but, what concerns me most is the damage to the kidneys (which is irreversible) and the cardiac arrhythmias (which can cause sudden death).
So, what should you do instead of taking a diuretic? Let's take it one condition at a time.
Heart Failure: If your heart is failing, taking diuretics is not going to make it stronger. Fluid pools in the legs with left-sided heart failure. I say just live with it. Don't cover it up with diuretics. What you need is a total health program to rehabilitate your heart. That means getting the right food (ie, whole natural foods, with plenty of fruits and vegetables, while avoiding junk carbs and junk fats) the right exercise (being careful and diligent about it, respecting your limitations) shedding excess weight, tightly controlling sodium (ie, the amount you put in your mouth, not what your kidneys do with it), etc. Heart-supporting supplements such as Coenzyme Q10, Taurine , Acetyl-l-carnitine, high-dose Vitamin D3, and others should be considered. And of course, you should work with a doctor, but not one who is going to lace you with diuretics. Look, the fluid in your legs is there; you can live with it for a while. Just accept it. Use it as a way to monitor your progress. If you do many things right, the fluid buildup will slowly dissipate- without forcing measures. And as it starts going down- on its own accord- you'll know you are on the right track. What you want is a real recovery- not some medical fabrication.
High Blood Pressure: You could say that most people with high blood pressure have walking high blood pressure, meaning that there is no emergency, and they don't feel sick. It means they have time to apply natural methods and avoid the pharmaceutical route. Again, it starts with natural diet, exercise, weight control, habit control, de-stressing, de-caffeinating, etc. etc. And again, there are natural supplements worth considering, such as fish oil, resveratrol, CoQ10, policosonal, magnesium, and more. It's all very safe stuff. But, why take a diuretic? You don't have high blood pressure because your kidneys are impaired. You may have impaired kidneys because you have high blood pressure, but don't get the cart before the horse. And as I explained, you can't normalize your kidneys by taking diuretics. Even the seeming good that comes from taking a diuretic for high blood pressure isn't all that much. Why do you think they often combine diuretics with other anti-hypertensive drugs? It's because the results from taking a diuretic alone is often unsatisfactory and inadequate. I say forget about it. Adding a layer of pharmacological dehydration to your condition is not going to help you. And don't let them use fear to control you. OH, you're gong to have a heart attack or a stroke if you don't start taking the drugs right away! You may have had high blood pressure for years without knowing it. Millions of Americans have it right now and don't know it. And yes, some of them will go on to have heart attacks and strokes, but don't assume for a second that those who take diuretics and other prescriptions for hypertension become immune to heart attacks and strokes. That's part of the big lie. They're selling this stuff- just like flu vaccine.
There is one caveat regarding high blood pressure, and that concerns malignant hypertension. Malignant hypertension is a condition in which the blood pressure spikes so high and so fast, that it is truly a medical emergency. Symptoms are acute: extreme headache, visual disturbances, gait disturbances, cognitive disturbances- even speech impediments. I am not challenging emergency medical treatment of malignant hypertension. However, keep in mind that it comprises a very tiny percentage of cases of hypertension. The vast majority of patients fall into the walking hypertension category, for which natural alternative methods are far superior.
Venous insufficiency: This is where the venous valves which prevent backflow are defective causing the ankles and legs to swell, and there is also an unsightly appearance of the broken, damaged veins. If it were me, I would walk as much as possible, use the slant board every day, wear supportive legwear, raise the foot of my bed slightly, eat well (again, lots of fruits and vegetables), and I would take natural botannicals that have been shown to support vascular health, such as horse chestnut, butchers broom, and grape seed extract. But, I would not take diuretics, which can only mask the condition.
Ascites: This is where the abdomen swells because of liver disease. There are a lot of things you can do to aid an ailing liver, but taking diuretics is not one of them. On the contrary, diuretics strain the liver. Obviously, the lifestyle issues must be addressed, including eating habits, drinking habits, drugs habits, etc. And there are many supplements that can aid an ailing liver, including Silymarin from millk thistle, NAC, SAM-e, TMG, lipoic acid, and more. Obviously, a bloated abdomen can look alarming, but it's not usually painful. Just let it subside by itself (which it will) when you do everything else right. And again, as the swelling slowly subsides, you will know that you are on the right course. So, you can use it as a barometer of your progress. There is no good reason to mask it with diuretics.
This doesn't begin to cover all the conditions for which diuretics are used, but hopefully, you are getting the idea. Am I saying that there is no legitimate, beneficial use of diuretics? Let me put it this way: I can't think of a single condition for which I, Ralph Cinque, would be willing to take a diuretic. Not one. Whatever the problem might be, I would deal with it in other, more constructive ways.
In case I haven't made myself clear, I DON'T LIKE DIURETICS. They don't do any good. They just create the illusion of improvement. You can't force the kidneys to work better. It just isn't possible. It only invites trouble. Serious, major trouble.
In the November issue of Nutrition and Cancer, Italian researchers reported on a protective effect against cancer from plant compounds that include flavinoids and proanthocyanidins. Collectively known as "polyphenols" these compounds are found in fruits and vegetables, and other plants foods, including whole grains, nuts, and legumes. It's believed that the protective effect of plant foods against a wide range of chronic diseases is due largely to polyphenols.
Dr. Carlo La Vecchia and colleagues from the University of Milan evaluated data collected at multiple Italian centers since the early 1990s. The studies included a total of 9,622 cases of cancer and 16,050 controls. Based on questionaires, the participants' diets were analyzed for 6 classes of flavonoids: isoflavones, anthocyanidins, flavanols, flavanones, flavones and flavonols. Also, 6 distinct classes of proanthocyanidins were evaluated. And the results showed the following:
For those whose intake of total flavonoids was in the top one-fifth of participants, there was a 44 percent lower risk of oral cancer and a 40 percent lower risk of laryngeal cancer compared to those whose intake was in the lowest fifth. Participants whose intake of flavanones was among the top one-fifth had a 49 percent lower risk of oral cancer and a 40 percent lower risk of laryngeal cancer, and those whose flavonols were highest experienced 38 percent less oral cancer and 68 percent lower risk of laryngeal cancer. Among those whose flavanol intake was highest there was a 36 percent decrease in laryngeal cancer compared to the lowest group, and for subjects whose flavanone intake was highest, the risk of esophageal cancer was 62 percent lower.
When colorectal cancer was considered, subjects whose intake of anthocyanidins was highest had a 33 percent less risk of this disease compared to the lowest group, and for those having the highest intake of flavonols, flavones and isoflavones, there was a 36 percent, 22 percent and 24 percent lower risk respectively. Proanthocyanidins lowered the risk of colon cancer by 42 percent.
The researchers found that rates of breast, ovarian, and kidney cancers were similarly slashed by high polyphenol consumption.
Dr La Vecchia and coauthors noted that a recent Japanese investigation revealed a decreased risk of localized prostate cancer among those with the greatest intake of isoflavones- a class of nutrients with low intakes among Italians. He concluded by saying:
"The findings from this large network of Italian case-control studies have provided support for an apparent protective role of flavanones on upper aerodigestive tract cancers; flavonols, anthocyanidins, and proanthocyanidins on colorectal cancer; flavonols and flavones on breast cancer; isoflavones on ovarian cancer; and flavonols on renal cancer."
So, what foods are highest in polyphenols? Berries top the list, including all berries, and blueberries may be at the very top. Fruits in general are very high in polyphenols, particularly richly-hued fruits. Pomegranites, cherries, red grapes, and red plums are very high in polyphenols, but even apples and pears score high. Vegetables are generally lower in polyphenols than fruits, but red vegetables, such as red beets and red cabbage are exceptions.Then, nuts, beans, and whole grains are close to equal in their phenolic content. Cocoa is a legume, and it's high in polyphenols, but obviously, it takes a lot of processing to transform cocoa beans into chocolate. If you consume chocolate, you should avoid milk chocolate, and you should look for chocolate that is sweetened with fruits rather than refined sugar. However, even with that, I don't think chocolate should be eaten as a dietary staple. I think we all know, intuitively, that when we eat a plum, we are eating a natural food, but when we eat chocolate, we are eating candy.
The most important thing is to eat a wide variety of fresh fruits and vegetables every day.
We are inundated with reports about studies of the health benefits of alcohol, especially relating to the heart, and you have to wonder who is paying for all those studies. The alcohol industry pays for much of that research, but not as much as the U.S. government pays for. But now, scientists from the UK's Independent Scientific Committee on Drugs (ISCD) have released a study which assessed which drugs cause the most harm to both drug-users and to society. And according to their analysis, alcohol is the most harmful drug in the world- worse than both crack cocaine and heroin.
Published in the medical journal Lancet- one of the most respected medical journals in the world- this study used a process called "Multi-Criteria Decision Analysis" (MCDA) to assess damage caused by various drugs. Nine of the criteria looked at specific harms inflicted on drug-users, while the other seven criteria looked at the harms caused to others. The results were that alcohol was found to be nearly three times more harmful than cocaine and eight times more harmful than Ecstasy.
"It is intriguing to note that the two legal drugs assessed — alcohol and tobacco — score in the upper segment of the ranking scale, indicating that legal drugs cause at least as much harm as do illegal substances," said David Nutt, chairman of ISCD, and author of the study. His report concluded that "aggressively targeting alcohol harms is a valid and necessary public health strategy."
Nutt was forced to resign from the British Advisory Council on the Misuse of Drugs (ACMD) last year after criticizing British ministers for ignoring scientific evidence showing that alcohol, which is legal, causes more damage than cannabis (marijuana), which is illegal.
The World Health Organization estimates that risks linked to alcohol cause 2.5 million deaths a year from heart and liver disease, road accidents, suicides and cancer -- accounting for 3.8 percent of all deaths.
The WHO also says that alcohol is the third leading risk factor for premature death and disabilities worldwide.
Although this report appeared in the highly revered Lancet, coverage of it was conspicuously absent from the American mainstream media. Here they pounce on every positive news story about alcohol but go silent on the negative ones. Why is that? It's because of the War on Drugs. It makes no sense to criminalize marijuana and other drugs while alcohol is perfectly legal. So, to rationalize that hypocrisy, they laud the supposed health benefits of alcohol. But don't buy into it. Alcohol is toxic to every cell in your body, and it impairs at every level of consumption, down to the smallest drink. The intoxicating effect of alcohol can be easily demonstrated from just one drink. The ideal amount of alcohol in anyone's health program is the amount I consume, which is zero.
A new study out of the University of North Carolina has shown that those who consume the most magnesium cut their risk of developing type 2 diabetes over the next 20 years, approximately in half. That's a huge difference. But, it's not the first such study. A large study out of Harvard Univeristy done in 2003 and involving over 125,000 people produced similar results.
Why would magnesium lower the risk of diabetes? We think of magnesium as a hard mineral, like calcium, and it is the second most abundant mineral in bone after calcium. However, magnesium is more than a structural mineral. It is also an enzymatic mineral. It acts as a "co-factor" in many of the body's chemical reactions, including reactions that process glucose. So far, we know of over 300 biochemical reactions in which magnesium serves as co-factor, but there may be more.
Magnesium is widely distributed in natural foods, and the best sources are plants. Nuts, beans, and whole grains are all rich in magnesium. Green vegetables are high in magnesium, and the greener they are, the more magnesium they have. That's because magnesium is at the center of the chlorophyll molecule which produces the green color. Hence, the green color is the visual manifestation of the presence of magnesium. It's odd because magnesium, by itself, is white, not green. But, within the ring-like structure of chlorophyll with magnesium at the center, it acts like a prism that turns it green. Spinach is often listed as a rich source of magnesium, and that's because it is so green. Fruits also provide magneisum, with bananas and figs being the highest among the commonly eaten fruits.
If your diet is high in animal foods and refined foods, you will come up short in magnesium. You must eat a wide variety of unrefined plants in order to get enough magnesium. How much magnesium do you need? The current RDA for magnesum in adults is 400 mgs. If every bite of food you eat is an unrefined plant, I do believe you will get that much or more. The average American is said to be getting only 250 to 300 mgs a day- a marginal deficiency which, over time, increases the risk of disease. And, it's alarming to realize that children are among the most shortchanged in magnesium.
But, if you are an adult eating a healthy, plant-based diet, as I recommend, do you also need magnesium supplements? I'll answer by saying that I don't mind a bit that my Extend Core Multi from VRP provides an extra 150 mgs of magnesium per day. I consider it good insurance, and it has the most absorbable forms of magnesium, such as magnesium aspartate and magnesium citrate. Magnesium succinate and magnesium taurinate are also good forms of magnesium, much better than the old standard magnesium oxide, which is poorly absorbed. So, I'm sure I'm getting enough magnesium, but if I had certain health problems, such as high blood pressure, I would take even higher amounts. We offer an all-magnesium supplement called Opti-Mag which is excellent and has multiple forms of readily absorbed magnesium. And, I think of Opti-Mag as a therapeutic supplement, as a way of using magnesium to address certain health issues. ADD in children or adults is another condition for which extra magnesium is warranted.
But, it starts with eating an unrefined, plant-based diet. That's the key to getting enough magnesium and so many other vital nutrients. Plants rule!
I received a call yesterday from an 88 year old woman who has multiple health problems, including fluid on her lungs, and among the drugs that she is taking is a diuretic. And it got me thinking of how widespread the use of diuretics is. Diuretics are the most widely prescribed drugs to treat hypertension, and they are considered first-line treatment. Diuretics are always prescribed in cases of heart failure. Fluid retention just about anywhere in the body is treated with diuretics- and not just common leg swelling. For instance, if a patient doesn't like the puffiness around her eyes in the morning, a diuretic is often given for that too.
Let's get one thing straight: diuretics do not cure anything; they do not correct anything. What they do is add a layer of pharmacological dehydration to whatever problem already exists. In so doing, they can camouflage the existing problem. Pharmacological (drug-induced) dehydration is an abnormality, a disease, an iatrogenic disease. It is a dangerous deviation from normal. And, diuretics work not by enabling the kidneys to work better, but by interfering with and disrupting their normal, healthy function. To understand why that is so, we have to look at how the kidneys work.
Kidney filtration starts with blood passing through a specialized tuft of high-pressure capillaries called a glomerulus. Because of the high pressure, water and disssolved substances are forced out of the capillary into the capsule that surrounds the glomerulus, called Bowman's capsule. Then comes a long tubular system known as the renal tubule. There, the body reclaims some of the initial filtrate, including about two-thirds of the salt and water, and virtually all of the organic compounds, such as glucose and amino acids. The whole idea is to reclaim the good and leave behind the bad.
Diuretics work by sabotaging the reclamation process so that more of the initial glomerular filtrate reaches the bladder. When that happens, valuable minerals, such as sodium, potassium, and magnesium, are lost. And keep in mind that the normal performance of the kidneys is a very delicate and intricate process. The body goes to great and complicated lengths to balance its chemistry, including it's pH, by way of the kidneys. To go in there, as with a sledgehammer, and pharmacologically force sweeping changes to this delicate process is bound to cause havoc. You wouldn't try to adjust a wrist watch with a sledge hammer, but they might as well be doing that when they give people diuretics.
So, what is the result of taking diuretics? As I said, It puts you into a state of pharmacological dehydration which gets superimposed on top of your original pathological condition. So, are you better or worse? But, don't be fooled by appearances. The result may have some semblance to a normal, healthy state, but it is actually further removed from it. You, the poor patient, are being deceived, and unfortunately, so is your misguided doctor. It's very frustrating to me that so few doctors realize that the "improvement" that comes from taking a diuretic is just a trick, a charade, a medical shenanigan. Nobody gets their issues resolved by taking diuretics. Nobody. It's just a way of masking symptoms and putting additional strain on the body. I suppose it wouldn't matter if it were harmless. But, it isn't. It causes widespread disruption of the body's delicate balance.
I like to make an analogy to a bicycle wheel being "out of true." To get that perfect rotation back, a wobbly wheel is placed in a device, and then the spokes are adjusted- some tightened and some loosened until the wheel rotates evenly again. But, you can't go about it wily-nily. If you don't know what you're doing, and you start cavalierly tightening and loosening spokes to correct the wobble, you can easily create another wobble somewhere else that is often worse than the original one. You'd be surprised how easy it is to make a bad wheel worse when trying to fix it- if you don't know what you're doing. You can easily dig yourself in deeper. And that's exactly what happens when you take a diuretic; you're just digging yourself in deeper, making a bad situation worse. And that's why when you start taking a diuretic, your problems never go away. It's just a matter of time before the failure of it becomes apparent with the manifestation of new symptoms- that will undoubtedly be treated with other drugs. They are setting you up for unending medical dependency. So, even if there seems to be an initial improvement symptomatically from taking the diuretic, it will always prove to be temporary and fleeting. No real good comes from it. Diuretics never restored anyone to health. It's just a trap, a miserable, medical trap.
Am I saying that there is no legitamate, beneficial use of diuretics? Let me put it this way: I can't think of a single condition in which I would be willing to take a diuretic. Not one. If I had high blood pressure, I would do other things to bring it down, constructive things, relating to diet, exercise, stress relief, and the use of safe, natural supplements. If my heart were failing, I would take actions that stood a chance to make it stronger rather than cover up the manifestations of my weak heart with diuretics. If I had fluid retention relating to a glandular deficiency, I would have that situation analyzed and addressed. For instance, if I were found to be hypothyroid, I would certainly be willing to take thyroid hormone, but I would not, be willing to take diuretics. If my legs were swollen because of venous insufficiency (bad valves etc.) I would walk as much as possible, use the slant board every day, wear supportive legwear, eat well (meaning lots of fruits and vegetables), and I would take natural botannicals that have been shown to support vascular health, but I would not take diuretics. And if I had fluid on my lungs, I would address the causes of it, but I would not waste time and complicate my condition by taking diuretics. It's a road that leads nowhere good.
In case I haven't made myself clear: I DON'T LIKE DIURETICS. They don't do any good; they just create the illusion of improvement. It's just another way that doctors cause havoc under the guise of helping people.