People's Pharmacy: Contradictory medical advice frustrates patients

Q: I am fed up with medical flip-flops. Whether it is hormone replacement therapy, calcium supplements, eggs or salt, first we get told one thing, and then doctors change their minds. In the meantime, we consumers are left wondering what to believe and whom to trust. I am still baffled by whether salt is as bad as I have always been told.

A: We understand how hard it is to make sense of contradictory evidence from medical research. You are right that there have been major reversals regarding eggs, calcium and salt.

For decades, Americans were told to avoid eggs to control cholesterol and decrease the risk of heart disease. Current science does not support this belief (Advances in Nutrition, September 2012).

Salt is another hot-button issue. An analysis of 167 randomized controlled trials found that reducing sodium intake lowers blood pressure modestly (American Journal of Hypertension, January 2012). Sodium restriction also raises cholesterol, triglycerides and stress hormones.

An eight-year study of 3,500 people found that those consuming the least sodium were at the highest risk of dying during the study (Journal of the American Medical Association, May 4, 2011).

This isn't to suggest that people should be increasing their salt intake, but not everyone needs to cut back.

Q: I have had trouble sleeping for years and have taken prescription drugs like amitriptyline, temazepam, zolpidem and alprazolam. I worry that long-term use of such medicines might have a bad effect on my health. Going off alprazolam was a nightmare I'm not anxious to repeat. What do you think about over-the-counter sleep aids?

A: There is growing concern that many of the prescription sleeping pills you mention might indeed have negative consequences. According to a study in BMJ Open (Feb. 27, 2012), people who took the kinds of sleeping pills you have used were at greater risk of developing heartburn or even dying. There was also an association with cancer.

Stopping any of these drugs suddenly can result in rebound insomnia and symptoms such as irritability, headache, dizziness, nausea and disorientation.

Many nighttime OTC drugs contain diphenhydramine (Benadryl). These include Advil PM, Sominex and Tylenol PM. Side effects can include dry mouth, dizziness and next-day grogginess (Human Psychopharmacology, July 2012).

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People's Pharmacy: Contradictory medical advice frustrates patients