This class of drugs is often the first medication you will be prescribed if you are deemed to have high blood pressure.  I will explain why diuretics should not be prescribed to the majority of the population and especially not to the elderly.  There are certain extenuating circumstances when diuretics may be of value but these will be rare.  Other examples of when this drug will be prescribed is for kidney failure, liver disease, congestive heart failure and all types of oedema.  See Part 2 and Part 3 and Part 4 of this article.

At what cost?

These drugs increase your output of urine but at what cost?  When the kidney is working without drugs it does its job with a sophisticated filtration system through a special cluster of high pressure capillaries known as a glomerulus.

How your kidneys function

The function of kidney filtration starts with blood passing through the glomerulus.  The high pressure forces water and other dissolved substances out of these special capillaries and into a capsule which surrounds the glomerulus.  This is known as Bowman’s capsule.  This capsule now contains all water, salt and dissolved substances, but the water and dissolved substances are then ‘reclaimed’ or reabsorbed by passing through a second filtration system known as the renal tubule system.  This insures that vital nutrients are not lost during the filtration process.

Nephrology

This whole filtering system is known as a nephron, hence the name nephrology, the branch of medicine to do with the physiology and diseases of the kidneys.  Each kidney has around a million of these nephrons.

The reclaimed nutrients include much of the salt and water, glucose, amino acids, lactate, magnesium, phosphate, calcium bicarbonate and uric acid.

The result of filtration = urine

After the process of filtration and reabsorption, the resulting urine is expelled from the body.  It contains around 95% water, urea and other substances including chloride, sodium, potassium, creatinine and metabolic waste and toxins all in varying degrees, depending on diet and health.

Ambush!

Now what diuretics do is to ambush the second reclamation filtering system so that much more of the initial filtrate from the glomerulus goes to the bladder.  Thus this filtrate still has vital nutrients within it.   This means more water and more minerals, such as magnesium, potassium and sodium, are sent to the bladder instead of being reclaimed.  Reclamation is a vital process which avoids depletion of necessary nutrients.

Different types of Diuretics

There are different kinds of diuretics which work in slightly different ways.  They each interfer in different areas of the kidney filtration system.  Loop diuretics for instance, undermine reabsorption at the ascending loop (see the diagrams) while thiazide diuretics undermine the system at the distal convoluted tubule.

Thiazide diuretics

• chlorothiazide (Diuril)
• chlorthalidone (Hygroton)
• hydrochlorothiazide (Hydrodiuril)
• indapamide (Lozol)
• methyclothiazide (Enduron)
• metolazone (Zaroxolyn, Diulo, Mykrox)

Loop diuretics

• bumetanide (Bumex)
• ethacrynate (Edecrin)
• furosemide [(Lasix)
• torsemide [(Demadex)

Potassium sparing diuretics

• amiloride hydrochloride
• spironolactone (Aldactone)
• triamterene (Dyrenium)

Now you know, you can decide

Yes, I know it’s a bit heavy going but if you understand a little of what’s going on, it will give you the reasons why these drugs are not good for you and allow you to make an informed decision as to whether you want to take them or not.

Kidneys and hormones

Remember that kidney function is extremely delicate and complex.  It is fine tuned to do a delicate balancing act.  As well as producing its own hormones, the kidneys are influenced by other hormones produced by glands such as the adrenals and the pituitary.   Your kidneys have the important and complicated task of controlling your pH system to maintain correct acid-base balance.

Diuretics do not improve your kidneys

Those who are prescribed diuretics probably think they are improving kidney function.  Nothing is further from the truth.  Your kidneys will be undermined by these drugs. They interfer with their proper function and do nothing to help the original condition.

Now you have 2 problems

In fact now you have two problems.  One is the condition you started with and now you have another abnormality to the one you already have because of pharmacological interference.  All a diuretic does is feign improvement.  It does not cure anything.  It won’t fix your problem but it will camouflage the original condition to the extent that when your condition worsens, the drug will not be blamed.  Your body will be blamed for not responding well to the medication.  So you now have two diseases, the naturally occuring one you started with and a second which is drug induced.

A medical manoeuvre

Yes, your swelling may go down, but any improvement that may appear to come from taking this drug is false.  It does not mean you’re getting better.  You, as well as your doctor are being tricked by a dishonest medical manoeuvre.  Nothing will be resolved by taking a diuretic but something will increase…and that’s the profits of the pharmaceutical industries that produce this drug.

Cavalier tinkering

Taking a diuretic will just exacerbate the original problem.  Cavalierly tinkering with this delicate, finely tuned and amazingly complex filtration system will only make matters worse and complicate your condition by further compromising the already upset biological system. What it will do is put you on the road to being a permanent visitor to the doctor’s office or worse to the hospital.

Research

There have been a number of studies done about diuretics.  I will quote a passage from a study from the JAMA (Journal of American Medical Assn) titled: Diuretics, Mortality and Nonrecovery of Renal Function in Acute Renal Failure

“Conclusions  The use of diuretics in critically ill patients with acute renal failure was associated with an increased risk of death and nonrecovery of renal function. Although observational data prohibit causal inference, it is unlikely that diuretics afford any material benefit in this clinical setting.  In the absence of compelling contradictory data from a randomized, blinded clinical trial, the widespread use of diuretics in critically ill patients with acute renal failure should be discouraged”.

Renal failure from drugs?

I really would like to know how many patients actually get to a stage of renal failure.  Could it be anything to do with pharmaceutical drugs taken over a period of time.  Could these drugs compromise kidney function to the extent that kidney failure is possible, if not inevitable, as the patient ages?

It is incredulous to me that this class of drugs known as diuretics, has escaped much of the criticism that some of our prescription drugs rightly receive.  If you can understand what it actually does to the body, you will wonder why it is so readily prescribed, especially when there are other ways of removing excess water, other ways that are safe and have no side effects.

Why not ask why?

Getting rid of excess water by using a drug is not a good idea and will likely compromise your kidney function and put undue stress on your kidneys.  All we know is that if we take a diuretic, we will want to use the loo more because the drugs are getting rid of the excess water in our bodies, but at what cost?

Nobody seems to ask the question: Why do I get puffy ankles and feet.  Why is it I am bloated and can’t get into my clothes.  Answer this question and you’re half way to understanding what you need to do to alleviate the condition, without drugs.

In Part 2 of this post I will try and answer some of these questions.