The prescription that worked too well—and the cascade that followed.

I lose sleep over the fact that some of the people sitting across from me are on seven, eight, sometimes twelve medications—and nobody in the chain of prescribers has ever sat down and traced how they got from one to twelve.

I’m not exaggerating that number. I see it regularly in my work with clinic patients at Revero and in conversations with private clients who come in carrying medication lists that look more like grocery receipts than treatment plans. Each medication was prescribed for a reason. Each reason was legitimate at the time. The problem isn’t that any individual prescription was wrong; it’s that nobody ever looked at the full picture and asked whether the cascade was doing more harm than the original symptom.

This is what I call the medication spiral, and once you see it, you can’t unsee it.

How the Spiral Starts

The pattern is remarkably consistent. It almost always begins with a symptom that’s real, uncomfortable, and deserving of attention. Acid reflux. High blood pressure. Anxiety. Joint pain. Insomnia. The person goes to their doctor—who is doing the best they can with the tools and time they’ve been given—and the doctor prescribes a medication to manage the symptom.

In most cases, the medication works. The symptom improves. Patient and provider both move on.

What happens next is where the spiral begins to form.

The medication that resolved the original symptom introduces side effects. Sometimes those side effects show up within weeks; sometimes they take months or years to manifest. The person returns to their provider—or a different provider—with new complaints. Those complaints get treated as new conditions, earning their own prescriptions. Those prescriptions introduce their own side effects. The cycle deepens.

At no point in this cascade does anyone typically trace the new symptoms back to the original medication and ask: is this a side effect, or is this a new problem? That question requires time, systems thinking, and a willingness to question a treatment that appears to be “working” for the original complaint. The system wasn’t built for that kind of investigation, and fifteen-minute appointments don’t leave room for it.

The PPI Example

Proton pump inhibitors are the example I know most intimately, because I’ve walked through the downstream cascade with so many people that the pattern is burned into my clinical awareness.

The person starts a PPI for reflux. The reflux improves—sometimes dramatically. The prescription gets refilled. Years pass.

During those years, the PPI is suppressing stomach acid. That suppression impairs the absorption of B12, iron, calcium, magnesium, zinc, and vitamin D. The person doesn’t know this is happening; nobody told them to watch for it. They start experiencing symptoms that seem unrelated—fatigue, brain fog, muscle weakness, bone density concerns, mood changes.

Each symptom gets its own workup. The fatigue gets investigated; maybe they end up on a thyroid medication. The mood changes get noticed; maybe an antidepressant. The bone density concern generates a bisphosphonate prescription. The muscle cramping might lead to a magnesium supplement—which helps, but doesn’t fully resolve because the absorption pathway is still compromised by the PPI.

None of those providers are wrong in their individual assessments. Each symptom, looked at in isolation, justifies its treatment. The problem is that they’re all symptoms of the same upstream cause—chronic nutrient malabsorption driven by a medication that was supposed to be temporary and became permanent.

I’ve seen this pattern play out over twenty, thirty, even forty years of continuous PPI use. By the time someone sits across from me, they’re managing the side effects of the side effects of the side effects—and the original reflux that started everything may have been caused by low stomach acid in the first place, not high stomach acid. The medication may have been treating the exact opposite of the actual problem.

The Pattern Beyond PPIs

PPIs are the example I know best, but the spiral isn’t limited to one medication class. The pattern repeats across the pharmacy.

Statins can cause muscle pain and weakness (myalgia). That pain gets evaluated; sometimes it leads to pain medications or physical therapy referrals. Statins can also affect blood sugar regulation—potentially accelerating progression toward type 2 diabetes. The elevated blood sugar gets its own medication. None of these are attributed back to the statin; they’re treated as new conditions.

Blood pressure medications can cause fatigue, dizziness, or sexual dysfunction. The fatigue might lead to thyroid investigation or stimulant prescriptions. The sexual dysfunction might lead to a separate prescription for that. Each downstream treatment is clinically reasonable in isolation; the connection to the upstream medication is rarely traced.

Antidepressants can cause weight gain, sexual dysfunction, sleep disruption, and emotional blunting. The weight gain compounds metabolic dysfunction. The sleep disruption gets addressed with a sleep medication. The emotional blunting might lead to a dosage adjustment or an additional medication. The person is now managing multiple prescriptions when the original symptom—low mood—may have had a metabolic root that was never investigated.

Metformin, while generally well-tolerated and genuinely useful, can deplete B12 over time—a side effect that’s well-documented but inconsistently monitored. B12 deficiency can cause fatigue, neuropathy, mood changes, and cognitive dysfunction—symptoms that might be attributed to aging, diabetes progression, or new conditions rather than to the medication itself.

The thread through all of these examples is the same: a medication manages a symptom while creating conditions that generate new symptoms, which generate new medications, which generate new conditions. Nobody is being malicious. Everyone in the chain is doing their job. The system just isn’t designed to trace cascading effects across specialties, across years, and across a medication list that grows incrementally rather than arriving all at once.

What Nobody Asks

There’s a question that almost never gets asked in the medication spiral, and it’s the most important one: is the original medication still necessary?

Bodies change. Conditions evolve. The circumstances that warranted a prescription five years ago may not exist today—particularly if the person has made meaningful dietary and lifestyle changes in the interim. The PPI prescribed for reflux in 2015 might not be needed by someone who has eliminated processed food, addressed their stress response, and supported their digestive cascade. The blood pressure medication started in 2018 might not be needed by someone who has reversed their insulin resistance through carbohydrate restriction and lost thirty pounds.

The process of revisiting and potentially tapering medications requires time, clinical expertise, and close monitoring. It’s not a DIY project; I cannot stress that enough. Stopping medications abruptly—particularly PPIs, antidepressants, and blood pressure medications—can cause rebound effects that are genuinely dangerous. PPI rebound alone can produce symptoms worse than what prompted the original prescription.

What I’m advocating for isn’t reckless medication cessation. It’s a conversation. It’s the question: “Given who I am today—given how I eat, how I sleep, how I manage stress, how my labs look now—do I still need all of these? And if I do, are there root-cause strategies that might allow me to need fewer of them over time?”

That conversation requires a provider who’s willing to look at the full picture, think across specialties, and consider the possibility that some of the “conditions” being managed are actually downstream effects of the medications managing other conditions. It’s a different kind of clinical thinking than the standard model supports, and it’s the kind of thinking that health coaches and functional practitioners are specifically positioned to facilitate.

The Root-Cause Alternative

When I work with someone carrying a long medication list, the approach isn’t to start crossing things off. It’s to start building the foundation underneath—the dietary, lifestyle, and metabolic improvements that may reduce the body’s need for pharmaceutical support over time.

That foundation looks like the same work I describe in every post I write about chronic conditions: nutrient-dense, whole-food diet—typically ketogenic or carnivore. Proper sleep. Stress management. Movement. Sunlight. Environmental toxin reduction. Digestive support where needed.

As the foundation strengthens, the body often starts sending signals that the pharmaceutical support is less necessary. Blood pressure comes down. Blood sugar stabilizes. Mood improves. Reflux resolves. Thyroid function shifts. These changes don’t happen overnight, and they don’t happen for everyone—but when they do, they create an opportunity for the kind of conversation I described above: a careful, medically supervised reassessment of what’s still needed.

The goal isn’t to be anti-medication. The goal is to make sure the medication list reflects what the body actually needs today—not what it needed five or ten years ago, compounded by the side effects of what was prescribed in between.

The System and the People In It

I want to close by saying something I believe deeply: most doctors are good people doing their best inside a system that wasn’t designed for the kind of care this conversation requires.

The growing disconnect between patients and providers isn’t a character problem—it’s a structural one. Fifteen-minute appointments don’t leave room to trace a medication cascade. Insurance-driven models reward prescribing, not deprescribing. Specialization means no single provider sees the full picture. The curriculum that trained most providers included almost no clinical nutrition education—so the root-cause interventions that might prevent the spiral aren’t part of the toolkit.

Everyone in health and wellness entered the field because they wanted to help people. Some have had the self-awareness to recognize that what they were taught isn’t serving the people in front of them, and they’ve evolved. That shared intention—wanting to help—is the common ground that makes collaboration between conventional medicine, health coaching, and functional approaches possible.

The medication spiral isn’t a conspiracy. It’s a systems problem with predictable, traceable mechanics. Understanding those mechanics doesn’t require blaming anyone; it requires asking better questions and being willing to look at the full picture.

If you’re managing a medication list that feels like it grew without anyone planning it—if you suspect that some of what you’re taking might be treating the side effects of what you were already taking—that’s worth investigating. With your provider. With someone who understands root-cause work. With the patience and care that untangling years of compounding decisions requires.

I hope this gives someone the language to start that conversation.

Rance Edwards is a National Board Certified Health and Wellness Coach (NBC-HWC) with over 2,000 clinical hours of experience, specializing in chronic disease management and lifestyle medicine.

If you’re carrying a medication list that grew over the years and nobody ever traced the thread, I’d love to help you look at the full picture. Book a free discovery call—no pressure, just a conversation about where you are and what might be worth revisiting.

Sources

  • Shin, J., & Choi, J.Y. (2021). The risk of incident type 2 diabetes in statin users: a meta-analysis. Cardiovascular Drugs and Therapy, 36, 969–978. DOI: 10.1007/s40256-021-00516-3
  • Herrett, E., et al. (2021). Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials. BMJ, 372, n135. DOI: 10.1136/bmj.n135
  • American Diabetes Association. (2017). Standards of medical care in diabetes—2017: pharmacologic approaches to glycemic treatment. Diabetes Care, 40(Suppl. 1), S64–S74.
  • Medicines and Healthcare products Regulatory Agency (MHRA). (2022). Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk. Drug Safety Update, 15(11).