Alzheimer’s Disease and Tranquilizers

The rate of Alzheimer’s Disease has soared in recent decades. No one can really tell us why. If you know just three people over age 85, the odds are that you probably know at least one person with Alzheimer’s Disease. One out of every nine Americans over the age 65 has Alzheimer’s Disease. The repercussions of these facts are very serious, not only at a personal level for the individuals and families affected, but also for our society with so many people needing prolonged supportive care 24/7. Environmental factors seem to have an impact on the risk of Alzheimer’s Disease, as do various dietary influences and exercise patterns. New data from a study published in the British Medical Journal indicate that the rising use of tranquilizers might be one important reason for the rise in Alzheimer’s. Investigators reviewed records of 9,000 elderly persons over the period of 2000 - 2009, on whom they had at least six years of data. Nearly 1,800 developed Alzheimer’s Disease during the interval. They matched each Alzheimer’s Disease patient with four healthy controls (same age and gender) comparing their usage of benzodiazepines (Ambien, Ativan, Dalmane, Halcion, Klonopin, Librium, Lunesta, Restoril, Serax, Sonata, Xanax, Valium). They carefuly controlled their analysis for all kinds of potentially confusing factors, including other diseases and medications. Patients who had used these medications very little (less than 90 doses over those six to ten years) did not have an increased risk of Alzheimer’s Disease. Those who had used more, were more likely to develop Alzheimer’s Disease and the more they used, the more likely they were to have developed Alzheimer’s Disease. People who had used any of these drugs for more than six months, were twice as likely to have developed Alzheimer’s Disease by the end of the study. Six months (180 days) of use over six to ten years averages out to be twice a month or even less. Many who use these drugs use them much more than that. The study did not investigate the incidence of Alzheimer’s Disease for those individuals using even more of these drugs. As the likelihood of Alzheimer’s Disease rose with increasing use of the drugs, those who used even more might then be even more likely to develop Alzheimer’s Disease. Nor did they look at longer use. Again, I have seen many patients who have been using these drugs for decades, not just years. These drugs are on what is called the BEERS list. The BEERS list was first developed in 1991 by a geriatrician who catalogued...

A Burning Question - Harmful GERD Treatment

Sorry to do another “I told you so” (OK I really am not sorry) but a big study came out showing that taking acid lowering drugs, some of the most widely used drugs in America, HUGELY increases the rate of B12 deficiency. Like 65% hugely. Basic physiology - the stomach produces serious acid (like concrete-melting acidity) and it needs to. Why? To protect us from nasty stuff in our food like bacteria AND to digest food. You can’t absorb B12 if you don’t have enough acid. It is not “rocket science” then to figure out that lowering stomach acid will also destroy your ability to absorb B12. To me the story of this study is that it reveals how unthinking we can be. Heartburn is uncomfortable because the acid is in THE WRONG PLACE not because there is too much acid. That is nothing new at all. I learned that 30 years ago in medical school. Complicating the problem is that most docs don’t know how to test you for B12 deficiency. The B12 blood test misses the great majority of people with B12 deficiency. AGAIN, this is not new. I learned that in medical school. In recent years better tests have become available but too few of us know about them. If a doctor remembers that B12 deficiency throws off your ability to feel vibration and your balance, very, very few know how to discover that on physical examination unless it is so bad that you stumble down the hallway in the medical office. Is missing B12 deficiency a big deal? When conventional estimates of the number of people over age 60 who are B12 deficient run as high as 30% and the consequences (dementia, depression, fatigue, neurologic disease) are so high, it is a very big deal. One powerful example of the consequences of B12 deficiency is strongly common but way under appreciated. Did you know that an American over age 60 is three times more likely to die from a fall as she/he is to die from a car accident? That’s right. Over 15,000 die each year from falls and around 5,000 from car accidents. Why do so many elderly Americans stumble to their deaths? One reason is that B12 deficiency makes you unsteady on your feet. Whereas prescribing a drug that often makes a patient quickly feel better is easy, sorting out and helping the patient cure the cause, is much more difficult. GERD is a symptom, not a specific diagnosis. There are many causes...

Breast Cancer and Medication

Many years ago a study came out linking increased use of antibiotics to an increased rate of breast cancer. That study considered cumulative use of all antibiotics, not one specific antibiotic, thus suggesting a range of possible causes. There was insufficient evidence to prove that the antibiotics caused the breast cancers or even certainly made women more vulnerable. Maybe so, but not proven. Maybe changing the bacteria inhabiting women’s bodies influenced risk or impaired the normal cancer eliminating activities of the immune system. Maybe women who took more antibiotics were simply more likely to have mammograms, which we know tend to discover many breast cancers that do not need to be found. There were just too many questions to know what it all meant. Other studies, scattered over the years and appearing in minor medical journals, have found links between a diverse variety of cancers and medication use. Again, definitive proof is lacking. Cancers develop over years or even decades. From our habits and environment, each of us has innumerable exposures to many, many potentially cancer causing factors. Combining these exposures with medication use, including a certain medication or combinations of certain medications, assuredly leads to a massive range of effects. Nailing down the truth is extremely difficult. Such uncertainty allows for nearly any interpretation you want to make. Just ask the tobacco industry about that. A new study does a pretty reasonable job of linking one class of blood pressure medications to invasive breast cancer. Investigators considered the impact of calcium channel blocking medications (NORVASC, PROCARDIA, CARDENE, CALAN). Women with breast cancer were 2.5 times more likely to have taken calcium channel blockers (usually for high blood pressure) for 10 or more years than women without cancer. Again this link does not prove causation. However, combined with other studies linking calcium channel blockers to breast and other cancers, suspicions are rising. Nearly 100 million Americans are prescribed calcium channel blockers each year. If they do raise the risk of cancer, the consequences are pretty big. Although calcium channel blockers were found connected to breast cancer, unlike other blood pressure medications in this study, that finding should not make you complacent about other drugs. As we all know, breast cancer is not the only health problem to which people are subject. Much more can go wrong. Just as they can help manage symptoms, medications can harm us. The bottom line message to me is pretty much the same song I always sing - Be very careful about what you...

No Benefit Without Risk - Aspirin, Ibuprofen, TylenolNo Benefit Without Risk - Aspirin, Ibuprofen and Tylenol

Many medications are available only by prescription (unless you own a computer or travel to another country). That is because of the risks that accompany their use. When drugs become available we tend to believe that availability is some sort of certification that they are safe, and weak compared to prescription meds. Not true. Recent news that daily use of aspirin lowers the risk of a number of cancers (especially esophagus, colon, rectum and lung) is another example of apparently wonderful information that is not, if you know enough. Seems great, doesn’t it? Take a safe drug and prevent some very nasty diseases. Shouldn’t I be taking it anyway, because it prevents heart attacks and strokes? Here comes the buzz kill. Other studies, larger and more carefully designed, have not found this effect. Also, studies have found that taking aspirin does not prevent a first heart attack or stroke, as we had thought it would. It might be a good idea for that purpose in some middle-aged individuals, and probably is for those who have already had a heart attack or stroke. Finally, recent data shows that daily aspirin doubles the risk of macular degeneration, already one of the most common causes of age-related blindness. Aspirin used to be routinely given to infants with fever. Then we learned that this could lead to (potentially fatal) Reyes Syndrome. I have never liked using it in this circumstance, because fever is generated by the body in its effort to make itself an unpleasant place for bacteria and viruses to live. Squashing the fever squashes the immune response and, as research shows, prolongs illness. Ibuprofen, (aka ADVIL, MOTRIN, MUPRIN, RUFEN) seems like a good choice to so many. Inflammation is “bad”, so anti-inflammatory is then good. Ibuprofen is the leading cause of impaired kidney function in the US. Years ago a kidney specialist told me she would not see a new patient for kidney trouble until the patient had been off ibuprofen entirely for at least a month, because dropping the kidney-imparing ibuprofen fixed 75% of the patients sent to her. Ibuprofen markedly increases the risk of the most serious problem commonly seen in marathon runners. Their kidneys slow down from the exertion. Taking ibuprofen makes it worse. Their sodium drops and they can die. Not good. Many athletes take ibuprofen before engaging in their sport. Ironically, ibuprofen increases damage to muscles and soft tissue because “inflammation” is one aspect of the healing process. At the medical meeting of physicians working with...