Too Many Meds for Us Older Folks

 

In a recent study of 422 adults with early signs of dementia, 55% were regularly taking six or more prescription medications. “Many drugs may be especially harmful to older adults with cognitive impairment, such as benzodiazepines, used to treat anxiety, and oxybutynin, used to treat urinary incontinence. These drugs have sedating effects that increase the risk of delirium and can worsen dementia,” said study author Matthew Growdon, MD, an aging research fellow at the San Francisco VAMC and the University of California San Francisco’s Division of Geriatrics. In addition to adverse interactions and outcomes, overprescribing of medications (polypharmacy) also contributes to challenges with adherence, since more complicated medication regimens require more time and attention, and increase the potential for making mistakes and inadvertent misuse.

Of particular concern is the administration of drugs to elderly residents of nursing homes and elder care facilities primarily for the purpose of keeping them sedated and easier to mange. Often the problem arises because a patient is seeing several different medical providers and none of them communicate with the others regarding prescriptions. Often, a pharmacist will catch a problem, but only if someone obtains all of their prescriptions from the same pharmacy.

In addition to making dementia worse, drug interactions can have many other serious health effects.

The researchers advise reviewing all the medications that you or a loved one may be taking with your primary healthcare provider on a regular basis. I can personally attest the the effectiveness of this. In the case of my mother, who was suffering from Alzheimer's, she had been taking 13 different prescription medications. After a review with a new primary care physician, she was taking only 3.

Don't assume that your doctor or pharmacist is aware of every medication that you are taking. Make certain that they are.

Antibiotic Free? Really?

 

US raised livestock are often treated with antibiotics not only to treat infections but to prevent them. At the same time, antibiotic resistant infections are on the rise, with about 25% of them attributable to meat. Resistant bacteria may not respond to antibiotics, prolonging infections and making them more serious, preventing needed surgeries and causing severe illness and even death.

For this reason, if you eat meat, you are urged to buy only meat and poultry that has been raised without antibiotics. (The drugs may still be used to treat an actual infection, but not used as a preventive measure - there are less risky ways to do that.) The United States Department of Agriculture (USDA) approves meat labels with claims such as "No Antibiotics Ever," "No Added Antibiotics" and "Raised without Antibiotics." But are these claims reliable?

Not very, according to a new study published in Science that found that a substantial portion of cattle destined for the ‘Raised without Antibiotics’ market have been given antibiotics.

The study tested 670 cattle from designated "raised without antibiotics" feed lots for traces of the drugs. They found that about 15% of the animals tested positive for "at least" one antibiotic. How can this be?

Because the USDA runs the label program on the honor system. (Seriously, they do.) To use "no antibiotic" claims on their labels, producers must submit documentation to the USDA. Once. After that, there are no inspections to verify compliance. Not ever. What could possibly go wrong, right?

What can you do? To be certain that the meat you buy is indeed raised without antibiotics first ignore any label claims. Instead, buy meat labeled "USDA Organic". Organic farms and processing facilities are inspected at least annually and are subject to unannounced "surprise" inspections at any time. Organic livestock must, by definition, be antibiotic-free.

Hydration and Your Heart

 

It is hard to live in this world of ubiquitous water bottles and not be aware of the importance of staying well hydrated. New findings suggest that consuming sufficient amounts of fluids throughout life not only supports essential body functioning but may also reduce the risk of severe heart problems in the future. Staying well-hydrated may be associated with a reduced risk for developing heart failure. 

Heart failure, a chronic condition that develops when the heart does not pump enough blood for the body's needs, affects more than 6.2 million Americans, a little more than 2% of the population. It is also more common among adults ages 65 and older.

The study, conducted by the National Heart, Lung and Blood Institute in Bethesda, MD and published in the European Heart Journal, found that people with a high serum sodium level in their blood, an indicator of chronic dehydration, were 54% more likely to develop heart failure in later years than those with normal serum sodium levels. Those with the most elevated serum sodium levels were twice as likely to develop a condition where the heart muscle becomes thickened and pumps blood less efficiently (ventricular hypertrophy).

What should you do? The study authors suggest that most people should consume four to six 8oz glasses of water every day. If you are younger, larger, or more physically active or if you live in a hotter, more humid environment, you probably need a bit more. Also, it need not literally be glasses of water. Juices, tea, coffee and many fruits and vegetables contribute to your intake. A simple way to remember? Keep one of those water bottles with you and sip on it through the day.

Food Addiction - Its a Thing

 

We are suffering an epidemic of obesity in the USA, and it is getting worse instead of better. From 2000 through 2020 the US obesity rate increased from 30.5% to 41.9%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%. And that is just obesity. Over 73% of Americans are overweight. That's right, three out of four of us. The negative health consequences of all this excess American lard include high blood pressure, heart disease, cancers, diabetes, stroke and arthritis, not even considering the mental health and quality of life consequences.

Most people automatically assume that those who struggle with their weight lack willpower and that they just need to eat less and exercise more.  While certainly that can be true in some cases, a growing body of evidence points to a very different root cause - food addiction.

Food addiction is just like drug or alcohol addiction. Addiction means the body has become chemically dependent on one or more substances and needs these substances to function “normally”. So when we are talking about a specific food as potentially being a substance of abuse we are saying that the body has become dependent on a particular food or eating behavior. The most common addictive foods are foods high in sugar, white flour, fat, grains and salt or some combination of these.

Compounding the problem, processed and fast foods are often deliberately formulated with addictive ingredients intended to create cravings for more.

Brain scans of people consuming highly processed foods reveal the exact same neural activity seen in drug, alcohol, nicotine and other addictions. Laboratory experiments on rats have demonstrated that sugar - just one of several potentially addictive ingredients in possessed foods - has an effect on the brain similar to that of morphine.

One of the main signs of food addiction is a loss of control over your eating behavior. If you feel like you want to stop but can’t, you eat to the point of feeling sick, or you feel ashamed or guilty about your eating, you may be suffering from food addiction.

For people who suffer from food addiction it’s also common to experience symptoms of withdrawal when they stop eating a certain food.

Food addiction also can affect your relationships and social life. People with food addiction may have problems at work or school, lose interest in activities they used to enjoy, avoid social events or become isolated from family members and friends. It is not a happy life.

Overcoming food addiction typically involves following the same model that’s used to treat other types of addictions - detox, behavioral changes, avoiding certain trigger foods. Professional medical and mental health support is needed more often than not, so talk to your primary care physician about possible options.

At the end of the day is is not all about willpower and people addicted to eating need and deserve the same consideration and support as any other addicted person would receive.

The Sunshine Vitamin

 

Vitamin D is often called "the sunshine vitamin" because the sun is the body’s main source of vitamin D. The skin produces a natural form of vitamin D from a form of cholesterol, called 7-dehydrocholesterol. Sunlight is key: the sun's UVB rays convert this cholesterol in the skin into a vitamin D3 precursor. These initial forms of vitamin D3 then pass their way through the liver and the kidneys, where they are converted into a form of vitamin D that can be used by the body.

Vitamin D plays many important roles in the body. While it is found in a few foods such as oily fish, red meat, and egg yolks, the sun is still our main source of vitamin D. There are a number of different factors that can result in vitamin D deficiency, with a lack of adequate sunlight being the main cause. 

Between being indoors more and using sunscreen more often some people who don’t get enough vitamin D from the sun can often benefit from taking a vitamin D supplement. But megadoses are not only unnecessary, they can be dangerous. Vitamin D is a fat soluble vitamin, meaning the body stores any excess in fat rather than disposing of it as it does with water soluble vitamins. Taking high doses can cause it to accumulate to unhealthy levels.

The best way to know whether or not to supplement and how much is to confer with your doctor. A simple blood test will reveal whether your vitamin D levels are adequate or not and then an appropriate supplemental dose can be recommended.

How much sun does the average person need to maintain healthy vitamin D levels? Not all that much. According a a study at King's College in London, just 5 minutes of unprotected mid-day sun exposure four times a week is plenty. If you have brown or black skin, make it 7 minutes. 

 

Healthy Skin and Nutrition

 

It seems like everywhere you turn, you find advice for using supplements to maintain healthy skin and avoid serious skin problems. Even supposedly reliable sources such as WebMD insist "Your skin needs the right balance of nutrients!" Much of this advice focuses on antioxidants like vitamins A, C and E. 

Unfortunately there is little evidence that particular nutrients are especially effective for skin health or that deficiencies result and skin conditions. There are large trials that show just the opposite. Antioxidant supplementation does not seem to reduce the risk of skin cancers at all. 

I would be the very last person to suggest that sensible supplementation had no value. But if you want healthy skin, eat a balanced Mediterranean style diet, limit alcohol, don't smoke, use sunscreen and wear a hat. That doesn't sound too sexy if you are selling supplements, but it works.

The Berry Best

 

Strawberries are at their peak in late June and early July. They are an unusual food in that they are not only delicious but they are among the very healthiest fruits that you can eat. Great tasting AND good for you? How often does that happen?

Strawberries are a juicy, red fruit with a high water content (90%). That means they have a incredibly low calorie density. A whole pound of strawberries is just 150 calories. The seeds provide plenty of dietary fiber per serving. Strawberries contain many healthful vitamins and minerals. Of particular note, they contain anthocyanins, which are flavonoids that can help boost heart health. The fiber and potassium in strawberries can also support a healthy heart.

A serving of 3 strawberries gives you just 17 calories, 4 carbs and a gram of fiber. They also contain also thiamin, riboflavin, niacin, folate, and vitamins B-6, A and K, potassium, magnesium and calcium.

But enough about that, they taste great! You can toss them on cereal, waffles, french toast or yogurt and spark up breakfast. You can blend them into a smoothie or snack on them plain or with a soft cheese. Put them on a salad. Improve your deserts by having them on ice cream. If you are talented and motivated you can even make them into jam.

It is true that strawberries will spoil quickly. They are like little sponges so it is important to keep them as dry as possible. Store them in the refrigerator in a large covered container with paper towels between the layers, ideally not touching. Do not rinse them off until right before you plan to eat them.

If you bought too many to use up quickly, they are easy to freeze and will keep well that way. Trim off the tops, rinse them, cut them in half and let them air dry on a paper towel. Once dry, freeze them in a single layer and then transfer to a freezer bag. (You can freeze them directly in the bag, but they will all sick together.)

Choose organic if you can. All berries tend to have higher traces of pesticides and fertilizers than other fruits. If you can't get organic just rinse them well before eating.

Whether you get them at a farmer's market or your regular grocery, this is the time to enjoy them.

Some Good News About Statins

 

Statins are widely prescribed to control high cholesterol and are somewhat controversial because of their many significant side effects. But recent research may have found an important and beneficial, if unintended, use for statins.

A recent study published in the journal Clinical and Translational Medicine suggests that statin drugs may be effective at slowing the growth of cancerous tumors. The study by the Center for Molecular Biology in Berlin, found that by inhibiting the expression of the MACC1 gene in mice statins successfully stopped the spread of cancers. A subsequent review of cancer among statin users found that the drugs reduced cancer incidence by about 50%.

Much more research is needed but human trials are planned for the near future.

Tofu or Nofu?

 

 

Tofu, a fermented curd from soybeans, is a staple in nearly all Asian cultures. Nutritionally, it has a lot going for it. A half-cup serving has up to 22 grams of protein, little saturated fat and lots of iron and calcium. It is one of the few plant-based protein sources that is complete, meaning it contains all of the nine essential amino acids required to build and repair protein tissues in the body. It provides only 3.5g of carbs and all for about 110 calories.

There are several varieties of tofu. "Silken"blends very easily but has only about 6 grams of protein. Soft tofu is good for soups and stir fries while firm tofu can even be grilled. Tofu tends to taste like whatever it is cooked in or with, so it can be bland or spicy or fiery hot, according to your taste.

Still, many people in the US are wary of eating tofu because, like all soy products, it contains plant estrogens (phytoestrogens) and there has been conflicting information about whether these are harmful or helpful.

The phytoestrogens in soy are called isoflavones and they have a very similar chemical structure to human estrogen. Both can bond to estrogen receptors in the body. This means that, depending upon which receptors they bond to, phytoestrogens can either act like a weak form of human estrogen or block human estrogen from being absorbed.

When phytoestrogens act like a weak human estrogen then can be protective against certain conditions such as osteoporosis. But there is concern that they may also fuel breast cancer in the same way that human estrogen can. This doesn't seem to be the case however. Most studies have found that soy isoflavones have a protective effect against cancers. In fact, Asian populations where a high amount of soy is consumed have breast cancer rates as much as 60% lower than in the USA. (This is slowly changing as Asian societies begin to adopt a more western diet.)

There is some evidence that isoflavones can inhibit the grown and metastasis of cancer cells and have a protective effect against heart disease.

If you just don't like tofu fine. But avoiding it for health reasons is poorly supported by research.

 

Overtesting Your Heart

 

According to research by the American Heart Association and published in the journal Circulation earlier this year, about half of all US adults who undergo a heart procedure or test did not need it. 

The issue of "low-value" medical care is a longstanding one, the heart association notes. The term refers to health care services that are unlikely to benefit patients in a meaningful way, exposing them to potential harm and wasting money. It's estimated that low-value medical care accounts for about 30% of health care spending in the United States — or up to $101 billion annually.

Among the low-value tests and treatments are annual exercise stress tests for people who have undergone angioplasty or surgery to clear blocked arteries, echocardiograms to assess people who have fainted but show no signs or symptoms of heart problems, and coronary calcium tests for people already known to have heart disease.

Individual doctors may rely on their personal experience, and the belief that a test or treatment helps patients, and just stick with it. Or they may simply be unaware of the evidence that a given practice is actually low-value. Then there is the fear of being sued, which can prompt doctors to practice "defensive medicine" and order tests to be sure nothing was missed.

Research suggests that up to half of stress tests performed in the United States would be rated as "rarely appropriate," the AHA says. The problem with that is not only time and money wasted but that it can also lead to invasive testing that carries more risks and yet more expense.

What can be done? Actions on different levels are needed, said Dr. Vinay Kini, chair of the AHA statement writing group.

On the broad level, the U.S. health care system is designed to reward quantity — more tests, more treatments — versus quality. A payment system based on quality of care is the "way forward," Kini said, though it is complicated to define quality. Patients also play a role.. In some cases, they demand tests or treatments that are not necessary, and their provider accommodates them.

What should you do? Be skeptical. Unless it is an emergency, like a heart attack, have a conversation with your provider about any tests being recommended and be sure that you fully understand not only the reason for the test but also the risks and benefits of going ahead with it. The final decision is yours.