Author Archives: Bix

Anticholinergic Drugs (Antidepressants, Muscle Relaxants, Antihistamines: Benadryl, Tylenol PM) Linked To Cognitive Impairment – Again

Anticholinergic (AC) drugs cause cognitive impairment. If you already have cognitive impairment, they cause it to get worse. I wrote about a study a few years ago that found cognitively normal people who took at least one anticholinergic drug developed cognitive impairment. From that study: “The use of AC medication was associated with increased brain atrophy and dysfunction and clinical decline.”

Here’s yet another study – from last week. Again, none of these participants had any cognitive or memory problems before the study.
Press Release: Common Class Of Drugs Linked To Increased Risk Of Alzheimer’s Disease.

Participants with AD biomarkers who were taking anticholinergic drugs were four times more likely to develop MCI* than persons lacking biomarkers and not taking the drugs.

Persons at genetic risk for AD who took anticholinergic drugs were approximately 2.5 times more likely to develop MCI than those without genetic risk factors and who were not taking the drugs.

* MCI: mild cognitive impairment, “often a precursor to dementia and Alzheimer’s disease”

Study: Association Of Anticholinergic Medication And Alzheimer’s Disease (AD) Biomarkers With Incidence Of Mild Cognitive Impairment (MCI) Among Cognitively Normal Older Adults, Neurology, 2 September 2020

Conclusions: Anticholinergic medications (aCH) increased risk of incident MCI and cognitive decline, and effects were significantly enhanced among individuals with genetic risk factors and cerebrospinal fluid (CSF)-based AD pathophysiological markers. Findings underscore the adverse impact of aCH medications on cognition and the need for deprescribing trials, particularly among individuals with elevated risk for AD.

What are anticholinergic drugs?

They work by blocking acetylcholine — a type of neurotransmitter or chemical messenger known to be critical for memory function — from binding to receptors on certain nerve cells. The effect is to inhibit parasympathetic nerve impulses, which are involved in a variety of involuntary muscle movements, such as those in the gastrointestinal tract and lungs, and bodily functions like salivation, digestion and urination.

There are many AC drugs. Here’s a list that I picked up from VirginiaGeriatrics.org a few years ago:

Commonly used drugs with moderate to high anticholinergic properties:

Antiarrythmics:
Disopyramide – Norpace®
Procainamide – Pronestyl®
Quinidine – Quinaglute®, Quinidex®

Antiemetics:
Dimenhydrinate – Dramamine®
Meclizine – Antivert®, Bonine®
Trimethobenzamide – Tigan®
Prochlorperazine -Compazine®

Antihistamines:
Azatadine – Optimine®
Chlorpheniramine – Chlor-Trimeton®
Clemastine – Tavist®
Diphenhydramine – Tylenol PM®, Sominex®, Benadryl®
Hydroxyzine – Atarax®, Vistaril®
Promethazine – Phenergan®

Antiparkinson Agents:
Benztropine – Cogentin®
Biperiden – Akineton®
Procyclidine – Kemadrin®
Trihexyphenidyl – Artane®

Antipsychotics:
Chlorpromazine – Thorazine®
Clozapine – Clozaril®
Mesoridazine – Serentil®
Olanzapine – Zyprexa®
Promazine – Sparine®
Quetiapine – Seroquel®
Thioridazine – Mellaril®

Antispasmotics:
Atropine – Sal-Tropine®
Belladonna alkaloids – Donnatal®, Bellatal®, Barbidonna®
Dicyclomine – Antispas®, Bentyl®
Flavoxate – Urispas®
Hyoscyamine – Anaspaz®, Levbid®, Cystospaz®, Levsin/SL®
Oxybutynin – Ditropan®
Scopolamine
Tolterodine – Detrol®

Skeletal muscle relaxants:
Carisoprodal – Soma®
Chlorzoxazone – Parafon®, Forte®
Cyclobenzaprine – Flexeril®
Methocarbamol – Robaxin®
Orphenadrine – Norflex®

Tricyclic Antidepressants:
Amitriptyline – Elavil®
Desipramine – Norpramin®
Doxepin – Sinequan®
Imipramine – Tofranil®
Nortriptyline -Aventyl®, Pamelor®

It’s not an exhaustive list. There are more antidepressants, sleep aids, drugs for asthma and chronic bronchitis, antacids like Zantac, allergy and cold meds, diuretics, drugs for bladder control, even eye drops like Atropine used to dilate pupils. Many can be purchased over-the-counter, without a prescription.

A Pocket Guide (click to enlarge):

That anticholinergic drugs cause structural and functional changes in the brain – of healthy people – and increase the risk for dementia and Alzheimer’s doesn’t get the airtime it should because … look at all these drugs! Drug companies sponsor airtime. They would be digging their own graves. And if people develop Alzheimer’s? No problem; there will be a drug for that too. This is what happens when industries, especially high-profit industries like pharmaceuticals, have too large an influence on regulatory bodies.

Related:
‘Strongest Evidence Yet’ Links Anticholinergic Drugs, Dementia, Medscape, January 2015

Cumulative Use Of Strong Anticholinergics And Incident Dementia, A Prospective Cohort Study, JAMA Internal Medicine, March 2015

Drugs With Anticholinergic Properties, Cognitive Decline, and Dementia in an Elderly General Population, The 3-City Study, JAMA Internal Medicine, July 2009

New Study: Low Vitamin C = Low Muscle Mass

Lower Dietary And Circulating Vitamin C In Middle- And Older-Aged Men And Women Are Associated With Lower Estimated Skeletal Muscle Mass, The Journal of Nutrition, 27 August 2020

To our knowledge, this is the first study assessing the relation of dietary and circulating vitamin C with the sarcopenic risk factor of loss of skeletal muscle mass in a large UK cohort [over 13,000 participants] of both men and women of middle and older age. Our results show significant positive associations between dietary vitamin C intake and measures of FFM [fat-free mass, a proxy for skeletal muscle mass] using multivariable regression models, adjusted for known lifestyle and biological covariates.

Mechanisms:

The mechanistic roles for vitamin C in skeletal muscle physiology include the synthesis of carnitine and collagen. These are important because collagen is a key structural component of skeletal muscle cells and tendons, and carnitine is essential for metabolism of long-chain fatty acids during physical activity.

Also:

Because vitamin C is an electron donor [that is, an anti-oxidant], this may reduce oxidative damage to muscle as well as reducing the concentrations of inflammatory cytokines in the circulation.

Conclusion:

This study has shown significant positive associations between both dietary and circulating vitamin C and measures of skeletal muscle in a large cohort of free-living middle- and older-aged men and women. These results suggest that ensuring sufficient dietary vitamin C intake, by promoting a diet rich in fruits and vegetables, may help to reduce age-related loss of skeletal muscle and thus have wide-reaching public health benefit.

The study included this graph. I don’t think fruits and vegetables will surprise anyone. But, of the top four sources, why include a line item for potatoes? Because it ends up being where many people get their vitamin C, even if they don’t know it.

One medium baked potato has about 17 mg vitamin C. Here’s a slightly smaller potato that’s been microwaved that has about 24 mg. Compare that to a medium apple that has only about 8 mg. Or a medium tomato with 15 mg. (Still, it may be hard to beat an orange, which comes in at 63 mg.)

Study Finds Drinking Just 1/4 Cup Of Cow’s Milk Per Day Increases Risk For Breast Cancer

Press release: New Study Associates Intake Of Dairy Milk With Greater Risk Of Breast Cancer, Loma Linda University, 25 February 2020

Study: Dairy, Soy, And Risk Of Breast Cancer: Those Confounded Milks, International Journal of Epidemiology, 25 February 2020

Excerpts from press release:

Intake of dairy milk is associated with a greater risk of breast cancer in women, according to a new study conducted by researchers at Loma Linda University Health.

Consuming as little as 1/4 to 1/3 cup of dairy milk per day was associated with an increased risk of breast cancer of 30%,” [first author of the paper, Gary E. Fraser, MBChB, PhD] said. “By drinking up to one cup per day, the associated risk went up to 50%, and for those drinking two to three cups per day, the risk increased further to 70% to 80%.

Current U.S. Dietary guidelines recommend three cups of milk per day. “Evidence from this study suggests that people should view that recommendation with caution,” Fraser said.

“[Frazer said] the data predicted a marked reduction in risk associated with substituting soymilk for dairy milk. This raises the possibility that dairy-alternate milks may be an optimal choice.”

A hazardous effect of dairy is consistent with the recent AHS-2 report suggesting that vegans but not lacto-ovo-vegetarians experienced less breast cancer than non-vegetarians.

Fraser said the possible reasons for these associations between breast cancer and dairy milk may be the sex hormone content of dairy milk, as the cows are of course lactating, and often about 75% of the dairy herd is pregnant. Breast cancer in women is a hormone-responsive cancer. Further, intake of dairy and other animal proteins in some reports is also associated with higher blood levels of a hormone, insulin-like growth factor-1 (IGF-1), which is thought to promote certain cancers.

How does the USDA get away with telling women to consume 3 cups of milk a day when research indicates it increases breast cancer risk?

Robin Bathing

I like this perspective. How she’s looking over her shoulder at me.

They get so puffed up and bulky when they bathe, the robins especially. Robins seem to love the water. They land in these makeshift bathtubs we’ve set up and dunk their heads and shake their feathers. But they also just sit there in the water, quietly, looking around, taking things in. I can learn from a robin.

American Dagger Caterpillar, Pretty But Prickly

This little caterpillar was crawling on our car. I think it’s an American Dagger caterpillar which becomes an American Dagger moth:

It’s new home:

As to those black hairs sticking up from it’s body:

The American dagger moth caterpillar doesn’t sting like a wasp. The irritating hairs break off in the skin where they can cause hives, welts, or dermatitis. So, to avoid getting “stung,” you shouldn’t pick up these fuzzy yellow caterpillars.