What can harm or help preserve memory

What Harms and what Helps preserve Memory

There’s a plethora of research on things that can harm the brain including memory. Not surprising, many of these are things that also harm other organs and can cause or advance diseases. Some of the top offenders:

  • Stress – especially long-term stress when cortisol production is prominent, interferes with thinking and learning.
  • Obstructive sleep apnea significantly increases the risk for dementia.
  • Obesity – fat cells secrete inflammatory chemicals that damage many tissues
  • A lack of sleep – regularly sleeping less than 5 hours a night is associated with worse cognition (compared with those getting 7 to 8 hours a night).
  • Sedating medications – older antihistamines, strong pain medications, some beta blockers used for high blood pressure and heart problems, to name just a few. Discuss this with your health care provider if you are on a medication that can cause drowsiness or problems with clear thinking.
  • High blood sugar – from diabetes or poor diet. Processed foods, especially high in sugar baked goods, soft drinks and candy can increase the blood sugar and cause harm even if you don’t have diabetes.

What helps preserve and even strengthen memory and thinking ability? This list is also long!

  • Exercise – even a thirty minute walk each day helps with blood circulation and with special memory. Physical activity is also associated with an increase in brain cells and improved long-term memory.
  • Relaxation – just looking out a window for ten minutes a day is helpful.
  • Healthy foods – those high in antioxidants are especially beneficial – for example berries, green vegetables, whole grains, fish, and beans. Turmeric and sage tea are also credited with brain protective effects.
  • Social engagement – talking with others, even if the subject isn’t theoretical physics or other deep topics, aids memory and other brain functions.
  • Music and art (making and appreciating), crafts like knitting, jigsaw puzzles and word games all can help.

This article is not intended to replace your health care provider. The intent is to make important information about medications and other things that can affect your health available.

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The best way to prevent an infection

The best way to prevent infections

Since we’re living in an era when there isn’t an antimicrobial drug for every infection, prevention is critical. Although there have been a lot of advances in medicine, proper hand washing is the best way to prevent picking up or spreading an infection. Proper in italics because this is key, and I would venture to say most people don’t do that. That changed after reading Dr. Frederic Saldmann’s Wash Your Hands! (New York: Weinstein Books, 2008).

It’s no secret that hands carry a lot of germs, and not just those that cause skin infections or gastroenteritis. We cough into our hands, touch computers and elevator buttons, shake hands, touch our face, grab onto the handrails of stairs, touch toilet seats and sink faucets, touch our face, pick up fruits and vegetables at the grocery store, touch our face, and then do a split-second wash that may be giving the germs just the chance they need to start a very big family and also get free housing.

Proper hand washing includes washing every part including the space between fingers and cuticles. In the article “Implementing Infection Prevention and Control Precautions in the Community” by Deborah Ward (British Journal of Community Nursing, March 2017, vol. 22, #3) it’s noted that fingernails and fingertips have the highest number of organisms. The author adds that rings and other jewelry can also be a reservoir for germs. She also notes that alcohol-based sanitizers don’t kill the germs that cause the pseudomembranous colitis, a serious lower GI infection.

Drying is just as important because, per Dr. Saldmann’s book, moist hands carry five hundred times as many pathogens as dry hands! Yet another study found that about a third of hand washers don’t dry their hands. And using a damp towel can contaminate washed hands. The most startling news is that using a warm-air dryer actually leads to a significant increase in the number of germs on hands compared with the number before washing them!

After shaking hands with someone that had a recent trip to the bathroom and didn’t wash their hands, there’s a 33% chance you’ll get some of the bacteria from their feces in your mouth within a couple hours. If you think it’s rare for someone to not wash their hands after using the restroom, guess again. In one study, almost half of the research subjects didn’t wash their hands then if they were alone; that’s five times the rate of those who are in the bathroom with other people around. Proper hand washing takes less than a minute – a worthy investment!

Citrus versus Cancer: Guess which one Wins!

Citrus versus Cancer:  Guess which one Wins!

Before plunging into all the nutrients and cell protectors found in citrus fruits, it is worth stating an important fact once again. That key concept is that with these foods, as with most super foods, the benefits add up to much more than the sum of its parts. To put it another way, you can’t take the specific molecules, even in the amounts proportionate to what they are in the fruit, and reap the same rewards. These compounds work together. This writer can think of no other comment on this amazing aspect of many foods than the word miraculous. To profit fully from these foods, eat them as they are – the whole food. Even juices are often far inferior to their original containers. And really, why do we want to add time, effort and expense to our diet?

Numerous anticancer compounds are found in citrus fruits, maybe more than any other food, and per the National Cancer Institute a complete package of natural cancer inhibitors. Some of these cancer fighters include the following:

 

  • Pectin which is a soluble fiber, impairs growth factors that cancers need to keep growing. This same compound benefits the cardiovascular system as well. The white lining of citrus fruit is especially high in pectin.
  • Citrus flavonoids in the juice, pulp and skin are antioxidants (protecting cells from free radical damage – something that comes from many sources including normal energy production and inflammation). They are also antimutagenic – preventing the cell mutations that are the first step in cancer development. Flavonoids are also anti-inflammatory and antimicrobial. They also strengthen blood vessels as well as tendons, cartilage and ligaments.
  • Folate in citrus is another compound that helps protect the DNA. Folate also helps protect the cardiovascular system.
  • Limonene is a phytonutrient (nutrient found in plants) in the oil of citrus peel. They function to detoxify – another cancer fighting action of citrus. Animal research has shown this compound can help shrink tumors. These chemicals may also have antimicrobial properties. Add citrus zest to fruit dishes and coleslaw.
  • Vitamin C helps protect against nitrosamines, carcinogens associated with GI cancers such as stomach cancer. Vitamin C’s effects are strengthened by bioflavonoid polyphenols that are also found in citrus. C also decreases stroke and cataract risk.

Carotenoids are found in particular in tangerines and grapefruit. These also fight cancer. Citrate levels in urine are increased with orange juice consumption and that helps stop kidney stone formation. This was noted in David Grotto’s book 101 Foods that could save your life (Nutrition Housecall, 2007).

Other references:  Tonia Reinhard’s Super Foods (Firefly Books, 2014), Eat This and Live by Don Colbert (Siloam, 2009) and Fourteen Foods that will change your life SuperFoods (HarperCollins, 2004).

Medications that can increase the risk of Pneumonia

Medications that can increase the chance of getting Pneumonia

While colds usually spread easily from person to person, the germs that cause pneumonia often are found in a dormant state in people and the lung infection doesn’t develop until the immune system is weakened and/or stomach contents backs up into the throat and into the airway. Germs in that fluid can thus get into the air sacs and start an infection there. As with any foreign invader, the pathogens (germs) are detected by the body and the inflammatory process starts. Part of inflammation includes the production of an exudate, a fluid with white blood cells and debris. This exudate fills some of the air sacs and decreases the surface area where oxygen can be absorbed and carbon dioxide eliminated. The lack of oxygen makes people feel weak and short of breath. If severe, it can kill the person.

The pneumonia vaccines can decrease the chances of getting severe, invasive (spreads throughout the body) pneumonia, but it doesn’t always prevent it. In “Use of Opioids or Benzodiazepines and risk of pneumonia in Older Adults:  A Population-based Case-Controlled Study” by S. Dublin, et al (Journal of the American Gerontological Society, 2011; 59: 1899-1907) over 90% of the people who gotten pneumonia had received the vaccine. Although the vaccine can help protect, clearly much more must be done to decrease pneumonia risk.

Because some medications increase the risk of pneumonia, this under-rated topic was selected by this author. It came to my attention after listening to “Pneumonia Diagnosis” by Willian Sonnenberg (FP Audio Digest 452, January, 2017, by the American Academy of Family Physicians). The drug classes implicated:

  • Proton Pump Inhibitors, medications used to treat ulcers and GERD (gastroesophageal reflux disease), increase stomach content pH so fewer germs that cause pneumonia are killed. These drugs have only been implicated in strep pneumoniae as a cause of pneumonia
  • Drugs with anticholinergic effects – some of those for urge incontinence, older antihistamines, and certain tricyclic antidepressants (TCAs) can increase pneumonia risk
  • Inhaled corticosteroids (used for asthma and COPD) may increase the risk up to 69%
  • Benzodiazepines, used for anxiety and sleep, could also increase pneumonia risk
  • In the Dublin article, the research didn’t confirm the link with benzodiazepines and pneumonia but did find that some opioids can make pneumonia more likely to develop.
  • Morphine, codeine and fentanyl were found to suppress some aspects of the immune and inflammatory response. This effect was particularly strong the first few weeks of use.
  • Use of benzodiazepines were associated with an increased chance of infection in the critically ill, increase the chance of community acquired pneumonia and increase the 30-day mortality following pneumonia per an on-line pharmacology journal (Formulary.journal.com for January, 2013 based on an article on such in the medical journal Thorax).

 

This article is not intended to replace your health care provider. The intent is to make important information about medications available.

Antibiotic Resistance – A very real Danger

Antibiotic Resistance – A very real danger

The emergence of bacteria that are resistant to various antibiotics has been deemed a major public health threat. This sobering judgment if from an article in the Health and Human Services and Centers for Disease Control’s Morbidity and Mortality Weekly Reports. The article, “Elements of Outpatient Antibiotic Stewardship” by G. Sanchez, et al (MMWR for November 11, 2016, Vol. 65, number 6), was written for prescribers but the message is applicable to everyone.

We are all stakeholders in the use of antibiotics. Health care providers may be tempted to give a patient a prescription for an unnecessary antibiotic course because they are rushed or in an effort to please survey-writing patients. It is much easier to do that than to take the time to explain why an antibiotic isn’t needed and to describe other things that may speed recovery from a viral infection or help the person feel better.

Patients encourage the inappropriate use of antibiotics when they visit a health care provider when they have a cold or allergies, imagining that antibiotics will help. Furthermore, if the provider hedges about prescribing the coveted antibiotic, the patient may ignore the providers experience- and education-based decision and continue to push. It can get to the point where the provider senses a negative and damaging comment from the patient may result, or just feel too tired or rushed to bother with more education.

It may not seem like a big deal, this overuse of antibiotics, but the research and statistics reveal how damaging this situation is. Bacteria that are resistant to many antibiotics contribute to an estimated 23,000 deaths in the U.S. each year. They are also responsible for some 2 million infections every year. Although antibiotics can be life-saving, inappropriate prescribing and use of antibiotics is the major reason why there are disease-causing bacteria that aren’t killed or kept from increasing in number.

Bacteria reproduce so quickly, it isn’t surprising that mutations develop. Mutations are abnormalities in an organism’s genes that develop because of exposure to a mutagen (a vague name for anything that instigates the error in DNA). Usually mutations don’t give the affected cells an advantage. Indeed, mutations usually make for weaker organisms, but because some mutated bacteria aren’t harmed by an antibiotic they were exposed to, they increase in number and spread, causing infections that are hard to treat.

Antibiotic resistance develops when antibiotics kill, or keep from reproducing, some bacteria in the body, but not all bacteria. Those that survive increase in number because the antibiotic has destroyed much of the competition. These bacteria can easily be spread to others and can also spread their mutated genes to other bacteria so that they’ll also be resistant to the same antibiotics.

The best way to stop antibiotic resistance isn’t with new antibiotics but with careful and appropriate use of the ones we have. In a November of 2015 article in Reader’s Digest, “When to Say No To an Antibiotics Prescription,” (reproduced from a Consumer Reports on Health), people are encouraged to not push for antibiotics for viral infections such as influenza, colds, acute bronchitis or sinus infections when there are no serious symptoms. If someone is unsure about what constitutes “serious symptoms” or signs, they should contact their health care provider. As with all information on this website, readers should not substitute it for the advice and care of their health care provider.

Garlic and Onions and Leeks, Oh my!

Garlic and Onions and Leeks, Oh my!

It isn’t fair to stereotype these wonderful foods as doing nothing more that causing bad breath. There is so much more to these foods than that. Oh, there are more beautiful and more tasty foods out there, but do they really deliver the nutrients as well as this root-based vegetable family? With 1,200 onion varieties in the world, I guess it isn’t such a small family.

Onions are especially valued for their quercetin. This is a powerful antioxidant, rendering harmful compounds unable to cause their damage to human cells. This is why they help our body fight cancer. Quercetin has also been found helpful in lessening allergy symptoms. Onions possess other nutrients such as vitamin C, B6, potassium and manganese.

Research has also uncovered that onions may help alleviate the symptoms of upper respiratory infections. Lowering the risk of osteoporosis is another possible benefit from onions. If the strong flavor of onions decreases your intake of onions, you’ll be relieved to learn that cooking does not affect the flavonoid (including quercetin) or phenol compounds in these wonderful vegetables.

Leeks are related to onions and wonderful too. They are also high in the flavonoids quercetin and kaempferol, making them good antioxidant additions to the diet. They are also high in vitamin C and K, as well as manganese.

Garlic is just plain a superstar. It too is high in manganese, and a good source of vitamin C and vitamin B6. It also contains phytochemicals (chemicals that come from plants) and some of the benefits aren’t available until the garlic is crushed and allowed to sit for ten minutes before being eaten. Garlic also has strong antimicrobial properties, helping to kill bacteria, viruses and even fungi and parasites! Its anti-inflammatory effect makes it a potential aid in treating asthma and allergies. As if that isn’t enough, it can help lower blood pressure and decrease blood clot formation.

All three of these root vegetables (or are they herbs?) have been linked to cholesterol lowering as well. If you add that to the other vitamins in them, and consider their very low calorie content, surely they’ll start to look pretty beautiful. If you like to garden, all three are easy to grow as well. Enjoy these white roots and add all three to your diet on a regular basis.

References:  Tonia Reinhard, Super Foods, the Healthiest Foods on the Planet, 2nd edition. New York:  Firefly Books, 2014.

Dr. Don Colbert, Eat this and Live!  Lake Mary, FL:  Siloam, A Strang Company, 2009.

This information is not intended to replace the care of your Primary Care Provider.

Medications that increase the risk of falling

Medications that increase the risk of falling

There are several ways medications can make a fall more likely to occur. One such way is by causing sedation or confusion. When there is decreased vigilance, things like rugs or clutter are more apt to go unnoticed or interpreted as an obstacle. Alcohol alone or combined with such medications can worsen such hazards. Other medications interfere with a smooth, coordinated gate. Other medications cause orthostatic hypotension. Aging and some diseases can also produce this effect. With changing position to one that is more upright, such as from lying flat to standing, a lot of blood pools in the lower legs. That leads to less blood returning to the heart and thus less pumped to the head and upper extremities. Normally the body can correct for that change quite quickly. Orthostatic hypotension refers to a lack of such a rapid adjustment.

In “Evaluation of the Medication Fall Risk Score” by C. Yazdani and S. Hall (American Journal of Health System Pharmacy, 1/1/2017, e32-39), the medications that are most likely to increase the risk of falls are sedating medications (for example opiates and opioids), some of the antidepressants, certain medications used to treat epilepsy, drugs used to treat psychosis, NSAIDs (non-steroidal anti-inflammatory drugs), and some of the antihypertensive agents.

There are some medications that have what is called an anticholinergic effect. This is a technical term referring to the suppression of the “rest and digest” state of the automatic nervous system. Not many drugs have this as their intended outcome, rather it is a property of a drug that can’t be removed, so to speak. Some of the medication classes listed above have this effect and one member of the drug class may have a stronger anticholinergic effect than another. For example, some tricyclic antidepressants (TCAs) have a prominent anticholinergic effect while another TCA doesn’t. Anticholinergic effects include dry mouth, constipation, sedation, tachycardia (rapid heartbeat) and pain from light from a diminished ability of the pupils to constrict.

Older antihistamines often have such an effect, so keep this in mind when taking diphenhydramine and other such drugs. “Use of medications with anticholinergic-activity and self-reported injurious falls in community-dwelling Elderly” (by K. Richardson, et al, in Journal of the American Geriatrics Society, 63:1561-69, 2015) included research that looked at this important contributor to falls. The authors noted that anticholinergics can increase the fall risk because of sedation as well as possible confusion and blurred vision. They also noted that older individuals tend to have the most problems with anticholinergics.

Considering that one-third of those over age 65 fall each year, this is no small matter. This 2013 CDC fact was noted in “Urological Implications of Falls in the Elderly:  Lower Urinary Tract symptoms and alpha-blocker medications” (L. and J. Schimke, Urologic Nursing, September and October, 2014, pages 223-229). Nocturia – having to get up at night to urinate, as well as urge incontinence (having a sudden intense need to urinate) make falls more likely. Unfortunately, a medication sometimes prescribed for older men with prostate problems – alpha blockers, can cause orthostatic hypotension and thus also contribute to falls. Some of the medications used for urge incontinence have anticholinergic properties that can increase the fall risk. So be careful not to substitute one cause of falls for another.

This article is not intended to replace your health care provider. The intent is to make important