Prilosec and Dementia (Alzheimer's)

A recent study about PPIs suggested that their long term use was associated with increased risk of dementia.

jamaneurol.2015.4791

I had a patient who immediately stopped her prilosec without discussing this with me!

In the study, German researchers simply looked at their health system database of over 70,000 patients over age 75. Using the data they looked at patients who did not have a dementia diagnoses in 2004; then did have one in 2011. Then they looked at medication use in those almost 30,000 who had this diagnosis, and found that, of the 2,800 original patients who had chronic use of PPI there were about 1600 diagnoses of dementia as opposed to expected 1200.

This is an absolute increase of 400 patients in over 30,000 cases. As well, this study depended on the proper diagnosis being sent to the insurance company. Furthermore, patients who took over the counter PPIs, like prilosec could not be controlled for.

Unlike newspaper headlines that stated this was a cause and effect (it certainly was far from it) the researchers stated that the association was interesting and rated further studies.

I prefer not giving any medication if possible. However if there is a clear need for a PPI; such as an ulcer, gastritis, or reflux, the risk of stopping the drug is probably much worse than that of dementia!

Unnecessary and Dangerous Treatments in the Elderly

Many studies are being published that show certain treatments are associated with lower general mortality. Often these benefits are very small, and the old (over 75) are not included.

For example, recent news stories about the SPRINT study published in the New England Journal of Medicine said that the ideal blood pressure now should be 120/80 or lower. However this study only looked at people with increased risk of heart disease. They also did not include diabetics, where another study showed increased risk if we lowered blood pressure to 120 from 140.

These results can be confusing. I would recommend that if the blood pressure can be lowered without complications (like dizziness, falls, etc.) that is ideal. But to be too aggressive can be dangerous.

Many older patients are taking statins such as Lipitor. These drugs have been shown to prevent inflammation in the arteries and decrease the risk of heart disease.However life span is shorter in older individuals, so are these drugs really helping?

Using a model of the U.S. population, researchers estimated the effects of treating all adults aged 75 to 94 with statins for primary prevention over 10 years. They found, based on statistics that there was a definite but small benefit; however a 10-30% increase in risk for adverse events could cancel out the cardiovascular benefits.

So yes, if well tolerated certainly continue statins in the elderly; but with any side effects (most common being muscle pain) we should not hesitate to stop them without too much concern!

Finally, we all know colonoscopy every 10 years after the age of 50 can prevent up to 80% of colon cancer deaths. But when do we stop? When life expectancy is less than 10 years, the risk of screening (as opposed to follow-up for disease) colonoscopy is higher than any potential benefits. For most people this is at age 75; for some in the early 80's; but really never over 85.

Fix Fat Kids - drink water, avoid calories and stay away from fructose!!

Childhood Obesity has many causes, but one of the factors we can actually change is the diet.

Water

Sugar (or corn syrup) flavored drinks are unnecessary and have very high levels of useless calories. Researchers wondered if offering water to overweight children would actually lead to weight loss.

This study in New York was performed in schools that already had removed sugar sweetened drinks from the cafeterias. The study involved 483 public schools that installed “water jets” (large, fast-dispensing, electrically-cooled, water jugs costing about $1000 each) in cafeterias from 2008 to 2013 and 744 schools that did not.

They found small but significant decreases in obesity in the schools offered water; one of the reasons could have been that students in schools with water jets bought about 14 fewer half-pints of fat-free chocolate milk per student per year - a savings of money as well!

Schwartz AE et al., JAMA Pediatr 2016 Jan 19

Fats

In another study researchers looked at whether (in adults) calorie equal low fat or low carb diets were more effective. Interestingly low fat diets led to greater fat loss (not weight loss). However the difference was small. So it is not as critical you avoid carbs to lose weight; as long as you avoid excess calories!

Fructose

fructose is a natural sugar found in many fruits and vegetables. It is also the main sugar found in high-fructose corn syrup; an inexpensive sweetener very often substituted for raw sugar in processed foods. Many pundits have claimed that this is unhealthy. A recent study confirms this.

Forty-three obese U.S. children (age, 8-18 years) with high sugar intake followed a diet for 9 days that replaced added sugar with starch. The goal was to reduce total sugar intake to 10% of daily calories, and fructose intake to 4%, while maintaining baseline caloric intake and weight. All food was provided by the researchers.

After 10 days there was an average weight loss of over 2 pounds (even though they ate the same amount of calories!), as well as decreases in blood pressure, fasting sugar, and cholesterol.

These sugars are bad for you and should be avoided!!

http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/epdf

With common sense we can stop this epidemic!

Video Games and IQ

Most children love to play video games - almost to the extend of addiction. There have been some arguments that this can lead to improved computer literacy. However many studies that I have previously mentioned clearly show that we should be limiting screen time to children.

Now a study reviewed video games. More hours of video gaming were associated with lower verbal IQ as well as some distinct changes in brain chemistry that are sometimes found in autism spectrum disorders. In fact, the authors support the evaluation of autism spectrum and depressive disorders in children who choose video gaming over other age-appropriate behaviors (e.g., socializing).

I would discourage video games before teenage years (when you probably can't control it!).

Takeuchi H et al., Mol Psychiatry 2016 Jan 5