Dementia 'linked' to common over-the-counter drugs | Hacker News Reader

Dementia 'linked' to common over-the-counter drugs

bbc.co.uk

113 pointsk-mcgrady60 comments

Is it that surprising that inhibiting choline would be a bad idea? Choline's positive effects on memory and the brain are very well known and increases in acetylcholine are one of the main methods of actions of nootropics in the racetam class.

Profound effects of combining choline and piracetam on memory enhancement and cholinergic function in aged rats. http://www.ncbi.nlm.nih.gov/pubmed/7301036

Effects of citicholine and of the combination citicholine + piracetam on the memory (experiments on mice). http://www.ncbi.nlm.nih.gov/pubmed/2392950

Comparative studies on the effects of the nootropic drugs adafenoxate, meclofenoxate and piracetam, and of citicholine on scopolamine-impaired memory, exploratory behavior and physical capabilities (experiments on rats and mice). http://www.ncbi.nlm.nih.gov/pubmed/3136617

And people have been told to avoid egg yolks since the whole Ancel Keys debacle.

This study might not be the final word, but as someone who has taken quite a few antihistamine pills over the years, I was certainly a little concerned upon seeing hay-fever mentioned. I'm glad to see that the medication I took is a little different from the ones in the study.

From the article:

> A study has linked commonly used medicines, including over-the-counter treatments for conditions such as insomnia and hay-fever, to dementia.

> All of the types of medication in question are drugs that have an "anticholinergic" effect.

From Wikipedia: [1]

> Cetirizine /sɛˈtɪrɨziːn/ (trade names Zyrtec, Reactine).

> Unlike many other antihistamines, Cetirizine does not exhibit anticholinergic properties.

[1] http://en.wikipedia.org/wiki/Cetirizine

Let me complement your helpful answer with some details about the stuff I'm eating..

Fexofenadine (Allegra, Telfast..):

"Unlike older antihistamines, fexofenadine does not have anticholinergic activity." http://www.medscape.com/viewarticle/406437_3

Bilastine (Bilaxten):

"No anticholinergic adverse events were observed in the clinical trials.." http://en.wikipedia.org/wiki/Bilastine

"bilastine's safety profile is satisfactory, since it lacks anticholinergic effects" http://www.ncbi.nlm.nih.gov/pubmed/22149338

Thankyou, I was just about to search for Allegra, my current favourite.

As someone who doesn't respond to second-generation antihistamines, this sucks. The one I take is even listed on the "anticholinergic" Wikipedia page (Chlorpheniramine). I've always been worried about the long term effects of the drug, and limit my dosage as much as possible. I guess an allergy free life is worth some dementia risk later down the line.

I wonder if choline supplementation would counteract this effect. In fact, I wonder if choline supplementation might help stave off dementia in general. As much as 90% of the population may be deficient in choline.[0]

[0] http://en.wikipedia.org/wiki/Choline#Groups_at_risk_for_chol...

(Wild speculation ahead)

I think it has to -- almost all of the nootropics that people use (-iracetams) are recommended to be taken with choline supplements, as people tend to get headaches without them. These nootropics were looked at as Alzheimer-preventing or -delaying drugs, and they cause an uptick in choline use that necessitates the supplements. I feel that indicates choline is used in keeping the mind strong against Alzheimers.

Sadly, choline promotes the production of TMAO by gut bacteria, which in turn promotes the formation of arterial plaque.

I know that choline supplementation via lecithin pills (turns into choline + inositol) certainly helps my ability to focus.

There is still so much that we do not understand about the brain and its diseases.

When we find the source of dementia, alzheimer, etc, I won't be surprised if very common activities put people at higher risk. Artificial sweeteners, OTC drugs, THC, and drinking water out of plastic bottles can all be 'linked' to brain diseases in a similar fashion to the study mentioned in the article. __Correlation does not imply causation__.

I think the important stat out of this article is that over ~20% of people in the study ended up developing dementia. It is hard to compare this with past trends because we didn't understand brain diseases like we are understanding them today, but that is extremely scary for an aging population.

This is apparently a new study, but the idea is not new. For example, see this article from American Family Physician in 2009: http://www.aafp.org/afp/2009/0301/ot2.html

A quote:

> Background: Medications with anticholinergic properties are often associated with adverse events, including falls, cognitive dysfunction, delirium, and loss of independence.

That's from 2009, and it is stated as something already known.

Also, it should be noted that loratadine ("Claritin"), which lots of people take, has anticholinergic effects. See http://doctorslounge.com/chest/drugs/antihistamines/claritin...

That's weird... The following article has a quote from one of the dementia study authors that specifically calls out loratadine/Claratin as an antihistamine that does not have anticholinergic effects:

http://www.telegraph.co.uk/news/science/science-news/1137023...

This article examines and compares the anticholinergic effects of antihistamine drugs. It seems that loratadine has an anticholinergic potency greater than chlorpheniramine which is one of the experimented drugs in the study.

http://www.ncbi.nlm.nih.gov/pubmed/15627436

Yep, that's weird.

I agree with not using drugs except if necessary (i.e. not a simple cold).

Also, I hate when an article has the word "scientists" with the quoted work "linked". Looks too much like click baiting.

As someone who takes ~70mg of diphenhydramine per night to help with insomnia, this is terrifying to me.

Doesn't that not even work better than placebo after a few days?

I stopped taking over-the-counter drugs years ago unless its vitally necessary. Common colds, allergies etc are not too difficult to bear in most circumstances and with the all the side-effects of pharma drugs I prefer to go with alternative medicines ex. local honey, lemons, etc.

> I prefer to go with alternative medicines ex. local honey, lemons, etc.

These alternatives clearly have the advantage of being side-effect free for most people, but I have always been very skeptical about their effectiveness. Are there actually any reliable studies on the efficacy of local honey in treating allergies? And I thought that the role of vitamin C in warding off colds had been pretty well debunked. (I assume that's what the lemons are for.)

Don't get me wrong, I really wish all this nice stuff worked. Show me firm evidence that it does, and I'm sold. (And some of it I'm happy to do even if it's not effective in the pharmacological sense, just because it feels/tastes nice.) But as I said, I'm skeptical.

I haven't found any hard evidence to support the local honey for allergies thing, but honey really does have some remarkable medicinal properties, especially as a natural antibacterial:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609166/

I agree with the parent when it comes to things like the cold. I seriously don't understand people who take paracetamol and tons of other over the counter stuff for that. When it comes to allergies though (hay fever in my case) I can barely function without antihistamines (and with them I'm still a wreck). I haven't found any of the home remedies to be effective for it whereas in the case of the cold plenty of water and some lemon and ginger tea seems to improve things a bit. In fact I've noticed I feel better with that than over the counter stuff for the cold.

> I seriously don't understand people who take paracetamol and tons of other over the counter stuff for that. When it comes to allergies though...

Isn't that exactly like the grandparent comment's "allergies etc are not too difficult to bear in most circumstances"? I, like you, have bad allergies and I can't live without Singulair+Zyrtec. But...

I've had three colds and one bout of bronchitis this season, and I took OTC meds including painkillers because I had unbearable sinus congestion/pain and headaches each time. I also ended up doubling down on my usual meds for allergies+asthma since that got worse too. Colds aren't all mild with no complications. I don't begrudge people seeking symptom relief.

Taking medications that alleviate the symptoms of upper respiratory congestion also aid in preventing sinus infections down the road. Diminishing the effects of a cold has more benefit than just providing comfort, you are also helping to eliminate a breeding ground for nasty bacteria.

My wife will reliably get acute sinus infections following a cold if she doesn't take decongestants. She is generally aversive to taking any medication, but after 8 sinus infections in one year, she now always takes decongestants when a cold starts.

I'm sure that happens to some people but I doubt it happens to a majority and everyone I knows pops whatever they can get their hands on for the cold.

I'm thinking I might have that same issue. Can you share what works for her?

I'm not the parent, and I haven't had 8 in one year, but I've had a few, and my colds always come with congestion...

I use the hell out of neti pots/sinus rinses, steam inhalation (like a cup of tea - which, drinking lots of fluids also helps), and pseudoephedrine.

just like the other person who replied to you, a neti-pot and pseudoephedrine (which you have to go to the pharmacy counter to get in the US, but does not require a prescription).

That Placebo Effect is so strong I don't even bother to debunk natural remedies. Plus, I might be throwing the baby out with the bath water, but right now I'm very skeptical of a lot of pharmacuticals studies. They just lied to us so many times when it comes to the efficacy of their newest drug.

I get your skepticism, but does it not help that pharmaceutical studies are closely reviewed by the FDA before a drug can be marketed? Getting a new drug approved is far from easy.

Not nearly as much as you might think. Check out "Bad Pharma" by Ben Goldacre. It's a treatment of the statistical and legal tricks used by drug companies to overstate the efficacy of new drugs, without breaking any actual FDA regulations.

Even after using all the known tricks for cherry-picking results, p-hacking, and the like, there exist much-abused FDA 'fast track' options for getting a 'needed' drug out before the science is confirmed, and quite often the science never gets around to being confirmed. Even big-name drugs like Tamiflu have been shown later to be no better than generics at best and completely useless at worst.

It's also not that hard---perform your own research, under conditions you specify, using analysis methods you dictate, with the ability to retry over and over and over until a favorable result arises by chance, THEN the FDA scrutinizes it.

The same FDA that is staffed by ex-pharmaceutical executives, and the same pharmaceutical companies that are staffed by ex-FDA staff? The FDA is really not something you can reasonably, or should, trust.

Try it for yourself, and don't be so dependent on third parties to tell you how to live your life. There's nothing to lose and a whole world of independence to gain. Honey and lemon is awesome if you have a cold - if you're not trying it yourself because there isn't a study to prove its efficacy, then you're missing out on one of the true great values in life: experiencing things for yourself.

One thing I've found is that honey is an amazing sore-throat cure.

For coughs, check out olive leaf extract. I very rarely recommend things, but it's amazing how suddenly and completely it makes you stop coughing!

That sounds amazing. Can you recommend a brand, dosage? Are you saying it cures the cough or just suppresses it?

Two tablets (recommended daily max) suppresses for me the actual coughing within 15 minutes absolutely and completely for about 6 hours. Brand here in Australia is 'Living Healthy'. Each capsule: (1) 2.92mg dry olive leaf (Olea europaea) (2) 35mg equiv. to Oleuropein (3) 100mg Arographis paniculata leaf dry (4) 2.5mg equiv. to Andrographolide (5) 5mg zinc gluconate.

Image @ http://www.terrywhitechemists.com.au/living-healthy-olive-le... ... manufacturer 'Orion Laboratories' recently acquired by http://www.perrigo.com.au/

replying as breadcrumbs so I can reference this remedy later.

There's quite a lot of anecdotal evidence in support of both. Lemons for colds are more a relief than a cure according to [1]. The way I tend to look at, people have survived/healed themselves for thousands of years prior to the advent of modern medicine. Some methods are not that effective while many others are even if due to a placebo effect.

A large part of staying healthy I believe is being preventative. Many 'normal' activities can actually be coined as cures to common ailments. Staying active, sleep, eating healthy, not over-eating etc.

[1] http://www.mayoclinic.org/diseases-conditions/common-cold/in...

Prior to the advent of modern medicine people didn't heal themselves. They died at record rates from things that are minor inconveniences now.

That's true of some illnesses and stages of history, and not of others.

The advances of modern medicine shouldn't blind us to the fact that humans and other animals/organisms have always had immune systems that fight off disease naturally, and that practices like good nutrition, sleep and physical fitness, and yes, some folk remedies, all assist the immune system to function optimally - even if by placebo effect.

Sure, modern medicine can take over where the body's natural defenses and traditional health practices are inadequate.

But bacteria and viruses have existed for longer than humans have, and as a species we've survived a pretty long time without modern medicine.

I'm mostly referring to symptoms and lesser illnesses such as colds, headaches, sores and such

An open wound was almost certainly a recipe for gangrene prior to antiseptics and antibiotics.

In this study[0], honey compares favorably to silver sulfadiazine dressing for healing burn wounds.

[0] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845359/

Antiseptics have been in use for at least two thousand years now.

I think this straying from my main point. All I was trying to say is when possible stick to natural stuff in all other circumstances I'm all for modern medicines.

I feel obligated to say that "alternative medicine" means treatment attempts that are not based on science or evidence.

They are based on evidence, but that evidence has not been scientifically evaluated.

And given how that worked for cultures before the modern age, I'll stick to those who choose to study medicine. Not those who simply prescribe whatever they felt worked once, for a reason unknown to them.

Why do you need a straw man to justify your point?

Which, to me, is equivalent to saying it's not based on evidence.

Which means that you are also saying that the court system is not based on evidence.

Honest question: what convinces you that over-the-counter drugs have a negative effect rather than a neutral or even positive effect?

It's pretty well documented that over the counter pain killers such as acetaminophen, aspirin, and ibuprofen can have long term negative consequences with long term use. Allergy meds appear to be joining this group. In many cases the threshold for harm is fairly low in terms of lifetime cumulative dose. In some cases there are long-term benefits to these drugs(aspirin for instance) but there are definitely downsides. That isn't to say that pursuing alternative treatments to colds and allergies makes sense.

The study[1], if anyone is interested. I couldn't gain free access through my university it seems, oh well.

[1] = http://archinte.jamanetwork.com/article.aspx?articleid=20917...

Somewhat unsurprising to me. I once accidentally overdosed on an anticholinergic drug, and it was the most unpleasant experience of my life. It was a combination of psychosis and hallucinations coupled with what I imagine dementia to be like. Hideous. Of course, expect the two to be linked in the long term is ridiculous on my behalf, but if it can have that effect in the short term...

For what it's worth, diphenhydramine (mentioned in the article) is Benadryl, and it's widely known that it causes hallucinations in high doses:

https://www.erowid.org/pharms/diphenhydramine/diphenhydramin...

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