Tuesday, December 24, 2013

Are you having trouble remembering things? One of these meds may be the problem

En espaƱol l For a long time doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know that memory loss as you get older is by no means inevitable. Indeed, the brain can grow new brain cells and reshape their connections throughout life.

Most people are familiar with at least some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency, and illnesses such as Alzheimer's disease and depression.
Woman rubbing temples, Medications that cause memory loss
Forgetful? Your prescription meds could be interfering with your memory. — Larry Williams/Corbis
But what many people don't realize is that many commonly prescribed drugs also can interfere with memory. Here are 10 of the top types of offenders.

1. Antianxiety drugs (Benzodiazepines)

Why they are prescribed: Benzodiazepines are used to treat a variety of anxiety disorders, agitation, delirium and muscle spasms, and to prevent seizures. Because benzodiazepines have a sedative effect, they are sometimes used to treat insomnia and the anxiety that can accompany depression.
Examples: Alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).
How they can cause memory loss: Benzodiazepines dampen activity in key parts of the brain, including those involved in the transfer of events from short-term to long-term memory. Indeed, benzodiazepines are used in anesthesia for this very reason. When they're added to the anesthesiologist's cocktail of meds, patients rarely remember any unpleasantness from a procedure. Midazolam (Versed) has particularly marked amnesic properties.
Alternatives: Benzodiazepines should be prescribed only rarely in older adults, in my judgment, and then only for short periods of time. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss, but delirium, falls, fractures and motor vehicle accidents.
If you take one of these meds for insomnia, mild anxiety or agitation, talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments. If you have insomnia, for instance, melatonin might help. Taken before bedtime in doses from 3 to 10 mg, melatonin can help to reestablish healthy sleep patterns.
Be sure to consult your health care professional before stopping or reducing the dosage of any benzodiazepine. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

2. Cholesterol-lowering drugs (Statins)

Why they are prescribed: Statins are used to treat high cholesterol.
Examples: Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
How they can cause memory loss: Drugs that lower blood levels of cholesterol may impair memory and other mental processes by depleting brain levels of cholesterol as well. In the brain, these lipids are vital to the formation of connections between nerve cells — the links underlying memory and learning. (The brain, in fact, contains a quarter of the body's cholesterol.)
A study published in the journal Pharmacotherapy in 2009 found that three out of four people using these drugs experienced adverse cognitive effects "probably or definitely related to" the drug. The researchers also found that 90 percent of the patients who stopped statin therapy reported improvements in cognition, sometimes within days. In February 2012, the Food and Drug Administration ordered drug companies to add a new warning label about possible memory problems to the prescribing information for statins.
Alternatives: If you're among the many older Americans without known coronary disease who are taking these drugs to treat your slightly elevated LDL ("bad") cholesterol and low HDL ("good") cholesterol), ask your doctor or other health care provider about instead taking a combination of sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily).

Next page: Antiseizure drugs, antidepressants, narcotic painkillers »

3. Antiseizure drugs

Why they are prescribed: Long used to treat seizures, these medications are increasingly prescribed for nerve pain, bipolar disorder, mood disorders and mania.
Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), ezogabine (Potiga), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote) and zonisamide (Zonegran).
How they can cause memory loss: Anticonvulsants are believed to limit seizures by dampening the flow of signals within the central nervous system (CNS). All drugs that depress signaling in the CNS can cause memory loss.
Alternatives: Many patients with seizures do well on phenytoin (Dilantin), which has little if any impact on memory. Many patients with chronic nerve pain find that venlafaxine (Effexor) — which also spares memory — alleviates their pain.

4. Antidepressant drugs (Tricyclic antidepressants)

Why they are prescribed: TCAs are prescribed for depression and, increasingly, anxiety disorders, eating disorders, obsessive-compulsive disorder, chronic pain, smoking cessation and some hormone-mediated disorders, such as severe menstrual cramps and hot flashes.
Examples: Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).
How they can cause memory loss: About 35 percent of adults taking TCAs report some degree of memory impairment and about 54 percent report having difficulty concentrating. TCAs are thought to cause memory problems by blocking the action of serotonin and norepinephrine — two of the brain's key chemical messengers.
Alternatives: Talk with your health care provider about whether nondrug therapies might work just as well or better for you than a drug. You might also want to explore lowering your dose (the side effects of antidepressants are often dose-related) or switching to a selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI). Of the drugs in this category, I find venlafaxine (Effexor) to have the fewest adverse side effects in older patients.

5. Narcotic painkillers

Why they are prescribed: Also called opioid analgesics, these medications are used to relieve moderate to severe chronic pain, such as the pain caused by rheumatoid arthritis.
Examples: Fentanyl (Duragesic), hydrocodone (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), morphine (Astramorph, Avinza) and oxycodone (OxyContin, Percocet). These drugs come in many different forms, including tablets, solutions for injection, transdermal patches and suppositories.
How they can cause memory loss: These drugs work by stemming the flow of pain signals within the central nervous system and by blunting one's emotional reaction to pain. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition. So use of these drugs can interfere with long- and short-term memory, especially when used for extended periods of time.
Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory drugs (NSAIDs) are the frontline therapy for pain. Unfortunately, NSAID therapy is less appropriate for older patients, who have a much higher risk of dangerous gastrointestinal bleeding. Research shows the risk goes up with the dosage and duration of treatment.
Talk with your doctor or other health care provider about whether tramadol (Ultram), a nonnarcotic painkiller, might be a good choice for you. In my practice, I often recommend supplementing each 50 mg dose with a 325 mg tablet of acetaminophen (Tylenol). While there are prescription drugs that combine tramadol and acetaminophen, these products have only 37.5 mg of tramadol, and in my practice I've found that patients generally need the larger dose.

Next page: Parkinson's drugs, hypertension drugs, and sleeping aids »

6. Parkinson's drugs (Dopamine agonists)

Why they are prescribed: These drugs are used to treat Parkinson's disease, certain pituitary tumors and, increasingly, restless legs syndrome (RLS).
Examples: Apomorphine (Apokyn), pramipexole (Mirapex) and ropinirole (Requip).

How they can cause memory loss: These meds activate signaling pathways for dopamine, a chemical messenger involved in many brain functions, including motivation, the experience of pleasure, fine motor control, learning and memory. As a result, major side effects can include memory loss, confusion, delusions, hallucinations, drowsiness and compulsive behaviors such as overeating and gambling.
Alternatives: If you are being treated for RLS, ask your doctor or pharmacist whether one of your prescription or over-the-counter medications may be the trigger. Potential culprits include many antinausea and antiseizure medications, antipsychotic drugs with tranquilizing effects, some antidepressants, and some cold and allergy medications. In this case, your RLS — and memory problems — could potentially be resolved by simply replacing the offending medication with another drug.

7. Hypertension drugs (Beta-blockers)

Why they are prescribed: Beta-blockers slow the heart rate and lower blood pressure and typically are prescribed for high blood pressure, congestive heart failure and abnormal heart rhythms. They're also used to treat chest pain (angina), migraines, tremors and, in eyedrop form, certain types of glaucoma.
Examples: Atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol."
How they can cause memory loss: Beta-blockers are thought to cause memory problems by interfering with ("blocking") the action of key chemical messengers in the brain, including norepinephrine and epinephrine.
Alternatives: For older people, benzothiazepine calcium channel blockers, another type of blood pressure medication, are often safer and more effective than beta-blockers. If the beta-blocker is being used to treat glaucoma, I recommend talking with your health care professional about potentially using a carbonic anhydrase inhibitor, such as dorzolamide (Trusopt), instead.

8. Sleeping aids (Nonbenzodiazepine sedative-hypnotics)

Why they are prescribed: Sometimes called the "Z" drugs, these medications are used to treat insomnia and other sleep problems. They also are prescribed for mild anxiety.
Examples: Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).
How they can cause memory loss: Although these are molecularly distinct from benzodiazepines (see No. 1 above), they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal.
The "Z" drugs also can cause amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a meal or driving a car — with no recollection of the event upon awakening.
Alternatives: There are alternative drug and nondrug treatments for insomnia and anxiety, so talk with your health care professional about options. Melatonin, in doses from 3 to 10 mg before bedtime, for instance, sometimes helps to reestablish healthy sleep patterns.
Before stopping or reducing the dosage of these sleeping aids, be sure to consult your health care professional. Sudden withdrawal can cause serious side effects, so a health professional should always monitor the process.

9. Incontinence drugs (Anticholinergics)

Why they are prescribed: These medications are used to relieve symptoms of overactive bladder and reduce episodes of urge incontinence, an urge to urinate so sudden and strong that you often can't get to a bathroom in time.
Examples: Darifenacin (Enablex), oxybutynin (Ditropan XL, Gelnique, Oxytrol), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura). Another oxybutynin product, Oxytrol for Women, is sold over the counter.

How they can cause memory loss: These drugs block the action of acetylcholine, a chemical messenger that mediates all sorts of functions in the body. In the bladder, anticholinergics prevent involuntary contractions of the muscles that control urine flow. In the brain, they inhibit activity in the memory and learning centers. The risk of memory loss is heightened when the drugs are taken for more than a short time or used with other anticholinergic drugs.
A 2006 study of oxybutynin ER, for example, found its effect on memory to be comparable to about 10 years of cognitive aging. ("In other words," as the study's lead author put it, "we transformed these people from functioning like 67-year-olds to 77-year-olds.")
Older people are particularly vulnerable to the other adverse effects of anticholinergic drugs, including constipation (which, in turn, can cause urinary incontinence), blurred vision, dizziness, anxiety, depression and hallucinations.
Alternatives: As a first step, it's important to make sure that you have been properly diagnosed. Check with your doctor or other health professional to see if your urinary incontinence symptoms might stem from another condition (such as a bladder infection or another form of incontinence) or a medication (such as a blood pressure drug, diuretic or muscle relaxant).
Once these are ruled out, I'd recommend trying some simple lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less before bedtime, and doing Kegel exercises to strengthen the pelvic muscles that help control urination.
If these approaches don't work out, consider trying adult diapers, pads or panty liners, which can be purchased just about anywhere. They can be worn comfortably (and invisibly) under everyday clothing and virtually eliminate the risk of embarrassing accidents. In my experience, many patients are reluctant to try this approach, but once over the initial hurdle, come to prefer it for security and peace of mind.
Correction: An earlier version of this article mistakenly implied that mirabegron (Myrbetriq), which the FDA approved last year for the treatment of overactive bladder, is an anticholinergic drug; in fact, it is in a new class of medications called beta-3 adrenergic agonists and is not expected  to cause memory loss seen with anticholinergic medications. There currently are no data describing the effect of Myrbetriq on cognition.

10. Antihistamines (First-generation)

Why they are prescribed: These medications are used to relieve or prevent allergy symptoms or those of the common cold. Some antihistamines are also used to prevent motion sickness, nausea, vomiting and dizziness, and to treat anxiety or insomnia.
Examples: Brompheniramine (Dimetane), carbinoxamine (Clistin), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl) and hydroxyzine (Vistaril).
How they can cause memory loss: These medications (prescription and over-the-counter) inhibit the action of acetylcholine, a chemical messenger that mediates a wide range of functions in the body. In the brain, they inhibit activity in the memory and learning centers, which can lead to memory loss.
Alternatives: Newer-generation antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec) are better tolerated by older patients and do not present the same risks to memory and cognition.
Ask the Pharmacist is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You? (Atria Books).

Sunday, October 13, 2013

The Simple Secret for

Normal Blood Sugar & A1c Levels

Now You Finally Have the Chance to Promote Normal Blood Sugar,
A1c & Body Weight, and Soon!Keep Reading to Learn How It's Done…

Glucocil in the News

San Diego, CA - Mary's blood sugar is steady at 95. Connie's fasting sugar is now averaging 90 to 95 (she's 20 lbs lighter, too). And Maggie not only has a 5.6 A1c now, but she also lost weight along the way!

What's their secret?

Most people aren't aware of the "3 Essentials of Healthy Blood Sugar":
  1. Reduce the intestines' absorption of glucose from food
  2. Reduce the liver's production of glucose
  3. Increase glucose uptake in the body's cells
Target any one of the 3 Essentials and you'll improve your blood sugar and A1c, which reflects your average blood sugar over a period of 2-3 months. But target all 3 Essentials together and you'll help keep your levels in check, from sunup to sundown.
How? Well, proper diet and exercise are the first steps in promoting the 3 Essentials. But for many people, diet and exercise aren't enough.
That's why a team in San Diego—the capital of biotechnology research and development—worked for seven years to develop a natural, total blood sugar solution to target all 3 Essentials together. A product that works fast, is easy to use, and actually lowers your blood sugar and A1c.
After a substantial investment of time and resources—including human clinical studies at the University of Minnesota School of Medicine and Veterans Affairs Medical Center—they finally created a formula that delivers as promised. That breakthrough compound—trademarked as "Glucocil"—has been on the market for more than five years and has helped tens of thousands.
Glucocil combines 14 natural ingredients carefully selected on the basis of 149 clinical and laboratory research studies—in the most concentrated, bio-available forms and the right dosages—putting them into one easy-to-take softgel formula.
Designed from the start to be a total blood sugar solution, Glucocil offers a
full spectrum of benefits:

  • Lowers blood sugar levels
  • Supports normal A1c levels
  • Promotes weight loss
  • Reduces absorption of sugars & other carbohydrates
  • Promotes healthy insulin sensitivity & production
  • Supports normal blood lipid levels
  • Promotes heart, blood vessel and circulatory health
  • Maintains healthy nerve function
The formula is so powerful that in a 2008 clinical study published worldwide, just one of the ingredients delivered dramatic results:
  • Promoted normal A1c substantially
  • Promoted healthy blood sugar substantially
  • Promoted healthy cholesterol substantially
And a published clinical study from the Minneapolis VA Medical Center / University of Minnesota found that just 1 gram of proprietary Mulberry leaf extract in Glucocil reduced post-meal blood sugar elevations by 44%!
Being overweight and having high blood sugar levels often go hand in hand, because they can share the same root cause called "insulin resistance." Supporting the 3 Essentials not only promotes healthy blood sugar, but also promotes weight loss, which can then improve your blood sugar even further.
For example, a clinical study published in 2012 found that people who used a key Glucocil ingredient lost 13% of their weight after 12 weeks while significantly improving their blood sugar health!
Only Glucocil targets all 3 Essentials of Healthy Blood Sugar to produce results that have made it the #1 comprehensive blood sugar support product at GNC—the nation's largest specialty vitamin retailer—and earned it more than 100,000 Facebook fans and reported by news programs on ABC, CBS, Fox and NBC!
Due to popular demand, the manufacturer of Glucocil has made samples available online for everyone to find out how much Glucocil can help. It's a 15-day supply and takes just a few days to arrive at your door.
Try the Glucocil 15-day sample and see how much it can help you!
Here are just a few of the hundreds of testimonials from people using Glucocil to support healthy blood sugar and body weight!

Blood Sugar Steady at 95

"I've been using Glucocil for 3 weeks, and I love it. Even though I take 3 a day, it's still good for me, keeping my blood sugar steady at 95. Thank you!"
–Mary, California

Numbers Averaging 100-120 Now

"I ordered Glucocil and WOW. It works! My numbers are averaging 100-120 now! The product is awesome. I would highly recommend it!"
–Sharon, Ohio

I Have Lost 45 Lbs

"I went to the Internet to find a natural alternative to support healthy blood sugar levels. Alas! There were many, but one especially caught my attention by its many users and positive testimonials. GLUCOCIL!!! I immediately placed the order, and have been taking them ever since. I have lost 45 lbs, and my glucose levels are now normal. I am recommending it to all my friends and acquaintances because it really works!"
–Maria Cristina, Florida

Energy Up & Weight Down 35 Lbs

"Taking Glucocil has made me very conscious of my diet and exercise and my body weight has dropped 35 pounds in the past year and a half. As a result, my energy level is up. I am very pleased, and intend to keep this regimen of diet, exercise, and Glucocil."
–Joel, Texas

Fasting Now Averaging 90 to 95

"I've been taking Glucocil for about 2 months. I noticed immediately that I felt full longer after eating. Now, my fasting sugar levels are averaging 90 to 95, and I've lost 20 lbs (and counting)!"
–Connie, Virginia

Normal A1c and Lost 20 Lbs

"I started using Glucocil, and during the first 6 months my A1c was healthier. I also lost 20 pounds. The next 6 months, my A1c went down to 5.9. This last 6 months, my A1c was 5.6. I am so glad I found Glucocil to help me with my A1c. I plan on taking it to keep my A1c low."
–Maggie, Texas

Helped My Blood Sugar, and I Lost 26 Lbs

"I found Glucocil on the Internet and decided to give it a try. I would recommend Glucocil to anyone. I lost 26 lbs, and it helped with my blood sugar, with no side effects."
–Bob, West Virginia

If You Are a Skeptic Just Try It

If you are a skeptic like me, just try it. You'll love the results it yields."
–Sue, Missouri