Do Blood Pressure Medications Cause Memory Loss?

Written by Dr. Steve Chaney on . Posted in Uncategorized

Is The Cure Worse Than The Disease?

Author: Dr. Stephen Chaney

 

Do blood pressure medications cause memory lossHigh blood pressure has been called a silent killer. This is because it is possible to go for years with high blood pressure and not even know it. Even worse, the consequences of untreated high blood pressure can be catastrophic – stroke, heart attack, congestive heart failure, kidney failure – the list goes on and on.  But, what about when high blood pressure is treated?  Do blood pressure medications cause memory loss?

Because of that, the standard medical recommendation for years has been to:

  • Have your blood pressure tested frequently (at least once a year if your blood pressure is in the normal range and more frequently if it is elevated).
  • If your blood pressure is elevated, get on a blood pressure medication and try to keep your blood pressure as close to normal as possible.

But, is this always the best advice? Maybe not, particularly when we consider the confusing effects of blood pressure on cognitive function.

We have known for years that untreated high blood pressure in middle aged individuals significantly increases the probability that they will suffer cognitive decline in their later years (for example, R. F. Gottesman et al, JAMA Neurology, 71: 1218-1227, 2014).

Conversely, when we look at the elderly as a group we find that those with the lowest blood pressure actually have a higher risk of cognitive decline than those with the highest blood pressure (for example, B. Sabayan et al, Journal of the American Geriatric Society, 60: 2014-2019, 2012).

How can we reconcile such conflicting data on the correlation between blood pressure and cognitive decline in the elderly? Could it possibly be that it was the blood pressure drugs rather than blood pressure itself that was causing cognitive decline in the elderly?

Do Blood Pressure Medications Cause Memory Loss?

blood pressure medicationsA group of scientists in Italy set up a clinical study to determine whether blood pressure or use of blood pressure drugs better correlated with cognitive decline in elderly patients who already have some degree of cognitive impairment (E. Mossello et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2014.8164).

They enrolled 172 patients from 2 outpatient memory clinics in the study. The average age of the participants was 79 and all of them had some degree of cognitive impairment (68% with dementia and 32% with mild cognitive impairment). 70% of the study participants were on blood pressure drugs. Their blood pressure was measured on a daily basis, and they were tested for cognitive function at the beginning of the study and 9 months later.

The results of the study concerning:

  • Those with the lowest blood pressure had the highest rate of cognitive decline over the 9 month period. These results were similar to several previous clinical trials with the elderly.
  • The association between low blood pressure and cognitive decline was only seen in those subjects on blood pressure medications. Low blood pressure did not increase the risk of cognitive decline in unmedicated subjects.

There are, of course, some significant limitations to this study:

  • It is a small study of short duration.
  • It is the first study of its kind. It needs to be repeated.
  • It was done in an elderly population who already suffered from cognitive decline. We don’t yet know to what extent these conclusions will apply to younger people and to people without cognitive impairment.

Is The Cure Worse Than The Disease?

However, this study does raise a huge red flag that needs to be evaluated very carefully. It raises the issue of whether aggressive drug treatment to bring blood pressure under control may, under some conditions, cause more problems than it cures. It is not unlike the study a few years ago showing that aggressive treatment to lower blood sugar levels in type 2 diabetics actually increased the death rate (C. J. Currie et al, The Lancet, 375: 481-489, 2010).

It turns out that increased risk of cognitive decline is just one of several risks associated with aggressive drug treatment to lower blood pressure. Because of that realization an expert panel recently recommended that the threshold for the use of blood pressure drugs be raised from 130/90 to 140/90 for adults under 60 and to 150/90 for adults over 60.

Do blood pressure medications cause memory loss?  It’s not that high blood pressure has suddenly become healthier. Rather, the experts realized that the risks of aggressive drug treatment to lower moderately elevated blood pressure outweighed the benefits. The cure was worse than the disease!

Is There Another Option?

dash dietThe answer is a resounding yes, and we have known about it for years. It is called the DASH (Dietary Approaches To Stop Hypertension) diet. It is recommended by the American Heart Association, the National Heart, Lung & Blood Institute, the USDA 2010 Dietary Guidelines for Americans and the US Guidelines for Treatment of High Blood Pressure). Coupled with a few simple lifestyle changes it has been shown to be as effective as drugs at reducing high blood pressure, without the side effects of the drugs.

You can find the details of the DASH diet here (http://dashdiet.org/), but in simple terms, it is low in fat, high in fresh fruits and vegetable, fiber and low fat dairy products. The recommended lifestyle changes are weight control, restricted sodium intake and exercise.

Although not all experts agree, I personally recommend that you also make sure that you are getting the DV for calcium, magnesium and vitamin D from food and supplements and consider supplementing with long chain omega-3 fatty acids and polyphenols – especially resveratrol and related polyphenols from grape skins and seeds.

 

The Bottom Line

  • High blood pressure is a silent killer because people often don’t know they have it. If left untreated it can cause stroke, heart attack, congestive heart failure and kidney failure.
  • However, a recent study suggested that aggressive drug treatment to treat high blood pressure in the elderly can increase the rate of cognitive decline.
  • Because of this and other risks associated with aggressive drug treatment for high blood pressure, especially in the elderly, an expert panel recently recommended that the threshold for the use of blood pressure drugs be raised from 130/90 to 140/90 for adults under 60 and to 150/90 for adults over 60.
  • It’s not that high blood pressure has suddenly become healthier. Rather, the experts realized that the risks of aggressive drug treatment to lower moderately elevated blood pressure outweighed the benefits. The cure was worse than the disease!
  • Fortunately, there is another option, namely the DASH diet. The DASH diet, along with a few simple lifestyle modifications, has been shown to be as effective as drugs at reducing high blood pressure without the side effects of high blood pressure medications. Both the American Heart Association and the National Heart, Lung and Blood Institute recommend that the DASH diet and lifestyle changes be tried first, before considering use of blood pressure medications.
  • Although not all experts agree, I personally recommend that you also make sure that you are getting the DV for calcium, magnesium and vitamin D from food and supplements and consider supplementing with long chain omega-3 fatty acids and polyphenols – especially resveratrol and related polyphenols from grape skins and seeds.
  • Finally, high blood pressure is dangerous. Don’t ignore it. Get your blood pressure tested regularly. If it is elevated, talk with your doctor about the best combination of diet, and lifestyle change and whether medications are absolutely necessary to keep your blood pressure under control.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Should You Avoid Sugar Completely?

Posted October 24, 2017 by Dr. Steve Chaney

Is It The Sugar, Or Is It The Food?

Author: Dr. Stephen Chaney

 

Should we avoid sugar completely?  Almost every expert agrees that Americans should cut down on the amount of sugar we are consuming. However, for some people this has become a “sugar phobia”. They have sworn that “sugar shall never touch their lips”. Not only do they avoid sugar sweetened sodas and junk food, but they also have become avid label readers. They scour the label of every food they see and reject foods they find any form of sugar listed as an ingredient. Is this degree of sugar avoidance justified?

 

Should We Avoid Sugar to Keep it From Killing Us?

 

Let me add some perspective:

  • If you just take studies about the dangers of sugar at face value, sugar does, indeed, look dangerous. Excess sugar consumption is associated with increased risk of obesity, diabetes, and heart disease. However, when you look a little closer, you find that most of these studies have been done by looking at the correlation of each of these conditions with sugar sweetened beverage consumption (sodas and fruit juices).

A few studies have looked at the correlation of obesity and disease with total “added sugar” consumption. However, 71.6% of added sugar in the American diet comes from sugar sweetened beverages and junk food. None of the studies have looked at the sugar from healthy foods like fruits, vegetables, and whole grains. That’s because there is ample evidence that these foods decrease the risk of obesity, diabetes, and heart disease.

  • For example, if apples had a nutrition label, it would list 16 grams of sugar in a medium 80 calorie apple, which corresponds to about 80% of the calories in that apple. The sugar in an apple is about the same proportion of fructose and glucose found in high fructose corn syrup. Apples are not unique. The nutrition label would read about the same on most other fruits. Does that mean you should avoid sugar from all fruits? I think not.

Avoid Sugar or Avoid Certain Foods

 

avoid sugar from junk foodsThe obvious question is: “Why are the same sugars, in about the same amounts, unhealthy in sodas and healthy in fruits?” Let’s go back to those studies I just mentioned—the ones that are often used to vilify sugars. They are all association studies, the association of sugar intake with obesity and various diseases.

The weakness of association studies is the association could be with something else that is tightly correlated with the variable (sugar intake) that you are measuring. Could it be the food that is the problem, not the sugar?

If we look at healthy foods (fruits, vegetables, whole grains) they are chock full of vitamins, minerals, phytonutrients, fiber, and (sometimes) protein. Fiber and protein slow the absorption of sugar into the bloodstream. As a result, blood sugar levels rise slowly and are sustained at relatively low levels for a substantial period of time.

In sodas there is nothing to slow the absorption of blood sugar. You get rapid rise in blood sugar followed by an equally rapid fall. The same is true of junk foods consisting primarily of sugar, refined flour and/or fat.  Avoid sugar from those types of foods.

Another consideration is something called caloric density. Here is a simple analogy. I used to explain the concept of caloric density to medical students in my teaching days. There are about the same number of calories in a 2-ounce candy bar and a pound of apples (around 278 in the 2-ounce candy bar and 237 in a pound of apples). You can eat a 2-ounce candy bar and still be hungry. If you eat a pound of apples you are done for a while. In this example, the 2-ounce candy bar had a high caloric density (a lot of calories in a small package). Perhaps a more familiar terminology would be the candy bar was just empty calories.

Are Sodas and Junk Foods Killing Us?

avoid sugar from candyPutting all that together, you can start to understand why the foods the sugars are in are more important than the sugars themselves. When you consume sugars in the form of sugar sweetened beverages or sugary junk foods, your appetite increases. We don’t know for sure whether it is the intense sweetness of those foods, the rapid increase and fall in blood sugar, or the high caloric density (lots of calories ina small package) that makes us hungrier. It doesn’t matter. We crave more food, and it isn’t usually fruits, vegetables, and complex carbohydrates we crave. It’s more junk. That sets in motion a predictable sequence of events.

  • We overeat. Those excess calories are stored as fat and we become obese. [Note: The low carb enthusiasts will tell you our fat stores come from carbohydrates alone. That is incorrect. All excess calories, whether from protein, fat, or carbohydrate, are stored as fat.]
  • It’s not just the fat you can see (belly fat) that is the problem. Some of that fat builds up in our liver and muscles. This sets up an unfortunate sequence of metabolic events.
  • The fat stores release inflammatory cytokines into our bloodstream. That causes inflammation. Inflammation increases the risk of many diseases including heart disease and cancer.
  • The fat stores also cause our cells to become resistant to insulin. That reduces the ability of our cells to take up glucose, which leads to hyperglycemia and type 2 diabetes. [Note: The low carb enthusiasts will tell you carbohydrates cause type 2 diabetes. That is also incorrect. It is our fat stores that cause insulin resistance and type 2 diabetes. Our fat stores come from all excess calories, not just excess calories from carbohydrates.]
  • Insulin resistance also causes the liver to overproduce cholesterol and triglycerides and pump them into the bloodstream. That increases the risk of heart disease.
  • Sugar sweetened beverages and sugary junk foods also displace healthier foods from our diet. That leads to potential nutrient shortfalls that can increase our risk of many diseases.

However, none of this has to happen. The one thing that every successful diet has in common is the elimination of sodas, junk foods, fast foods and convenience foods. You should avoid sugar from those foods as much as possible. Once you eliminate those from your diet,you significantly enhance your chances of being at a healthy weight and being healthy long term.

 

What About Protein Supplements And Similar Foods?

Of course, the dilemma is what you, as an intrepid label reader, should do about protein supplements, meal replacement bars, or snack bars. They are supposed to be healthy, but the label lists one or more sugars. Even worse, the sugar content is higher than your favorite health guru recommends.  So, should you avoid sugar from supplements and the like?

In this case, a more useful concept is glycemic index, which is a measure of the effect of the food on your blood sugar levels. Healthy foods like apples may have a high sugar content, but they havea low glycemic index.

avoid sugar and consume protein to slow absorbptionThe same is true for the protein supplements and bars you are considering. Rather than looking at the sugar content, you should be looking for the term “low glycemic” on the label. That means there is enough fiber and protein in the food to slow the absorption of sugar into the bloodstream and stabilize your blood sugar levels.

What Does This Mean For You?

Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should work on ways to avoid sugar or reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners. I have warned about the dangers of artificial sweeteners previously.

We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. For example, some Starbucks drinks are mostly sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

So we don’t have to avoid sugar completely, but we should reduce sugar from sugar sweetened beverages and junk food.

 

The Bottom Line

 

We need to keep warnings about the dangers of sugar in perspective:

  • The studies showing that sugar consumption leads to obesity, diabetes, and heart disease have all been done with sodas and junk foods.
  • Many fruits have just as much sugar as a soda. They also contain about the same proportion of fructose and glucose as high fructose corn syrup. Yet we know fruits are good for us.
  • Diets rich in fruits, vegetables and whole grains decrease our risk of obesity, diabetes, and heart disease.
  • That is because the sugar in whole foods is generally present along with fiber and protein, which slows the absorption of sugar and prevents the blood sugar spikes we get with sodas and junk foods.
  • In the case of prepared foods like protein supplements, you should look for “low glycemic” on the label rather than sugar content. Low glycemic means that there is enough fiber and protein in the product to slow the absorption of sugar and prevent blood sugar spikes.
  • Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should all work on ways to avoid sugar from junk foods or to reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners.
  • We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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