Are Seniors Taking Too Many Medications?

Written by Dr. Steve Chaney on . Posted in Medications

The Dangers of Polypharmacy

Author: Dr. Stephen Chaney

 

seniors taking too much medicationModern medicines are truly miraculous. They control the  symptoms associated with many major diseases. At their best they  save lives. But have we become too reliant on medications to cure  everything that ails us?

Every medication has side effects, and many medications interact  with each other in harmful ways. That has become a major concern for our senior citizens because many of them end up on 5 or more medications, something the  medical profession refers to as polypharmacy.

Why Are Seniors Taking So Many Medications?

It starts innocently enough:

  • antioxidant aging Your cholesterol edges up a bit, and your physician recommends  that you go on a statin to reduce your risk of a heart attack. This  is in spite of the fact that it has been almost impossible to prove  that statins actually decrease heart attack risk in people who  have not yet had a heart attack (See “Do Statins Really Work?”  (https://healthtipsfromtheprofessor.com/cholesterol‐lowering‐ drugs‐right/) and “Does An Apple A Day Keep Statins Away?”  (https://healthtipsfromtheprofessor.com/apple‐day‐keep‐statins‐ away/))
  •  Sometimes your cholesterol may not even be elevated. In today’s world statins are often recommended if you are over a certain  age, are overweight, and have some other risk factor such as pre‐ diabetes or high blood pressure.
  •  Your blood pressure starts to inch up (something that happens to most people as they get  older), and your physician recommends one or two blood pressure medications.
  •  Your blood sugar gets a bit high, and your physician recommends a drug to control your  blood sugar to prevent your pre‐diabetes from turning into diabetes.
  •  Perhaps you develop a minor arrhythmia (something else that often happens as we get  older), and your physician recommends one drug to control your heart’s rhythm and  another drug to thin your blood.

Before you know it you are on several medications. As if that weren’t bad enough, each of these  medications has side effects, so you often need to add other medications to control the side effects  of the original medications. For example:

  •  Perhaps you develop heartburn, gas, and/or bloating from the statin, so your physician recommends a drug to control those side effects.
  •  Perhaps you develop headaches, depression, or g.i. symptoms from your blood pressure medication, and your physician gives you one or more drugs to control those symptoms.

I could go on, but I think you get the point. It is easy for senior citizens to end up on multiple  medications. The question is whether that is a good thing or a bad thing.

Are Seniors Taking Too Many Medications?

are supplements dangerousA recent study (Qato et al, JAMA Internal Medicine,  doi:10.1001/jamainternmed.2015.8581, published online March 21, 2016) shows just how big a problem this has  become. The authors conducted a longitudinal, nationally  representative sampling of community‐dwelling adults  aged 62 to 85 years old. They conducted in‐home  interviews that included medication inspections with  2351 participants in 2005‐2006 and again with another  2206 participants 5 years later in 2010‐2011.  The results were startling:

  •  Simultaneous use of at least 5 prescription medications increased from 30.6% in 2005‐ 2006 to 35.8% in 2010‐2011.   That is a 17% increase in just 5 years!
  •  The percentage of adults using medication combinations with the potential for major drug‐ drug interactions increased from 8.4% in 2005‐2006 to 15.1% in 2010‐2011.   That’s almost double in just the last 5 years! To put that into perspective, it means that almost 1 out of every 6 seniors in this  country is at risk of major drug‐drug interactions.
  •  Most of those dangerous interactions were due to physician prescribed medications,  although interactions with over the counter medications also contributed to the total.

The authors of the study concluded “These findings suggest that unsafe use of multiple  medications is a growing public health problem.”

The Most Dangerous Drug­-Drug Interactions

The problem is that these drug‐drug interactions aren’t minor  inconveniences. They can kill you. Here are some of the more  dangerous drug‐drug interactions the authors listed:  Let’s start with those drug‐drug interactions for physician‐ prescribed medication.

  •  Statins used in combination with some blood pressure  medications or with Coumadin can lead to excessive  bleeding, muscle damage and kidney failure.
  •  The combination of those same blood pressure medications with anti‐platelet blood  thinning medications like Plavix dramatically increases the risk of a heart attack and death.

DangerAnd, it’s not just interactions of physician‐prescribed drugs that are of concern. Interactions  between physician‐prescribed drugs and over the counter medications can be equally dangerous.

These interactions are particularly insidious because patients often don’t tell their doctors about  over the counter medications they are using. For example:

  •  The combination of blood thinners with pain relievers such as aspirin or Aleve generally  leads to excessive bleeding.
  •  However, the combination of certain anti‐platelet blood thinning medications such as  Plavix and either pain medications like Aleve or acid reflux medications like Prilosec can  have the opposite effect – causing blot clot formation (such as deep vein thrombosis)  which can lead to heart attacks and cardiovascular death.

Is There a Better Way?

age-related muscle lossIn an editorial that accompanied this study (JAMA Internal  Medicine, doi:10.1001/jamainternalmedicine.2015.8597)  Dr. Michael A, Steinman said “There are many older adults  who would be healthier if they threw away half of their  medications. Yet, there are people with multiple chronic  diseases who can benefit from multidrug therapy…We  [currently] do not have methods that allow us to reliably  evaluate medication therapy…for the outcomes that really  matter, namely whether a drug is actually helping the  patient, causing adverse effects, or is necessary at all.”

If your doctor doesn’t really know for sure whether the medications you are taking help you, hurt you, or have no effect, you might be wondering whether  there is a better way. The answer is a clear YES!

  •  Multiple studies have shown that lifestyle change is more effective than medications for  keeping blood pressure under control (for example: Guzman‐Castillo et al, BMJ Open,  doi:10.1136/bmjopen‐2014‐006070).
  •  Studies have also shown that lifestyle change is more effective than medications for  controlling diabetes (for example: Knowler et al, New England Journal of Medicine, 346:  393‐403, 2002).
  •  The evidence for heart disease is so strong that both the National Institutes of Health and  the American Heart Association recommend that a little TLC (Therapeutic Lifestyle  Change) be tried before resorting to statins and other medications to lower cholesterol and reduce heart attack risk (http://www.nhlbi.nih.gov/health/resources/heart/cholesterol‐ tlc).

Fortunately, you don’t need different lifestyle changes for different diseases. One size fits all!  I  have talked about a healthy lifestyle in great detail in past issues of “Health Tips From the  Professor.”  In brief, a healthy lifestyle consists of a  mostly plant‐based diet with healthy fats, healthy carbohydrates, and healthy proteins. Then add  in exercise, weight control, and appropriate supplementation and you have a winning  combination.

Why risk the dangers of multiple medications when there is a better way?

The Bottom Line

  1.  A recent study has clearly demonstrated that the use of multiple medications in senior  citizens aged 62 and older is starting to reach dangerous levels. Between 2005 and 2010:
    •  The percentage of seniors using 5 or more medications has increased from 30.6% to  35.8%. That’s a 17% increase in just 5 years.
    •  The percentage of seniors using medication combinations with the potential for  major drug‐drug interactions has increased from 8.4% to 15.1%. That’s almost  double and represents 1 out of every 6 senior citizens.
  2. These dangerous drug interactions aren’t trivial. They include excessive bleeding, heart  attack and stroke, renal failure and death, just to name a few.
  3.  There is a better way. Studies have shown that lifestyle change is more effective than  medication at controlling many chronic diseases such as heart disease, high blood pressure,  and diabetes. Lifestyle change has no side effects and no dangerous interactions. More  importantly, you don’t need different lifestyle changes for different diseases. One size fits  all! I have talked about a healthy lifestyle in great detail in past issues of “Health Tips From  the Professor” (https://healthtipsfromtheprofessor.com). In brief, a healthy lifestyle  consists of:
    •  A mostly plant based diet that includes healthy fats, healthy carbohydrates, and  healthy proteins.
    •  Exercise, weight control, and appropriate supplementation.
  4.  So if you or someone you love are taking multiple medications, talk with your doctor about  the lifestyle changes that you are willing to make. Most doctors would be delighted to  reduce the medications you are taking if you are willing to do your part.

 

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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Latest Article

Should We Use Supplements For Cardiovascular Health?

Posted July 10, 2018 by Dr. Steve Chaney

Are You Just Wasting Your Money On Supplements?

Author: Dr. Stephen Chaney

 

supplements for cardiovascular health wast moneyYou’ve seen the headlines. “Recent Study Finds Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.”  You are being told that supplements are of no benefit to you. They are a waste of money. You should follow a healthy diet instead. Is all of this true?

If I were like most bloggers, I would give you a simple yes or no answer that would be only partially correct. Instead, I am going to put the study behind these headlines into perspective. I am going to give you a deeper understanding of supplementation, so you can make better choices for your health.

 Should we use supplements for cardiovascular health?

In today’s article I will give you a brief overview of the subject. Here are the topics I will cover today:

  • Is this fake news?
  • Did the study ask the right questions?
  • Is this a question of “Garbage In – Garbage Out?
  • Reducing Heart Disease Risk. What you need to know.

All these topics are covered in much more detail (with references) in my book “Slaying The Supplement Myths”, which will be published this fall.

 

How Was This Study Done?

supplements for cardiovascular healthThis study (D.J.A. Jenkins et al, Journal of the American College Of Cardiology, 71: 2540-2584, 2018 ) was a meta-analysis. Simply put, that means the authors combined the results of many previous studies into a single database to increase the statistical power of their conclusions. This study included 127 randomized control trials published between 2012 and December 2017. These were all studies that included supplementation and looked at cardiovascular end points, cancer end points or overall mortality.

Before looking at the results, it is instructive to look at the strengths and weaknesses of the study. Rather than giving you my interpretation, let me summarize what the authors said about strengths and weaknesses of their own study.

The strengths are obvious. Randomized control trials are considered the gold standard of evidence-based medicine, but they have their weaknesses. Here is what the authors said about the limitations of their study:

  • “Randomized control trials are of shorter duration, whereas longer duration studies might be required to fully capture chronic disease risk.”
  • “Dose-response data were not usually available [from the randomized control studies included in their analysis]. However, larger studies would allow the effect of dose to be assessed.”

There are some other limitations of this study, which I will point out below.

Is This Fake News?

supplements for cardiovascular health fake newsWhen I talk about “fake news” I am referring to the headlines, not to the study behind the headlines. The headlines were definitive: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” However, when you read the study the reality is quite different:

  • In contrast to the negative headlines, the study reported:
    • Folic acid supplementation decreased stroke risk by 20% and overall heart disease risk by 17%.
    • B complex supplements containing folic acid, B6, and B12 decreased stroke risk by 10%.
    • That’s a big deal, but somehow the headlines forgot to mention it.
  • The supplements that had no significant effect on heart disease risk (multivitamins, vitamin D, calcium, and vitamin C) were ones that would not be expected to lower heart disease risk. There was little evidence from previous studies of decreased risk. Furthermore, there is no plausible mechanism for supposing they might decrease heart disease risk.
  • The study did not include vitamin E or omega-3 supplements, which are the ones most likely to prove effective in decreasing heart disease risk when the studies are done properly (see below).

Did The Study Ask The Right Question?

Most of the studies included in this meta-analysis were asking whether a supplement decreased heart disease risk or mortality for everyone. Simply put, the studies started with a group of generally healthy Americans and asked whether supplementation had a significant effect on disease risk for everyone in that population.

That is the wrong question. We should not expect supplementation to benefit everyone equally. Instead, we should be asking who is most likely to benefit from supplementation and design our clinical studies to test whether those people benefit from supplementation.

supplements for cardiovascular health diagramI have created the graphic on the right as a guide to help answer the question of “Who is most likely to benefit from supplementation?”. Let me summarize each of the points using folic acid as the example.

 

Poor Diet: It only makes sense that those people who are deficient in folate from foods are the most likely to benefit from folic acid supplementation. Think about it for a minute. Would you really expect people who are already getting plenty of folate from their diet to obtain additional benefits from folic acid supplementation?

The NIH estimates that around 20% of US women of childbearing age are deficient in folic acid. For other segments of our population, dietary folate insufficiency ranges from 5-10%. Yet, most studies of folic acid supplementation lump everyone together – even though 80-95% of the US population is already getting enough folate through foods, food fortification, and supplementation. It is no wonder most studies fail to find a beneficial effect of folic acid supplementation.

The authors of the meta-analysis I discussed above said that the beneficial effects of folic acid they saw might have been influenced by a very large Chinese study, because a much higher percentage of Chinese are deficient in folic acid. They went on to say that the Chinese study needed to be repeated in this country.

In fact, the US study has already been done. A large study called “The Heart Outcomes Prevention Evaluation (HOPE)” study reported that folic acid supplementation did not reduce heart disease risk in the whole population. However, when the study focused on the subgroup of subjects who were folate-deficient at the beginning of the study, folic acid supplementation significantly decreased their risk of heart attack and cardiovascular death.  This would seem to suggest using supplements for cardiovascular health is a good idea.

Increased Need: There are many factors that increase the need for certain nutrients. However, for the sake of simplicity, let’s only focus on medications. Medications that interfere with folic acid metabolism include anticonvulsants, metformin (used to treat diabetes), methotrexate and sulfasalazine (used to treat severe inflammation), birth control pills, and some diuretics. Use of these medications is not a concern when the diet is adequate. However, when you combine medication use with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial.

Genetic Predisposition: The best known genetic defect affecting folic acid metabolism is MTHFR. MTHFR deficiency does not mean you have a specific need for methylfolate. However, it does increase your need for folic acid. Again, this is not a concern when the diet is adequate. However, when you combine MTHFR deficiency with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial. I cover this topic in great detail in my upcoming book, “Slaying The Supplement Myths”. In the meantime, you might wish to view my video, “The Truth About Methyl Folate.”

Diseases: An underlying disease or predisposition to disease often increases the need for one or more nutrients that help reduce disease risk. The best examples of this are two major studies on the effect of vitamin E on heart disease risk in women. Both studies found no effect of vitamin E on heart disease risk in the whole population. However, one study reported that vitamin E reduced heart disease risk in the subgroup of women who were post-menopausal (when the risk of heart disease skyrockets). The other study found that vitamin E reduced heart attack risk in the subgroup of women who had pre-existing heart disease at the beginning of the study.

Finally, if you look at the diagram closely, you will notice a red circle in the middle. When two or three of these factors overlap, that is the “sweet spot” where supplementation is almost certain to make a difference and it may be a good idea to use supplements for cardiovascular health.

Is This A Question Of “Garbage In, Garbage Out”?

supplements for cardiovascular health garbage in outUnfortunately, most clinical studies focus on the “Does everyone benefit from supplementation question?” rather than the “Who benefits from supplementation?” question.

In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.

Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.

 

Should We Use Supplements For Cardiovascular Health?

 

If you want to know whether supplements decrease heart disease risk for everyone, this meta-analysis is clear. Folic acid may decrease the risk of stroke and heart disease. A B complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but the analysis did not include vitamin E and/or omega-3s.

However, if you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.

I would be remiss, however, if I failed to point out that we know healthy diets can decrease heart disease risk. In the words of the authors: “The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with [heart disease] risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and meat, but high in fruits and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet. These diets, with their accompanying recommendations, continue the move towards more plant-based diets…” I cover the effect of diet on heart disease risk in detail in my book, “Slaying The Food Myths”.

 

The Bottom Line

 

You have probably seen the recent headlines proclaiming: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” The study behind the headlines was a meta-analysis of 127 randomized control trials looking at the effect of supplementation on heart disease risk and mortality.

  • The headlines qualify as “fake news” because:
    • The study found that folic acid decreased stroke and heart disease risk, and B vitamins decreased stroke risk. Somehow the headlines forgot to mention that.
    • The study found that multivitamins, vitamin D, calcium, and vitamin C had no effect on heart disease risk. These are nutrients that were unlikely to decrease heart disease risk to begin with.
    • The study did not include vitamin E and omega-3s. These are nutrients that are likely to decrease heart disease risk when the studies are done properly.
  • The authors of the study stated that a major weakness of their study was that that randomized control studies included in their analysis were short term, whereas longer duration studies might be required to fully capture chronic disease risk.
  • The study behind the headlines is of little use for you as an individual because it asked the wrong question.
  • Most clinical studies focus on the “Does everyone benefit from supplementation question?” That is the wrong question. Instead we need more clinical studies focused on the “Who benefits from supplementation?” question. I discuss that question in more detail in the article above.
  • In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.
  • Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.
  • If you want to know whether supplements decrease heart disease risk for everyone, this study is clear. Folic acid may decrease the risk of stroke and heart disease. A B-complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but they did not include vitamin E and/or omega-3s in their analysis.
  • If you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.
  • However, we do know that healthy, plant-based diets can decrease heart disease risk. I cover heart healthy diets in detail in my book, “Slaying The Food Myths.”

 

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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