Caution – Nexium, Prilosec and Similar Meds Are Associated with Dementia, and Other Problems

A recent study of drugs to reduce stomach acidity is causing doctors and patients to reevaluate their use.  These drugs are known as proton pump inhibitors (PPIs); they are commonly used to reduce the discomfort of ‘heartburn’, a form of indigestion felt as a burning sensation in the chest, caused by acid regurgitation into the esophagus.  PPIs can be very important in cases of stomach ulcers or precancerous changes in the esophagus.  However, heartburn can be treated in other ways, as explained below.

Increased risk of Dementia: Here is a summary of the recent study that has raised awareness about the dangerous side effects of PPI drugs.  Older adults who use PPIs may be at increased risk for developing dementia, according to an observational study in JAMA Neurology.

Using claims from a large German health insurer, researchers studied nearly 74,000 adults aged 75 and older without dementia in 2004. By 2011, roughly 40% were diagnosed with dementia. Overall, 4% of participants used PPIs regularly during at least one 12-to-18-month interval during the study period.

After adjustment for confounders, including age, other drugs used, stroke, and depression, PPI use was associated with a 44% increased risk for incident dementia.

As potential mechanisms of action, the authors cite evidence suggesting that some PPIs can cross the blood-brain barrier and affect brain enzyme levels. They call for randomized trials to confirm their observational findings.

Other risks : Prolonged use of PPIs has been associated with iron and vitamin B12 deficiencies, low blood magnesium, osteoporosis-related fractures, small intestinal bacterial overgrowth, and community-acquired pneumonia.  These effects are believed to be related to changes in the intestinal bacteria (the microbiome) due to acid suppression. In the case of pneumonia, it may be due to growth of bacteria in the stomach and lungs because of insufficient stomach acidity. Whether less potent acid inhibitors like histamine H2 antagonists, cause similar changes to the microbiome is unknown. These drugs, such as Tagamet, Pepsid, or Xantac, act within an hour or less to decrease stomach acidity, and wear off within 12 hours.  They can be used intermittently, as needed, whereas PPIs are commonly used long term.

Home Remedies for heartburn

• Eat smaller portions at meals • Consume less fat • Avoid lying down for at least 2 hours after eating (avoid late-night snacks) • Wear loose fitting clothing • Elevate the head of the bed about 6 inches (this is best done by placing a block under the headboard, rather than stacking pillows) • Use a ‘bedlounger pillow’ or sleep in a reclining chair. Lose weight if needed (as little as 5 to 10 pounds may help) • Avoid alcohol, tobacco and foods that trigger symptoms, Chew gum (xylitol gum – available at the People’s store or online as Spry) is helpful when heartburn strikes.  Sip an ounce or two of water with added baking soda.

Because PPIs are among the most widely sold drugs in the world, the news about increased dementia risk and other complications is very important.  Be sure to talk to your doctor, nurse practitioner or physician’s assistant about your questions.  Here’s to a healthier you!

Sadja Greenwood, MD, MPH

Ginger – Medicinal Uses for its Peppery Zing

Ginger has long been known to help with nausea, from motion sickness to pregnancy.  A recent study from the University of Rochester showed that ginger capsules significantly reduced nausea severity due to chemotherapy, and that anticipatory nausea was a key factor in the severity of the problem for patients. 

Working with mice, researchers in Taiwan found that an extract of ginger blocked the toxin responsible for diarrhea caused by toxic strains of E. coli, which causes millions of cases of diarrhea worldwide each year, and many infant deaths in poor countries.

If confirmed by further studies, the findings could lead to an inexpensive, easy-to-obtain alternative to drug therapy for the condition, the researchers say. Additional studies are needed to determine the effective doses of ginger needed and whether it is safe for infants, who may experience unexpected side effects from large doses.

 Researchers at Columbia University shows purified components of ginger may have properties that help asthma patients breathe more easily. Asthma is characterized by bronchoconstriction, a tightening of the bronchial tubes that carry air into and out of the lungs. Bronchodilating medications (beta-agonists) work by relaxing the airway’s smooth muscle tissues. This study looked at whether specific components of ginger could help enhance the relaxing effects of bronchodilators. They found that ginger constituents 6-gingerol, 8-gingerol and 6-shogaol act synergistically with the β-agonist in relaxing the airway’s smooth muscles. The researchers at Columbia plan future studies to get a better understanding of the cellular mechanisms involved and to determine whether aerosol delivery of purified constituents of ginger may have therapeutic benefit in asthma and other bronchoconstrictive diseases.

For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise. Researchers directed two studies examining the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain. Participants in the studies, 34 and 40 volunteers, respectively, consumed capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow flexors with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise. The studies showed that daily ginger use reduced the exercise-induced pain by 25 percent, and this effect was not enhanced by heat-treating the ginger.

News from Women on Web

Since abortion is totally illegal in Poland, Women on Web people in Germany are sending medical abortion pills across the border by drone.  Apparently the senders and receivers are in visual contact.  In Brazil, and other Latin American countries where abortion is illegal and/or inaccessible, Women on Web is making medical abortion pills available – by mail – at greatly reduced rates or free if necessary.  Many pregnant women are terrified by the problem of microcephaly due to the zika virus.  Medical abortions must be done in the first 9 weeks.  You can support the work of Women on Web or Women on Waves if you are so inclined.  They give accurate information and have saved many women from dangerous, do-it-yourself abortion attempts.

Sadja Greenwood, MD, MPH

Cinnamon - Some Unexpected Findings

Cinnamon has been used since remote antiquity as a spice, a food preservative and a medicine. The kind we usually buy is Cassia Cinnamon - the bark of a tree grown mainly in China and Indonesia.  Cinnamon from Sri Lanka – so called Ceylon Cinnamon, is more expensive; it is prized for its flavor and its low content of a substance called coumarin.  Coumarin is a fragrant chemical compound found in many plants.  In high doses it may be toxic to the liver, and may have anticoagulant properties.  Cassia cinnamon has more coumarin, while Ceylon cinnamon has very little.  This is not a problem for most people, using cinnamon as a flavoring in the kitchen.  People with liver disease or on anticogulants should not use large amounts of Cassia cinnamon as a medicine.

Colorectal Cancer – in mice:  Adding cinnamaldehyde, the compound that gives cinnamon its distinctive flavor and smell, to the diet of mice, scientists at the University of Arizona found that mice were protected against colorectal cancer. In response to cinnamaldehyde, the animals' cells acquired the ability to protect themselves against exposure to a carcinogen through detoxification and repair.  The study appeared in Cancer Prevention Research in 2015.

The next step in the research is to test whether cinnamon, as opposed to cinnamaldehyde, prevents cancer using this same cancer model. Human studies have not been reported

Polycystic Ovary Syndrome: Women with this problem have enlarged ovaries with multiple cysts, infrequent menstrual periods, excess hair growth and sometimes obesity.  Previous research has shown that the use of cinnamon can reduce insulin resistance in women with PCOS.  Researchers from Columbia University enrolled 45 women with PCOS into a 6 month trial; those who received cinnamon had more regular menstrual cycles than women who were given placebo. The cinnamon group had 3.82 menstrual cycles during the 6 month trial, while women in the control group only had 2.2 cycles. Two of the women in the treatment group reported spontaneous pregnancies during the trial. "Though small, this rather elegant study shows that cinnamon may be an effective and inexpensive treatment for PCOS patients," said Steven T. Nakajima, MD, President of the Society for Reproductive Endocrinology and Infertility.  He is currently at Stanford.

Parkinson’s Disease – Study in mice: Scientist at Rush University Medical Center used cinnamon to treat the brain changes in mice with Parkinson’s disease (Journal of Neuroimmune Pharmacology, 2014). The study, supported by grants from National Institutes of Health, found that after oral feeding, ground Ceylon cinnamon was metabolized into sodium benzoate, which entered the brain, stopped the loss of important neurons, normalized neurotransmitter levels, and improved motor functions in mice with PD.  The researchers hope to translate their findings into human studies.

Cinnamon in type 2 Diabetes: Cinnamon has been said to lower blood sugar levels, but studies showing this effect have been small, with conflicting results.  Researchers at the College of Pharmacy, Western University of Health Sciences, looked at all published studies in a systematic review of cinnamon’s effect on blood sugar and lipid levels.  They found that the consumption of cinnamon in various trials resulted in a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A1c was found. They concluded that the variability found in these studies may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear.

Writing this column made me want to investigate the properties of Ceylon cinnamon.  It is available for about $15 on the internet – for ½ pound, which should last a long time.  You can find 2 ounces for less than $5.  Whichever kind you use, think of the long past history of this spice –Egyptians used it for enbalming in 2000 BCE; Nero burned it on the pyre of his second wife to atone for his role in her death; Arab traders brought it to Europe, Portuguese and Dutch traders fought over Ceylon. 

Sadja Greenwood MD, MPH - back issues on this blog

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Update on the Benefits of Coffee, Fiber and Oregano

In a study from the Harvard School of Public Health, people who regularly drank moderate amounts of coffee daily --less than 5 cups per day -- experienced a lower risk of deaths from cardiovascular disease, neurological diseases, Type 2 diabetes and suicide.  The benefit held true for caffeinated and decaffeinated coffee, suggesting it's not just the caffeine providing health perks but possibly the naturally occurring chemical compounds in the coffee beans. The findings are based on data from three large ongoing studies: 74,890 women in the Nurses' Health Study; 93,054 women in the Nurses' Health Study 2; and 40,557 men in the Health Professionals Follow-up Study.  The study’ first author, Dr. Ming Ding, wrote that bioactive compounds in coffee reduce insulin resistance and systematic inflammation. In general, people who frequently drank coffee were more likely to smoke and drink alcohol. To separate the effects of coffee from smoking, researchers repeated their analysis among never-smokers, and found that the protective benefits of coffee on deaths became even more evident.  The researchers warned that some people should be cautious about their caffeine intake, such as children and pregnant women

Women who eat more high-fiber foods during adolescence and young adulthood--especially lots of fruits and vegetables--may have significantly lower breast cancer risk than those who eat less dietary fiber when young, according to a new large-scale study led by Maryam Farvid at Harvard School of Public Health. Among all the women, there was a strong inverse association between fiber intake and breast cancer incidence. For each additional 10 grams of fiber intake daily--for example, about one apple and two slices of whole wheat bread, or about half a cup each of cooked kidney beans and cooked cauliflower or squash--during early adulthood, breast cancer risk dropped by 13%. The greatest apparent benefit came from fruit and vegetable fiber. The authors speculated that eating more fiber-rich foods may lessen breast cancer risk partly by helping to reduce high estrogen levels in the blood, which are strongly linked with breast cancer development.

Fiber intake is also associated with longevity – studies show a reduced risk of cardiovascular, respiratory and infectious diseases.  Fiber intake also lessens the risk of type 2 diabetes and obesity; intestinal bacteria (the microbiome again!) ferment dietary fiber and reduce the amount of glucose absorbed into the blood.

Oregano: Dr. Supriya Bavadekar, at Long Island University, is currently testing carvacrol, a constituent of oregano, on prostate cancer cells. The results of her study demonstrate that the compound induces apoptosis (cancer cell death) in these cells. Dr. Bavadekar and her group are presently trying to determine the signaling pathways that the compound employs to bring about cancer cell suicide. "We know that oregano possesses anti-bacterial as well as anti-inflammatory properties, but its effects on cancer cells really elevate the spice to the level of a super-spice like turmeric," said Dr. Bavadekar. "Some researchers have previously shown that eating pizza may cut down cancer risk. This effect has been mostly attributed to lycopene, a substance found in tomato sauce, but we now feel that even the oregano seasoning may play a role," stated Dr. Bavadekar. More work is needed on this promising finding.   Recent studies also indicate that oregano may inhibit liver cancer, breast cancer and foodborne bacteria.   

 Many herbs have an anti-inflammatory effect that make them helpful against a variety of health problems.  Tune in next week for an update on turmeric, cinnamon, ginger and coriander. 

Sadja Greenwood, MD, MPH back issues on this blog

New Year's Resolution #3 - Find an Enjoyable Way to Move Your Body

Here are some suggestions from the experts:

*If you haven’t been exercising, check in with the clinic to make sure your plan is safe and right for you.

*While 30 minutes a day is widely recommended for dedicated exercise, this can be broken into shorter times. In a study conducted at the University of Virginia, exercise physiologist Glenn Gaesser, PhD, asked men and women to complete 15 10-minute exercise routines a week. After just 21 days, the volunteers' aerobic fitness was equal to that of people 10 to 15 years younger. Their strength, muscular endurance, and flexibility were equal to those of people up to 20 years their junior. "It would be useful for people to get out of the all-or-nothing mind-set that unless they exercise for 30 minutes, they're wasting their time," says Gaesser.

*From a wise website called Zen Habits: when you make an exercise plan:

*write it down, and post it up.  

*Set an easy goal – like 5 minutes of exercise a day.  

*You can build a habit, and gradually increase it.  

*Be specific about what you are going to do, and when.  

*Have a trigger – such as breakfast – always exercise after breakfast – or any other daily event.

*Know exactly what your goal is – walk around one block, do 5 pushups from the sink, dance for 10 minutes to your favorite music.  *Stick to your goal for a month, before changing it.  

*Log your daily habit right after you do it.  

*Report it to others in your friendship group or family, by phone, email or just plain talk. Arrange in advance that this person will expect a daily report from you.  Reward yourself for your progress with something you love, like a great movie, or a dinner with friends (make it healthy!).

*Here are some ways to exercise that work for me:  I ride my stationary bike while I watch television or a movie.  I’m slow, but I can bike 6-8 miles without noticing it, and I feel great afterwards.  I keep 4 pound weights by my bedside, and do arm exercises while listening to music.  I dance to the California Cajun Orchestra – an easy Cajun line dance step I’m happy to teach anyone who give me a call (868-0493).  I walk the shaded streets of Bolinas to clear my mind. 

Sadja Greenwood: MD, MPH

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