Getting Off The Overmedication Train

The older we get, the more likely we are to be on more medications. It’s easy to assume that this is because, much like the ailments they treat, we accumulate them over time. And superficially at least, that’s what happens.

And yet, almost half of people over 65 in Canada are taking “potentially inappropriate medications”, or PIMs—in other words, medications that are not needed and perhaps harmful. This categorization includes medications where the iatrogenic harms (side effects, risks) outweigh the benefits, and/or there’s a safer more effective medication available to do the job.

See: The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study

You may be wondering: what does this mean for the US?

Well, we don’t have the figures for the US because we’re working from Canadian research today, but given the differences between the two country’s healthcare systems (mostly socialized in Canada and mostly private in the US), it seems a fair hypothesis that if it’s almost half in Canada, it’s probably more than half in the US. Socialized healthcare systems are generally quite thrifty and seek to spend less on healthcare, while private healthcare systems are generally keen to upsell to new products/services.

The three top categories of PIMs according to the above study:

1. Gabapentinoids (anticonvulsants also used to treat neuropathic pain)
2. Proton pump inhibitors (PPIs)
3. Antipsychotics (especially, to people without psychosis)

…but those are just the top of the list; there are many many more.

The list continues: opioids, anticholinergics, sulfonlyurea, NSAIDs, benzodiazepines and related rugs, and cholinesterase inhibitors. That’s where the Canadian study cuts off (although it also includes “others” just before NSAIDs), but still, you guessed it, there are more (we’re willing to bet statins weigh heavily in the “others” section, for a start).

There are two likely main causes of overmedication:

The side effect train

This is where a patient has a condition and is prescribed drug A, which has some undesired side effects, so the patient is prescribed drug B to treat those. However, that drug also has some unwanted side effects of its own, so the patient is prescribed drug C to treat those. And so on.

For a real-life rundown of how this can play out, check out the case study in:

The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

The convenience factor

No, not convenient for you. Convenient for others. Convenient for the doctor if it gets you out of their office (socialized healthcare) or because it was easy to sell (private healthcare). Convenient for the staff in a hospital or other care facility.

This latter is what happens when, for example, a patient is being too much trouble, so the staff give them promazine “to help them settle down”, notwithstanding that promazine is, besides being a sedative, also an antipsychotic whose common side effects include amenorrhea, arrhythmias, constipation, drowsiness and dizziness, dry mouth, impotence, tiredness, galactorrhoea, gynecomastia, hyperglycemia, insomnia, hypotension, seizures, tremor, vomiting and weight gain.

This kind of thing (and worse) happens more often towards the end of a patient’s life; indeed, sometimes precipitating that end, whether you want it or not:

Mortality, Palliative Care, & Euthanasia

How to avoid it

Good practice is to be “open-mindedly skeptical” about any medication. By this we mean, don’t reject it out of hand, but do ask questions about it.

Ask your prescriber not only what it’s for and what it’ll do, but also what the side effects and risks are, and an important question that many people don’t think to ask, and for which doctors thus don’t often have a well-prepared smooth-selling reply, “what will happen if I don’t take this?”

And look up unbiased neutral information about it, from reliable sources (Drugs.com and The BNF are good reference guides for this—and if it’s important to you, check both, in case of any disagreement, as they function under completely different regulatory bodies, the former being American and the latter being British. So if they both agree, it’s surely accurate, according to best current science).

Also: when you are on a medication, keep a journal of your symptoms, as well as a log of your vitals (heart rate, blood pressure, weight, sleep etc) so you know what the medication seems to be helping or harming, and be sure to have a regular meds review with your doctor to check everything’s still right for you. And don’t be afraid to seek a second opinion if you still have doubts.

Want to know more?

For a more in-depth exploration than we have room for here, check out this book that we reviewed not long back:

To Medicate or Not? That is the Question! – by Dr. Asha Bohannon

Take care!

The Iron Dilemma: Factors To Consider

Anemia affects around 10% of American seniors, and that number jumps to 34–39% if there’s a comorbidity such as diabetes, hypertension, or hypercholesterolemia, which in turn climbs with increasing age or with other chronic conditions:

The Prevalence of Anemia and Its Associated Factors among Older Persons: Findings from the National Health and Morbidity Survey

So, what can we do about it?

Get iron yes, but how?

We’d be remiss not to say: yes, do of course make sure you get plenty of iron.

Most people know that red meats, which are terrible for the heart and for cancer risk, are good sources of iron.

Well, good insofar as they provide plenty of it! They’re bad for other reasons.

❝Studies consistently show that consumption of red meat has been contributory to a multitude of chronic conditions such as diabetes, CVD, and malignancies.

There are various emerging reasons that strengthen this link-from the basic constituents of red meat like the heme iron component, the metabolic reactions that take place after consumption, and finally to the methods used to cook it.

The causative links show that even occasional use raises the risk of T2DM.❞

~ Dr. Ranjita Misra et al.

Source: Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities?

To heme or not to heme

Did you catch that in the middle there, about the heme iron component?

Dietary iron is broadly divided into two kinds: heme, and non-heme.

• Heme iron comes from animals
• Non-heme iron comes from plants

Bad news for vegans: non-heme iron is not so easily absorbed as heme iron.

This means that if you’re just eating plants, the RDA may be significantly lowballing the amount actually required. As a rule, about 1.8x more iron may be needed for vegans, to compensate for it being less easily absorbed.

Why this happens: it’s because of the phytic acid / phytate in the plants that contain the iron, blocking its absorption.

Good news for vegans: however, taking iron with vitamin C increases its absorption rate by about 5x better absorption, and several other side-along nutrients do similarly, including allium (from garlic), carotenoids (from many colorful plants), and fermented foods.

Why this happens: it’s because they bind with similar sites as phytic acid, without causing the same effect. To make a metaphor: these foods steal phytic acid’s parking space, so phytic acid can’t do its iron-blocking thing.

By happy coincidence, today’s featured recipe has all of these things in, by the way (vitamin C, allium, carotenoids, and fermented foods), and the star ingredient (fava beans) is a rich source of iron.

What are good sources of iron, then?

In the category of plants:

• Beans (pick your favorites / eat a variety)
• Lentils (pick your favorites / eat a variety)
• Greens (especially dark leafy greens)
• Apricots (you can get these dried, for convenience!)
• Dark chocolate (5mg per 1oz square!)*

*Ok, technically dark chocolate is not a plant; cacao is a plant; dark chocolate is usually plant-based, though, as there is no reason to add milk.

In the category of dairy products:

That’s not a publication error; dairy products are just not great for iron. Cheeses are more nutrient-dense than milk, and have less than 0.5mg per oz, in other words, the top dairy product has around 10x less iron than dark chocolate, which came in 5th place and let’s face it, we were doing broad categories there. If we listed all the beans, lentils, greens, etc it’d be a much longer list.

Eggs, which are sometimes considered under the category of dairy by virtue of not being an animal (yet!) but an animal product, have around 1mg per egg, by the way, so considering eggs are nearer 2oz, that’s not much better than the cheese.

“But what about if…”

The above is good science and general good advice for most people. That said, some people may have conditions that preclude the foods we recommended, or have other considerations, and so things may be different. Anemia can sometimes be caused by things that can’t be fixed by diet (beyond the scope of today’s article; another time, perhaps), but for example, if you have leukemia then definitely discuss things with your doctors first. Other illnesses, and some medications, can also have troublesome effects that can contribute to anemia. Again, we can offer very good general information here, but we don’t know your medical history, and our standard legal/medical disclaimer applies as always.

See also: Do We Need Animal Products To Be Healthy?

Take care!