Are You Taking PIMs?

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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!

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  • Parents are increasingly saying their child is ‘dysregulated’. What does that actually mean?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Welcome aboard the roller coaster of parenthood, where emotions run wild, tantrums reign supreme and love flows deep.

    As children reach toddlerhood and beyond, parents adapt to manage their child’s big emotions and meltdowns. Parenting terminology has adapted too, with more parents describing their child as “dysregulated”.

    But what does this actually mean?

    ShUStudio/Shutterstock

    More than an emotion

    Emotional dysregulation refers to challenges a child faces in recognising and expressing emotions, and managing emotional reactions in social settings.

    This may involve either suppressing emotions or displaying exaggerated and intense emotional responses that get in the way of the child doing what they want or need to do.

    Dysregulation” is more than just feeling an emotion. An emotion is a signal, or cue, that can give us important insights to ourselves and our preferences, desires and goals.

    An emotionally dysregulated brain is overwhelmed and overloaded (often, with distressing emotions like frustration, disappointment and fear) and is ready to fight, flight or freeze.

    Developing emotional regulation

    Emotion regulation is a skill that develops across childhood and is influenced by factors such as the child’s temperament and the emotional environment in which they are raised.

    In the stage of emotional development where emotion regulation is a primary goal (around 3–5 years old), children begin exploring their surroundings and asserting their desires more actively.

    Child sits next to her parent's bed
    A child’s temperament and upbringing affect how they regulate emotions. bluedog studio/Shutterstock

    It’s typical for them to experience emotional dysregulation when their initiatives are thwarted or criticised, leading to occasional tantrums or outbursts.

    A typically developing child will see these types of outbursts reduce as their cognitive abilities become more sophisticated, usually around the age they start school.

    Express, don’t suppress

    Expressing emotions in childhood is crucial for social and emotional development. It involves the ability to convey feelings verbally and through facial expressions and body language.

    When children struggle with emotional expression, it can manifest in various ways, such as difficulty in being understood, flat facial expressions even in emotionally charged situations, challenges in forming close relationships, and indecisiveness.

    Several factors, including anxiety, attention-deficit hyperactivity disorder (ADHD), autism, giftedness, rigidity and both mild and significant trauma experiences, can contribute to these issues.

    Common mistakes parents can make is dismissing emotions, or distracting children away from how they feel.

    These strategies don’t work and increase feelings of overwhelm. In the long term, they fail to equip children with the skills to identify, express and communicate their emotions, making them vulnerable to future emotional difficulties.

    We need to help children move compassionately towards their difficulties, rather than away from them. Parents need to do this for themselves too.

    Caregiving and skill modelling

    Parents are responsible for creating an emotional climate that facilitates the development of emotion regulation skills.

    Parents’ own modelling of emotion regulation when they feel distressed. The way they respond to the expression of emotions in their children, contributes to how children understand and regulate their own emotions.

    Children are hardwired to be attuned to their caregivers’ emotions, moods, and coping as this is integral to their survival. In fact, their biggest threat to a child is their caregiver not being OK.

    Unsafe, unpredictable, or chaotic home environments rarely give children exposure to healthy emotion expression and regulation. Children who go through maltreatment have a harder time controlling their emotions, needing more brainpower for tasks that involve managing feelings. This struggle could lead to more problems with emotions later on, like feeling anxious and hypervigilant to potential threats.

    Recognising and addressing these challenges early on is essential for supporting children’s emotional wellbeing and development.

    A dysregulated brain and body

    When kids enter “fight or flight” mode, they often struggle to cope or listen to reason. When children experience acute stress, they may respond instinctively without pausing to consider strategies or logic.

    If your child is in fight mode, you might observe behaviours such as crying , clenching fists or jaw, kicking, punching, biting, swearing, spitting or screaming.

    In flight mode, they may appear restless, have darting eyes, exhibit excessive fidgeting, breathe rapidly, or try to run away.

    A shut-down response may look like fainting or a panic attack.

    When a child feels threatened, their brain’s frontal lobe, responsible for rational thinking and problem-solving, essentially goes offline.

    The amygdala, shown here in red, triggers survival mode. pikovit/Shutterstock

    This happens when the amygdala, the brain’s alarm system, sends out a false alarm, triggering the survival instinct.

    In this state, a child may not be able to access higher functions like reasoning or decision-making.

    While our instinct might be to immediately fix the problem, staying present with our child during these moments is more effective. It’s about providing support and understanding until they feel safe enough to engage their higher brain functions again.

    Reframe your thinking so you see your child as having a problem – not being the problem.

    Tips for parents

    Take turns discussing the highs and lows of the day at meal times. This is a chance for you to be curious, acknowledge and label feelings, and model that you, too, experience a range of emotions that require you to put into practice skills to cope and has shown evidence in numerous physical, social-emotional, academic and behavioural benefits.

    Family dinner
    Talk about your day over dinner. Monkey Business Images/Shutterstock

    Spending even small amounts (five minutes a day!) of quality one-on-one time with your child is an investment in your child’s emotional wellbeing. Let them pick the activity, do your best to follow their lead, and try to notice and comment on the things they do well, like creative ideas, persevering when things are difficult, and being gentle or kind.

    Take a tip from parents of children with neurodiversity: learn about your unique child. Approaching your child’s emotions, temperament, and behaviours with curiosity can help you to help them develop emotion regulation skills.

    When to get help

    If emotion dysregulation is a persistent issue that is getting in the way of your child feeling happy, calm, or confident – or interfering with learning or important relationships with family members or peers – talk to their GP about engaging with a mental health professional.

    Many families have found parenting programs helpful in creating a climate where emotions can be safely expressed and shared.

    Remember, you can’t pour from an empty cup. Parenting requires you to be your best self and tend to your needs first to see your child flourish.

    Cher McGillivray, Assistant Professor Psychology Department, Bond University and Shawna Mastro Campbell, Assistant Professor Psychology, Bond University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • How To Recover Quickly From A Stomach Bug

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    How To Recover Quickly From A Stomach Bug

    Is it norovirus, or did you just eat something questionable? We’re not doctors, let alone your doctors, and certainly will not try to diagnose from afar. And as ever, if unsure and/or symptoms don’t go away or do get worse, seek professional medical advice.

    That out of the way, we can give some very good general-purpose tips for this one…

    Help your immune system to help you

    So far as you can, you want a happy healthy immune system. For the most part, we’d recommend the following things:

    Beyond Supplements: The Real Immune-Boosters!

    …but you probably don’t want to be exercising with a stomach bug, so perhaps sit that one out. Exercise is the preventative; what you need right now is rest.

    Hydrate—but watch out

    Hydration is critical for recovery especially if you have diarrhea, but drinking too much water too quickly will just make things worse. Great options for getting good hydration more slowly are:

    • Peppermint tea
      • (peppermint also has digestion-settling properties)
    • Ginger tea
    • Broths
      • These will also help replenish your sodium and other nutrients, gently. Chicken soup for your stomach, and all that. A great plant-based option is sweetcorn soup.
      • By broths, we mean clear(ish) water-based soups. This is definitely not the time for creamier soups.

    ❝Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse.

    Initial dietary choices when refeeding should begin with soups and broth.❞

    Source: American College of Gastroenterology

    Other things to avoid

    Caffeine stimulates the digestion in a way that can make things worse.

    Fat is more difficult to digest, and should also be avoided until feeling better.

    To medicate or not to medicate?

    Loperamide (also known by the brand name Imodium) is generally safe when used as directed.

    Click here to see its uses, dosage, side effects, and contraindications

    Antibiotics may be necessary for certain microbial infections, but should not be anyone’s first-choice treatment unless advised otherwise by your doctor/pharmacist.

    Note that if your stomach bug is not something that requires antibiotics, then taking antibiotics can actually make it worse as the antibiotics wipe out your gut bacteria that were busy helping fight whatever’s going wrong in there:

    A gentler helper

    If you want to give your “good bacteria” a hand while giving pathogens a harder time of it, then a much safer home remedy is a little (seriously, do not over do it; we are talking 1–2 tablespoons, or around 20ml) apple cider vinegar, taken diluted in a glass of water.

    ❝Several studies indicate apple cider vinegar (ACV)’s usefulness in lowering postprandial glycemic response, specifically by slowing of gastric motility❞

    (Slowing gastric motility is usually exactly what you want in the case of a stomach bug, and apple cider vinegar)

    Source: Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review

    See also:

    Take care!

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  • Somatic Exercises For Nervous System Regulation – by Rose Kilian

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve written before about the vagus nerve, its importance, and how to make use of it, but it’s easy to let it slip from one’s mind when it comes to exercises. This book fixes that!

    The promised 35 exercises are quite a range, and are organized into sections:

    • Revitalizing through breath
    • Stress and tension release
    • Spinal and postural health
    • Mindfulness and grounding
    • Movements for flexibility
    • Graceful balance and focus

    While it’s not necessary to do all 35 exercises, it’s recommended to do at least some from each section, to “cover one’s bases”, and enjoy the best of all worlds.

    The exercises are drawn from many sources, but tai chi and yoga are certainly the most well-represented. Others, meanwhile, are straight from physiotherapy or are things one might expect to be advised at a neurology consultation.

    Bottom line: if you’d like to take better care of your vagus nerve, the better for it to take care of you, this book can certainly help with that.

    Click here to check out Somatic Exercises For Nervous System Regulation, and take care of yourself!

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  • The Problem With Sweeteners

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The WHO’s new view on sugar-free sweeteners

    The WHO has released a report offering guidance regards the use of sugar-free sweeteners as part of a weight-loss effort.

    In a nutshell, the guidance is: don’t

    They make for interesting reading, so if you don’t have time now, you might want to just quickly open and bookmark them for later!

    Some salient bits and pieces:

    Besides that some sweeteners can cause gastro-intestinal problems, a big problem is desensitization:

    Because many sugar substitutes are many times (in some cases, hundreds of times) sweeter than sugar, this leads to other sweet foods tasting more bland, causing people to crave sweeter and sweeter foods for the same satisfaction level.

    You can imagine how that’s not a spiral that’s good for the health!

    The WHO recommendation applies to artificial and naturally-occurring non-sugar sweeteners, including:

    • Acesulfame K
    • Advantame
    • Aspartame
    • Cyclamates
    • Neotame
    • Saccharin
    • Stevia

    Sucralose and erythritol, by the way, technically are sugars, just not “that kind of sugar” so they didn’t make the list of non-sugar sweeteners.

    That said, a recent study did find that erythritol was linked to a higher risk of heart attack, stroke, and early death, so it may not be an amazing sweetener either:

    Read: The artificial sweetener erythritol and cardiovascular event risk

    Want to know a good way of staying healthy in the context of sweeteners?

    Just get used to using less. Your taste buds will adapt, and you’ll get just as much pleasure as before, from progressively less sweetening agent.

    Don’t Forget…

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    Learn to Age Gracefully

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  • Healthy Kids, Happy Kids – by Dr. Elisa Song

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    If you have young children or perhaps grandchildren, you probably care deeply about those children and their wellbeing, but there can often be a lot more guesswork than would be ideal, when it comes to ensuring they be and remain healthy.

    Nevertheless, a lot of common treatments for children are based (whether parents know it or not—and often they dont) on what is most convenient for the parent, not necessarily what is best for the child. Dr. Song looks to correct that.

    Rather than dosing kids with acetaminophen or even antibiotics, assuming eczema can be best fixed with a topical cream (treating the symptom rather than the cause, much?), and that some things like asthma “just are”, and “that’s unfortunate”, Dr. Song takes us on a tour of pediatric health, centered around the gut.

    Why the gut? Well, it’s pretty central to us as adults, and it’s the same for kids, except one difference: their gut microbiome is changing even more quickly than ours (along with the rest of their body), and as such, is even more susceptible to little nudges for better or for worse, having a big impact in either direction. So, might as well make it a good one!

    After an explanatory overview, most of the book is given over to recognizing and correcting what things can go wrong, including the top 25 acute childhood conditions, and the most critical chronic ones, and how to keep things on-track as a team (the child is part of the team! An important part!).

    The style of the book is very direct and instructional; easy to understand throughout. It’s a lot like being in a room with a very competent pediatrician who knows her stuff and explains it well, thus neither patronizing nor mystifying.

    Bottom line: if there are kids in your life, be they yours or your grandkids or someone else, this is a fine book for giving them the best foundational health.

    Click here to check out Healthy Kids, Happy Kids, and take care of yours!

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  • Fisetin: The Anti-Aging Assassin

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Out With The Old…

    Fisetin is a flavonoid (specifically, a flavonol), but it’s a little different than most. While it has the usual antioxidant, anti-inflammatory, and anti-cancer properties you might reasonably expect from flavonoids, it has an extra anti-aging trick up its sleeve that most don’t.

    ❝Fisetin is a flavonol that shares distinct antioxidant properties with a plethora of other plant polyphenols. Additionally, it exhibits a specific biological activity of considerable interest as regards the protection of functional macromolecules against stress which results in the sustenance of normal cells cytoprotection. Moreover, it shows potential as an anti-inflammatory, chemopreventive, chemotherapeutic and recently also senotherapeutic agent❞

    ~ Dr. Grynkiewicz & Dr. Demchuk

    Let’s briefly do some due diligence on its expected properties, and then we’ll take a look at its bonus anti-aging effects.

    The flavonol that does-it-ol

    Because of the similar mechanisms involved, there are three things that often come together, which are:

    • Antioxidant
    • Anti-inflammatory
    • Anticancer

    This list often gets expanded to also include:

    • Anti-aging

    …although that is usually the last thing to get tested out of that list.

    In today’s case, let’s kick it off with…

    ❝Fisetin (3,3′,4′,7-tetrahydroxyflavone) is a dietary flavonoid found in various fruits (strawberries, apples, mangoes, persimmons, kiwis, and grapes), vegetables (tomatoes, onions, and cucumbers), nuts, and wine that has shown strong anti-inflammatory, anti-oxidant, anti-tumorigenic, anti-invasive, anti-angiogenic, anti-diabetic, neuroprotective, and cardioprotective effects❞

    ~ Dr. Harish Pal et al.

    Read more: Fisetin and Its Role in Chronic Diseases

    Understanding its anticancer mechanisms

    The way that fisetin fights cancer is basically “all the ways”, and this will be important when we get to its special abilities shortly:

    ❝Being a potent anticancer agent, fisetin has been used to inhibit stages in the cancer cells (proliferation, invasion),prevent cell cycle progression, inhibit cell growth, induce apoptosis, cause polymerase (PARP) cleavage, and modulate the expressions of Bcl‐2 family proteins in different cancer cell lines (HT‐29, U266, MDA‐MB‐231, BT549, and PC‐3M‐luc‐6), respectively. Further, fisetin also suppresses the activation of the PKCα/ROS/ERK1/2 and p38 MAPK signaling pathways, reduces the NF‐κB activation, and down‐regulates the level of the oncoprotein securin. Fisetin also inhibited cell division and proliferation and invasion as well as lowered the TET1 expression levels. ❞

    ~ Dr. Muhammad Imran et al.

    Read more: Fisetin: An anticancer perspective

    There’s also more about it than we even have room to quote, here:

    Fisetin, a Potent Anticancer Flavonol Exhibiting Cytotoxic Activity against Neoplastic Malignant Cells and Cancerous Conditions: A Scoping, Comprehensive Review

    Now For What’s New And Exciting: Senolysis

    All that selectivity that fisetin exhibits when it comes to “this cell gets to live, and this one doesn’t” actions?

    It makes a difference when it comes to aging, too. Because aging and cancer happen by quite similar mechanisms; they’re both DNA-copying errors that get copied forward, to our detriment.

    • In the case of cancer, it’s a cell line that accidentally became immortal and so we end up with too many of them multiplying in one place (a tumor)
    • In the case of aging, it’s the cellular equivalent of “a photocopy of a photocopy of a photocopy” gradually losing information as it goes

    In both cases…

    The cell must die if we want to live

    Critically, and which quality differentiates it from a lot of other flavonoids, fisetin has the ability to selectively kill senescent cells.

    To labor the photocopying metaphor, this means there’s an office worker whose job it is to say “this photocopy is barely legible, I’m going to toss this, and then copy directly from the clearest copy we have instead”, thus keeping the documents (your DNA) in pristine condition.

    In fisetin’s case, this was first tested in mouse (in vivo) studies, and in human tissue (in vitro) studies, before moving to human clinical studies:

    ❝Of the 10 flavonoids tested, fisetin was the most potent senolytic.

    The natural product fisetin has senotherapeutic activity in mice and in human tissues. Late life intervention was sufficient to yield a potent health benefit.❞

    ~ Dr. Matthew Yousefzadeh et al.

    Read in full: Fisetin is a senotherapeutic that extends health and lifespan

    There’s lots more science that’s been done to it since that first groundbreaking study though; here’s a more recent example:

    Fisetin as a Senotherapeutic Agent: Biopharmaceutical Properties and Crosstalk between Cell Senescence and Neuroprotection

    Want some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Enjoy!

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