September 29, 2015

Supporting Brain Health: Chocolate? Yes. Anticholinergic Drugs? No.

Today brings another post from the health grab bag.

The Case for Cocoa
A recent report in the Journal of Alzheimer’s Disease suggests that polyphenols -- the micronutrients in chocolate -- might be used to maintain brain health and even prevent age-related neurodegenerative diseases like Alzheimer’s disease (AD).

For some time, the good reputation of chocolate-for-health has been on a roll. We’ve already heard that flavanols – cocoa’s particular polyphenols – have blood-thinning properties and pack a powerful antioxidant effect that reduces cell damage caused by coronary disease. A study published this summer in Medical News Today suggested that eating 100g of chocolate every day was linked to reduced risk of heart disease and stroke.

Earlier research also suggests that eating cocoa extract helps reduce age-related cognitive decline and supports healthy brain aging.

In the latest study, Dr. Giulio Maria Pasinetti -- professor of neurology at the Icahn School of Medicine at Mount Sinai in New York, NY – and his team found that cocoa polyphenols did a couple things in particular:
  • help reduce the production of damaging proteins now linked to AD – beta-amyloid and tau clumps.
  • help clear out those harmful proteins already aggregating in the brain.

Cocoa’s polyphenols are particularly adept at crossing the blood-brain barrier, an obstacle we’ve frequently encountered in both prescription meds and dietary supplements. For any substance to have an impact on brain function, it must first find its way into the brain from the blood… not always an easy hurdle.

Pasinetti summed up his study this way:
Therefore, emerging biomedical research experimental evidence, and new clinical translational studies all support the major interest in the development of cocoa as a botanical source for the maintenance and promotion of health, in particular, in the brain.

After urging additional studies, particularly with human subjects, Pasinetta sounded an alarm. Demand for cocoa is increasing as we learn more about it, but its availability is now challenged by disease and climate change. He recommends the development of new strains of cocoa that are more fruitful, and less vulnerable to disease.

The Case Against Anticholinergic Drugs
Articles often recommend what we SHOULD do to support brain health and function -- especially among seniors – with advice about diet, exercise, supplements, games, sleep.

But as a story on the website Next Avenue suggests, we need to keep in mind what we SHOULDN’T do to maintain cognitive function. The culprits the author mentions are seven “brain-toxic” anticholinergic drugs, pharmaceutical agents that block the neurotransmitter acetylcholine. The Wikipedia entry for this drug class provides a long list of uses, and the line-up of potential side effects – especially for older adults – goes on for pages.

Since anticholinergics block one of the key neurotransmitters – agents that facilitate activity within the brain and also the communication between the brain and body – these drugs reduce brain function. As a result, people often perceive their effect as sedation.

These drugs actually have the opposite effective of medications designed to treat Alzheimer’s. One of the most popular is Aricept (donepezil), which works to increase the neurotransmitter acetylcholine by blocking the brain enzyme that breaks it down.   

In younger people, anticholinergics might simply create drowsiness or unsteadiness. But research indicates that these drugs introduce low-level toxins into the brain, which in time can have lasting and damaging cumulative effects.

Listed below are the seven common anticholinergic drugs – as described in the Next Avenue article -- that pose risks to the health of senior brains:
  1. Sedating antihistamines. The prime example is diphenhydramine (brand name Benadryl), which is available over-the-counter and has strong anticholinergic activity. Non-sedating antihistamines, such as loratadine (brand name Claritin) are less anticholinergic and are safer for the brain.
  2. PM versions of over-the-counter (OTC) painkillers. Most OTC painkillers, such as acetaminophen and ibuprofen (brand names Tylenol and Motrin, respectively) come in a “PM” or night-time formulation, which means a mild sedative — usually an antihistamine — has been mixed in. Ditto for night-time cold and cough medications such as Nyquil.
  3. Medications for over-active bladder. These include bladder relaxants such as oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively).
  4. Medications for vertigo or motion sickness. Meclizine (brand name Antivert) is often prescribed to treat benign positional vertigo. It’s also used to treat motion sickness.
  5. Medications for itching. These include the strong antihistamines hydroxyzine (brand name Vistaril) and diphendyramine (brand name Benadryl), which are often prescribed for itching or hives.
  6. Medications for nerve pain. An older class of antidepressant known as “tricyclics” isn't used for depression that much any longer, but it's still used to treat pain from neuropathy. (These are also prescribed to reduce the chance of chronic nerve pain after shingles.) Commonly-used tricyclics include amitriptyline and nortriptyline.
  7. Muscle relaxants. These include drugs such as cyclobenzaprine (brand name Flexeril) and they are often prescribed for back or neck pain.

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