Are you part of this statistic?

Statistics show the percentage of Americans on prescription drugs has risen to new highs, 50 to 60 percent depending on the study.

What does that statistic indicate? Which answer is correct?

1. Illness is increasing in America
2. A higher percentage of Americans take prescription drugs, or 
3. Someone you know takes drugs that cause Alzheimers and other deadly diseases

Let's look at these possibilities, even the last one, which may sound ridiculous (but is not).

1. Illness is increasing in America

Yes, this statement is true and correlates with the statistic on rising prescription drug use. But the rise in drug use alone does not prove that illness is increasing. The data we saw earlier shows chronic diseases are on the rise in America and worldwide.

2. A higher percentage of Americans take prescription drugs

This is the "correct" answer to the question. 

It is interesting to note that prescription drug use and the chronic degenerative diseases are both increasing. Earlier, we saw that adverse reactions to drugs (ADRs) are the 4th leading cause of death in the United States.

It's reasonable to ask this question: 

Could the long-term use of drugs cause or promote the chronic diseases? The adverse reactions that drugs cause suggests this to be the case. And scientists describe a number of ways that this occurs. We'll cover one of them below.

3. Someone you know takes drugs that cause Alzheimers and other deadly diseases

Obviously, this is not the correct response to the original question. But this statement is true, based on additional research findings.

Patients assume that drugs prescribed by a doctor are safe enough to take. So, few people ask the question, "What are the deadly effects of prescription drugs?" Let's look at this concern.

Subtle Adverse Drug Effects

We looked at adverse drug reactions (ADRs) earlier. ADRs involve sudden illness that may lead to death. But in addition to causing ADRs, drugs have subtle adverse effects with continued use.

One scientific finding links higher drug use with the rise in Alzheimers and other deadly diseases. The explanation involves a technical term, the ACB, a burden on the brain and other parts of the body.  

Dementia And Other Serious Adverse Effects

What harm can prescribed drugs do?

Drugs can damage any part of the body with continued use. For example:

1. Regular drug use can increase the need for emergency care and stays in the hospital.
2. Over time, drugs may weaken bones and lead to fractures.
3. The regular use of certain drugs cause up to a 3-fold increase in the occurrence of dementia.

One large group of drugs have all of the above effects. And they have one thing in common. These drugs impede the action of acetylcholine, a substance secreted at the end of a nerve fiber.

Drugs can foul the machinery of the brain and body.

By interfering with the action of acetylcholine, drugs throw the function of the brain and the rest of the body out of balance. This is what leads to more medical care, bone fractures, and dementia in these patients.

Among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia. 

The Anti-Cholinergic Burden (ACB)

The burden of drugs on the brain and body are additive.

A patient (you or a loved one?) may be taking more than one drug that impairs the action of acetylcholine. When this occurs, the effects of these drugs in blocking acetylcholine add up. The combined effect in one person is called the anti-cholinergic burden (ACB).

The ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults.

Up to half of the drugs prescribed to older adults contribute to a patient's anti-cholinergic burden (ACB).

Medications with anticholinergic properties are used for a variety of diseases and constitute 30% to 50% of all medications commonly prescribed to older adults.

Polypharmacy And The ACB

Earlier, we saw that patients who took many drugs had more adverse drug reactions (ADRs). Now, we see that polypharmacy causes disease even when there are no adverse drug reactions. The anti-cholinergic effect of each drug adds up.

Aging And The ACB

The ACB causes more damage in older patients. Nerve cells produce lower amounts of acetylcholine as people age.

Drugs With High ACB Effects

Drugs vary in the strength of their anticholinergic effect. The drugs that create the greatest burden of this type on the body include:

• Amitriptyline (Elavil™)
• Atropine (Sal-Tropine™)
• Clozapine (Clozaril™)
• Dicyclomine (Bentyl™)
• Doxepin (Sinequan™)
• L-hyoscyamine (Symax™, others)
• Thioridazine (Mellaril™)
• Tolterodine (Detrol™, others)

At typical doses administered to older adults, amitriptyline, atropine, clozapine, dicyclomine, doxepin, L-hyoscyamine, thioridazine, and tolterodine demonstrated [anticholinergic activity] exceeding 15 pmol/mL.

Drugs With Moderate Effects

The drugs that create a significant but lesser ACB on the body include:

• Chlorpromazine (Thorazine™, Ormazine™)
• Diphenhydramine (Benadryl™, Unisom™, Sominex™, others)
• Nortriptyline (Allegron™, Aventyl™, Noritren™, Nortrilen™, Pamelor™, others)
• Olanzapine (Zyprexa™)
• Oxybutynin (Ditropan™, Lyrinel XL™, Lenditro™, Driptane™, Uripan™)
• Paroxetine (Paxil™, Brisdelle™, Paxil CR™, Pexeva™)

Chlorpromazine, diphenhydramine, nortriptyline, olanzapine, oxybutynin, and paroxetine had [anticholinergic activity] values of 5 to 15 pmol/mL. 

Drugs With Low Effects

This third group of drugs showed even lower ACB effects, but they were still significant:

• Citalopram (Celexa™, Cipramil™, others)
• Escitalopram (Cipralex™, Lexapro™, others)
• Fluoxetine (Prozac™, Sarafem™, others)
• Lithium (Lithium Carbonate ER™, Lithobid™, Eskalith™, Calith™, others)
• Mirtazapine (Remeron™)
• Quetiapine (Seroquel™)
• Ranitidine (Zantac™, Acid Reducer™)
• Temazepam (Restoril™)

Citalopram, escitalopram, fluoxetine, lithium, mirtazapine, quetiapine, ranitidine, and temazepam had values less than 5 pmol/mL. 

Types Of Drugs That Increase The ACB

The lists of drugs include anti-depressants, anti-psychotics, sleep aids, and others that affect brain function.

Drugs not intended to change the function of the brain raise the risk of dementia through the ACB. These drugs include anti-histamines, a stomach acid reducer, and others for overactive bladder, high blood pressure, and other common health disorders.

Other Kinds Of Adverse Drug Effects

The ACB is only one of many ways that drugs have adverse effects on health. Practically all drugs have adverse effects. To see the adverse effects that experts accept as due to the use of a drug, visit www.drugs.com or a similar site.

Suggested Actions

1. Don't follow the crowd in caring for your health. Most people seek a quick fix for their health problems. And drugs advertise that promise. These two factors (and others) make drugs popular and so many people sick. 
2. If you take prescribed drugs that increase your ACB consult your doctor to discuss changes. For your safety, do not make changes on your own. You may need to continue certain drugs until you improve your health by taking better care of yourself. 
3. Avoid taking over-the-counter drugs even if they do not increase your ACB. You may not notice any adverse drug effects now, but they can arise later for no apparent reason. 
4. Ask yourself what you can do to improve your health. This is the topic of the next lesson.

References

Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008 Jul;56(7):1333-41.

Hsu WH, Wen YW, Chen LK, Hsiao FY. Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes. Ann Fam Med. 2017 Nov;15(6):561-569.

About Horton Tatarian

I’m a biochemist who examines scientific findings on health and disease. My degree in biochemistry is from U.C. Berkeley. UCLA School of Medicine granted an M.D. degree in 1974. Since then, independent research prepared me to advise clients on natural ways of self-care.

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