No Pissing Joke

The 2003 Sleep in America Poll by the National Sleep Foundation—the latest data we have for older adults—reports that two out of three people (65%) ages of 55 and 84 reported having to wake up during the night to go to the bathroom to urinate at least a few nights per week. This condition is called nocturia and is often normal part of getting older. It can also be an indication of other medical conditions including infection, a tumor of the bladder or prostate, a condition called bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes and some medications which are also associated with nocturia. But usually, as we get older, the chemical regulation in our body changes making us less able to retain fluid, and therefore producing more urine. That and the fact that our bladder shrinks as we age creates the need to empty during the night.

This is of course preferable to incontinence.

Urinary incontinence drastically reduces your quality of life and is likely to contribute to an earlier nursing home placement. Unfortunately, urinary incontinence—where urine escapes unexpectedly—is a common problem among older women and men.

Older women are twice more likely to experience urinary incontinence than older men and the reasons are different for men and women. Pregnancy and childbirth, menopause, and the anatomical structure urinary tract account for this difference. Whereas both women and men can become incontinent from injury to nerves, birth defects, stroke, multiple sclerosis, and other physical problems.

Although it is more common the older a person becomes, urine incontinence is not inevitable with age, it is a medical problem.  There are behavioral and physical exercises that can help including medications, biofeedback, stimulation of nerves to the bladder (neuromodulation) vaginal mechanic devices (pessary) and finally surgery (including catheters), are all options for specific type of incontinence.

For men other then the obvious differences—pregnancy and childbirth (including heavy triathlon exercise for some women), menopause, and anatomical differences—urinary incontinence can be caused by nerve damage and/or by prostate problems. The prostate gland, which sits behind the pipe (urethra) that releases urine, commonly becomes enlarged with age. As the prostate enlarges, it may squeeze the urethra restricting the flow. Up to 90 percent in men in their seventies and eighties have some restricting flow problems.

In addition, one of the causes of urinary incontinence is poorly prescribed medications. Four main types of medication can cause urine incontinence. These are medications prescribed for high blood pressure, depression and for sleeping problems. The complication is that these might be the same medications that are used to address urine incontinence in the first place. Unless you face up to it, urine incontinence only gets worse. There are multiple avenues to explore in treatment, but the only first step is to discuss this with your primary care provider. The solution might be found after exploring many avenues but keeping it a secret is not an option.

© USA Copyrighted 2014 Mario D. Garrett

Is Dementia caused by Aluminum through Fluoridation?

In gerontology there are many divisive issues. Surprisingly, fluoridation is one of them. When more than a quarter of older adults do not have their teeth—in some parts of the country like the fluoridated states of Kentucky and West Virginia four out of ten older adults do not have their own teeth—but they are still made to drink water that has been fluoridated, there is a clear disregard for older adult health.

There are many reasons for fluoridation. However, scientific studies are inconclusive, of poor quality, and in all cases disregard older adults—especially those without teeth. In addition, there is the evangelical fervor from both sides of the argument—public health versus personal choice—which muddy an already complex scientific issue.

The link between fluoridation and ill health is not a direct one but involves the uptake of a known nerve toxin aluminum. Correlational studies linking aluminum with Alzheimer’s disease have been published since 1965. Half a century ago injecting aluminum in rat brains, three independent studies produced the tangle-like structures that characterize Alzheimer’s disease. Subsequently, numerous international studies have found more Alzheimer’s disease in areas with high aluminum levels in drinking water.

In 2011, the Japanese researchers Masahiro Kawahara and Midori Kato-Negishi made a forceful argument between aluminum and Alzheimer's disease. After decades of attempts to discredit this link, the authors point to strong evidence of aluminum as a culprit in forming the amyloid plaques in the brain. This and other studies continue to support the clinical studies done in rats that identify aluminum as toxic for the brain. The only problem was that aluminum does not naturally enter the brain.

There is a barrier between the body and the brain that stops metals reaching the brain. In 2013 Akinrinade and his colleagues from Bingham University in Nigeria, showed that the relationship between fluoride and aluminum is important in escaping into this barrier.  Fluoride combines with aluminum to form aluminum fluoride, which is then absorbed by the body where it eventually combines with oxygen to form aluminum oxide or alumina. Alumina is the compound of aluminum that is found in the brains of Alzheimer's disease. Fluorine attaches to aluminum and influences its absorption. Li Fucheng and his colleagues from Beijing, China, described high incidences of osteoporosis, osteomalacia, spontaneous bone fractures and dementia in villages in Guizhou Province, China where they were eating maize which had been baked in fires of coal mixed with kaoline. Kaoline contains aluminum and fluorides. These diseases are very similar to those occurring in European dialysis patients, unwittingly treated with water and gels containing aluminum.

The implications of this fluoride-aluminum relationship to Alzheimer’s disease are not linear. The solubility of aluminum and probably the ease with which it is absorbed varies markedly with the high acidity and alkalinity of water. In general, however, aluminum is most soluble in acidic water, especially if it contains fluorides.

The public health argument for fluoridation has never been made for older adults. Such institutional ageism is bad science and much worse this is bad public health. 

© USA Copyrighted 2014 Mario D. Garrett

Fluoridation and Dementia

Since 1962, on the recommendation of the United States Public Health Service, fluoride is used in the public drinking water supplied to about 2 out of 3 Americans. The decision to add fluoride to drinking water is made locally. The types of fluoride include fluorosilicic acid, sodium fluorosilicate, and sodium fluoride.

Studies have consistently shown positive outcomes for fluoridation in the health of teeth of children, adults and older adults—although these studies have been contested. The bigger contention is whether we need to indiscriminately fluoridate our teeth by ingestion of fluoride through our water supply without being able to control the level of exposure, the varying sensitivity of the recipient, and its accumulation in the body.

Fluoride is also ingested from fruit juices, sodas, popular breakfast cereals, lettuce and raisins and anything grown with pesticides since fluoridation is an effective killer of pests.

However beneficial the fluoridation is to the health of teeth it does not tell us the whole story, especially on the overall health of older adults. Since 25 percent of adults 60 years old and older no longer have their natural teeth, the arguments for the benefit of fluoridation is somewhat toothless.

Sodium fluoride is a bone anabolic drug. Healthy adult kidneys excrete 50 to 60% of the fluoride ingested each day. The rest accumulates in the body, largely in bones and pineal gland. The fluoride concentration in bone steadily increases over a lifetime and we are more likely to see large concentrations in older adults.  But the growth in bone quantity might be detrimental.

Christa Danielson and her colleagues compared the incidence of hip fractures in patients 65 years of age or older in three communities where two were without water fluoridated--to 1 ppm. Surprisingly, they found a small but significant increase in the risk of hip fracture in both men and women exposed to fluoridation. Other studies have found similar results. Suggesting that low levels of fluoride may increase the risk of hip fracture in the elderly and there seems to be a dose relationship with the higher the concentration of fluoride the higher the risk of hip fractures. It seems that fluoride may increase bone quantity—osteofluorosis, osteosclerosis—but it might also decrease bone quality and bone strength.

Just as troubling for older adults, is the evidence that Patočka Strunecká and her colleagues from  Charles University in the Czech Republic exposed. They found that long-term action of aluminofluoride complexes may represent a serious and powerful risk factor for the development of Alzheimer’s disease. In another study, rats fed for one year with 1-5 ppm fluoride in their water—the same level used in fluoridation programs—using either sodium fluoride or aluminum fluoride, resulted in the formation of beta-amyloid deposits—associated with Alzheimer’s disease.

Since the  US Environmental Protection Agency lists fluoride as having “substantial evidence of developmental neurotoxicity”  we expect to see other negative outcomes of fluoridation. Fluoridation is one area that demand better clinical trials with older adults. Perhaps by eliminating fluoridation we can put some teeth into laws protecting the health of older adults.

 © USA Copyrighted 2014 Mario D. Garrett