Ignore the clickbait: Metformin still prescribed for diabetics

DEAR DR. ROACH » I have read online and in our local newspaper that doctors are no longer recommending metformin as a treatment for Type 2 diabetes. Can you please explain why metformin is no longer being prescribed? — P.K. DEAR READER » I, too, have seen online ads saying that doctors no longer prescribe metformin, and if you click through enough times, you find that “one weird food” cures diabetes, and that a special diet totally eliminates the need for medication for all diabetics. This is referred to as “clickbait,” and I encourage you not to pay attention to it.

Metformin remains an important medication for many people with Type 2 diabetes, especially if they are overweight. For those people with diabetes who need medication despite an appropriate diet and regular exercise, metformin has been shown to be more beneficial, in terms of preventing diabetic complications and death, than most of the other medication options. It isn’t right for everyone, and people with poor kidney function may not be able to safely take it. Only your doctor, nurse practitioner or physician assistant knows what is best for you.

DEAR DR. ROACH » I started researching information about early dementia and also Alzheimer’s disease. I have perused numerous articles about cholinesterase inhibitors increasing acetylcholine levels that benefit the brain. Some medications are anticholinergic and might increase your risk of developing Alzheimer’s disease. Many of these medications are everyday, over-the-counter drugs. Shouldn’t the public be made aware of these drugs and their possible effect on our brain? — P.C. DEAR READER » One type of treatment for Alzheimer’s disease is a class of drugs called cholinesterase inhibitors. These include donepezil (Aricept) and others. Pharmacologically, these oppose drugs with anticholinergic properties. It makes sense, then, that anticholinergic drugs might make Alzheimer’s worse. The three classes of drugs that are strong anticholinergics — and which a recent study linked to Alzheimer’s — are older antihistamines, like diphenhydramine (Benadryl); tricyclic antidepressants, like amitriptyline (Elavil); and drugs for overactive bladder, like oxybutynin (Ditropan). These drugs still may be appropriate for some individuals, but they should be periodically evaluated to be sure they are effective and are not causing side effects. I tend to avoid prescribing these, as there are usually other alternatives that do not have the possible link to dementia.

DR. ROACH WRITES: A recent column on constipation has generated a lot of letters (I have found that columns on stomach and bowel problems reliably do so). Here are some of the suggestions I received:

--Probiotics or yogurt with live cultures. I often discuss these for diarrhea, but they can be helpful for constipation as well.

--Prunes. These have several substances that can help constipation.

--Adequate water intake. I just ran out of space to mention it in the column, but it’s important.

--Raising the feet during a bowel movement. This can be done with a footstool. This simple maneuver changes the pressure inside the abdomen, making voiding easier.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.