Can adding methyl groups to the diet reduce the negative effects of anticholinergic medication?

From the Guidelines

Adding methyl groups to the diet may help reduce some negative effects of anticholinergic medications, though evidence is limited. Methyl donors like betaine (500-3000mg daily), choline (250-500mg daily), and folate (400-800mcg daily) could potentially support acetylcholine production and neurotransmitter function that anticholinergics disrupt 1. Foods rich in these compounds include eggs, liver, soybeans, and leafy greens. Supplements like alpha-GPC (300-600mg daily) or CDP-choline (250-500mg daily) might be more effective as they cross the blood-brain barrier more readily. The mechanism involves providing building blocks for acetylcholine synthesis, potentially counteracting the receptor blockade caused by anticholinergics.

Some key points to consider when using anticholinergic medications include:

• Anticholinergic effects can occur with first-generation antihistamines, including dryness of mouth and eyes, constipation, inhibition of micturition, and an increased risk for provocation of narrow angle glaucoma 1
• Older adults are more sensitive to the psychomotor impairment promoted by first-generation antihistamines, are at increased risk for complications such as fractures and subdural hematomas caused by falls, and are more susceptible to adverse anticholinergic effects 1
• Anticholinergic drugs with reasonable documentation of efficacy and safety in childhood are oxybutynin, tolterodine and propiverine, but they can cause constipation and other anticholinergic side effects 1
• Promethazine and diphenhydramine have anticholinergic effects and can cause CNS depression, anticholinergic effects, extrapyramidal symptoms, and other side effects 1

However, this approach should not replace proper medical management of anticholinergic side effects, and patients should always consult their healthcare provider before starting any supplement regimen, as these compounds may interact with medications or affect underlying conditions.

From the Research

Anticholinergic Medication and Methyl Groups

• There is no direct evidence to suggest that adding methyl groups to the diet can reduce the negative effects of anticholinergic medication 2, 3, 4.
• Anticholinergic medications are known to have adverse effects, particularly in older patients, and can contribute to cognitive impairment and other negative outcomes 2, 4.
• The Anticholinergic Drug Scale and tables listing drugs with known anticholinergic properties may help in guiding clinical decision-making to reduce anticholinergic burden 2.
• Some studies have investigated the efficacy and safety of different formulations of anticholinergic medications, such as transdermal versus oral oxybutynin, and found that transdermal delivery may result in a improved anticholinergic side effect profile 3.
• However, there is no mention of methyl groups or their potential impact on anticholinergic medication effects in these studies.

Reducing Anticholinergic Burden

• Reducing anticholinergic burden is important, particularly in older adults, and can be achieved by avoiding, reducing dose, and deprescribing medicines with anticholinergic activity where clinically possible 4.
• Medication adherence is also crucial, and healthcare professionals play an important role in promoting adherence and understanding the reasons for non-adherence 5.
• Investigating individual variability in response to treatment may also be important in advancing disease treatment and developing tailored therapies 6.