Cola and osteoporosis

Cola and osteoporosis

This is important clinical research. With focus on administration of Vitamin

D-3, Vitamin K-2, Strontium, Calcium and Boron, we often pay too little

attention to the dietary factors that may worsen osteoporosis. This is one very

easy step, one very important step in the treatment of osteoporosis.



This is an exerpt from the National Library of Medicine abstract, for your

reading pleasure.





Tucker KL, Morita K, Quiao N, et al: Colas, but not other carbonated beverages,

are associated with low bone mineral density in older women: The Framingham

Osteoporosis Study. Am J Clin Nutr. 2006 Oct;84(4):936-42.



From Tufts University, Boston, MA 02111, USA. katherine.tucker@tufts.edu

Soft drink consumption may have adverse effects on bone mineral density (BMD),

but studies have shown mixed results. In addition to displacing healthier

beverages, colas contain caffeine and phosphoric acid (H3PO4), which may

adversely affect bone.

DESIGN: BMD was measured at the spine and 3 hip sites in 1413 women and 1125 men

in the Framingham Osteoporosis Study by using dual-energy X-ray absorptiometry.

Dietary intake was assessed by food-frequency questionnaire. We regressed each

BMD measure on the frequency of soft drink consumption for men and women after

adjustment for body mass index, height, age, energy intake, physical activity

score, smoking, alcohol use, total calcium intake, total vitamin D intake,

caffeine from noncola sources, season of measurement, and, for women, menopausal

status and estrogen use.

RESULTS: Cola intake was associated with significantly lower (P < 0.001-0.05)

BMD at each hip site, but not the spine, in women but not in men. The mean BMD

of those with daily cola intake was 3.7% lower at the femoral neck and 5.4%

lower at Ward's area than of those who consumed <1 serving cola/mo. Similar

results were seen for diet cola and, although weaker, for decaffeinated cola. No

significant relations between noncola carbonated beverage consumption and BMD

were observed. Total phosphorus intake was not significantly higher in daily

cola consumers than in nonconsumers; however, the calcium-to-phosphorus ratios

were lower.

CONCLUSIONS: Intake of cola, but not of other carbonated soft drinks, is

associated with low BMD in women. Additional research is needed to confirm these

findings.

Source: Newsletter from Dr. David S. Klein

Nutrition 101 - by Dr. Saleeby

Nutritional Intervention in the Middle-Aged Male Patient

While it is both natural and desirable to grow older, it is neither natural nor
desirable to feel or perform ‘older.’ Only a few short years ago, discussions
of erectile difficulties were unlikely topics for the average middle-aged male
patient. Frankly, few men were at all likely to admit to difficulties, at all.
Only after the introduction of Viagra® did the topic of erectile dysfunction
(ED) become regular or routine. Now, not only are these discussions routine,
but the topic is advertised on the side of a popular NASCAR race car.

Before we had Viagra®, impotence in the younger male was generally
considered to be a psychosomatic dysfunction. It is an interesting commentary
that only after a pharmacological intervention is introduced do many disease
states change from psychosomatic to physiologic in nature. While we now have
several good choices in medications with which to help reduce the symptoms of
ED, little is done to deal with the underlying conditions that lead to ED.
After elimination of the many common causes of iatrogenic and neurovascular
causes of ED, the typical patient is given the option of which pill to take.
This is indeed unfortunate because there are many interventions that the
physician can entertain that deal with the ED on a functional basis.

Male Hormonal Changes with Age
As men age past the age of 25, or so, testosterone levels can be expected
to drop, approximately 2% per year. Men at the age of 25 do not consider that
getting older, on a personal level. By the age of 50, testosterone levels have
dropped by 50%, and many men wonder where their youth and vitality went. This
is a well understood phenomenon, and many well-meaning physicians consider
testosterone replacement in this context. Testosterone will be metabolized into
estradiol. Treatment with testosterone without inhibiting this degradation will
result in elevations in serum estrogen.

What is less well recognized is the elevation in estrogen levels that
result during this same aging time-line. By the age of 40, many men will
demonstrate estrogen levels that exceed those of their spouses. The factor that
results in ED results more from the ratio of testosterone to estrogen than from
either hormone level, alone. That is, without addressing the elevation in
estrogen that is a normal, anticipated result from aging, the treatment of ED
with testosterone is likely to result in temporary, if any positive results. In
order to restore a healthy testosterone to estrogen ratio, the clinician must
inhibit the pathways that involve degradation of testosterone to estrogen. When
combined with enhancement of estrogen elimination, cholesterol levels can be
reduced, and weight loss can be anticipated.

The main metabolic pathways of testosterone to estrogen conversion involve
the enzymes 5-alpha reductase and aromatase. Both of these enzymes can be
effectively inhibited with inexpensive, available nutriceuticals. The
thoughtful balance of enzymatic inihibition with hormonal supplementation
results in restoration of healthy testosterone to estrogen ratios, and the
result is improvement or abatement of the symtoms of ED, reduction or
elimination of the problems seen with prostatic hypertrophy, and reduction in
serum cholesterol.

As with most other areas of interventional medicine, it is best to know
baseline hormonal levels before entertaining empiric intervention. Elevations
in estrogen can be treated with di-indol methane and indole-3 carbinol. When
combined with agents that stimulate biliary excretion, estrogen levels can be
lowered in a matter of a few weeks. The addition of saw palmetto and nettle
extract increases testosterone levels, relative to estradiol through the
inhibition of the 5 alpha reductase and aromatase enzymes. The reduction of
serum (total) estrogens can result in weight loss, and results in reduction in
depressive symptoms.

None of this is particularly difficult, and it is affordable to the vast
majority of the patient population. Sadly, the patient population has seen need
for these sensible approaches to health, but these same patients turn to lay
magazines, catalogues and self-serving marketers to provide the guidance that
they need. The general medical community has not taken the necessary steps to
educate ourselves in this vital area of preventive medicine. Until such time as
we collectively arm ourselves with the necessary understanding of functional &
nutritional medicine, the public will turn, in large numbers, to the clerk at
the vitamin store, the pharmacy technician and well-meaning neighbor for vital
(mis)information on the value of nutritional & nutraceutical maintenance of
health.

Source: newsletter@suffernomore.com

For male Natural Hormone Replacement Therapies contact Dr. Saleeby via www.saleeby.net

"And that's the way it is..."

Walter Cronkite (1916 - 2009)

A Plan Comes Together: The Sheep Obey

On May 1, 2009, the LA Times reported some amazing occurrences:

• Hospitals on New York’s Long Island were scrambling to bring extra workers in to handle a 50% surge in visitors to emergency rooms.
• In Galveston, Texas, the local hospital ran out of flu testing kits after being overwhelmed with patients worried about having contracted swine flu
• At Loma Linda University Medical Center near San Bernardino, California, emergency room workers set up tents in the parking lot to handle a crush of similar patients.
  In Chicago, ER visits at the city’s biggest children’s hospital are double normal levels, setting records at the 121-year-old institution.

So far, few of the anxious patients have had more than runny noses. The most disturbing revelations about these scenarios? They knew this was the way we would respond. What was published in 2006 has become fact in 2009.

A study conducted by the Harvard School of Public Health confirmed that public health officials could easily convince most people to alter their daily lives to stem the spread of influenza. “The Pandemic Influenza Survey” documented our willingness to do what we are told after only a little hyping that a deadly global pandemic was eminent. The 2006 survey included 1,700 Americans. More than 90 percent said they would [willingly] comply with government orders to postpone air travel, avoid public places such as movie theaters and shopping malls, and would keep their children home from school in the event of a flu pandemic. A full 94 percent said they would stay home from work for up to 10 days to help authorities control disease spread

How Soon We Forget

The word pandemic simply means a certain type of virus seems to be infecting persons over a wide area, in this case, several states and a few countries. The word “pandemic” is not synonymous with “massive death,” although the media would have us believe that the two are equal. In fact, most persons over 50 years of age experienced the last two documented pandemics and the pandemic scare of 1976. And according to a 2008 report by the CDC, “even those who experienced [the 1957 and the 1968] pandemics do not recall them as particularly memorable events.”

Most persons at least 43 years of age will no doubt recall the Swine flu hype of 1976. Starting from a single, infected military recruit, the threat of a pandemic and global death turned into a full-scale media and government circus. For many, the “Pandemic that Never Was” created havoc, death and long term disability. But the mayhem was not the work of a microscopic particle of replicating RNA. The carnage was created by the misguided steps our government and the overzealous drive from CDC officials to vaccinate.

The absolute belief in the effectiveness of vaccines resulted in the disability of 532 people who contracted Guillain-Barre Syndrome, a life-threatening form of paralysis. While many recovered in the ensuing months, at least 33 died and up to 10 percent remained paralyzed to varying degrees for the rest of their lives. While vaccine manufacturers reaped the rewards of government handouts to make vaccines, and secured legislation to protect them from liability (the Swine Flu Act of 1976), more than $1.3 billion of tax payer dollars were released to compensate those who had been injured by the swine flu vaccine.

For those X-Gens and Y-Gens under-40, ask your parents, grandparents and other senior relatives and friends what they recall about these Public Health panics. Surely they can shed some light about those moments in American history and their stories will help abate your fears of a “coming pandemic.” After all, they are alive to talk about it.

More Vaccines On The Way

Lessons about bad vaccines are rarely learned and the race to make more experimental doses has never been hotter. In 2005, Congress allocated $3.8 billion to developers with the stated goal of being able to “distribute a vaccine to every American within six months of the onset of a pandemic.” In 2006, our elected representatives went even further to ensure we are vaccinated: They created incentives for manufacturers by funding the Biodefense and Pandemic Vaccine and Drug Development Act of 2005, nicknamed BioShield II. (see previous article: Swine flu: The New Bird flu)

Along with BioShield II, legislation was passed to amend the Public Health Service Act and establish a division called Biomedical Advanced Research and Development Agency, or BARDA. The BARDA is responsible for coordinating and overseeing activities that support and accelerate research and development of countermeasures [i.e.vaccines] and other products that qualify as pandemic or epidemic products. The BARDA has budgetary authority to award contracts, grants, and cooperative agreements that will advance the research and development of drugs and vaccines. The creation of vaccines is big, serious business. To see the list of all agencies and federal legislation involved with creating pandemic vaccines and drugs as a countermeasure, spend some time website for the Center for Biosecurity.

On March 18, 2009, the BARDA requested $1.7 billion for FY 2010 to fund research and development of additional vaccines and drugs. Interestingly, just this week, President Obama released $1.5 billion of appropriations for pandemic planning. Although the funds were not specifically earmarked, it is probable that a portion of your tax dollars will go to fund BARDA. On May 1, 2009, the Working Group of the Infectious Disease Society of America chimed in and requested more funding for the current swine flu outbreak. Commending the President for releasing emergency appropriations for H1N1, the Working Group appealed to Congress for an additional $1.9 billion to fund the following:

• $870 million requested to expand cell and egg-based vaccine capacity. This money was requested from the previous Administration, but not funded in FY 2008. The money will also be used to purchase antivirals for the federal stockpile and to accelerate the R&D of rapid diagnostic tests;
• $350 million for States and localities to purchase equipment; funding staff and maintain 24-hour disease-reporting hotlines; increase public and clinician education about vaccines; distribute medical countermeasures [vaccines and antivirals], and refill staff positions lost to budget cuts;
• $122 million for State antiviral stockpiles for the treatment of people who become ill; and
• $563 million for States and localities to purchase personal protective equipment and antivirals for prophylaxis of healthcare and critical infrastructure workers.

This is amazing. A billion here, a billion there. A close look at these requests and it is apparent where the money flows: Directly into the pockets of the drug companies who make antivirals like Tamiflu and Relenza. The research and development funds will go toward new, novel flu vaccines, shots that much of the public has confirmed it would refuse.

On October 5, 2006 a survey reported by Reuters News service posted an article called, “Americans doubt need for flu vaccine: survey,” by Maggie Fox. The survey documented that fewer than half of Americans planned to get the flu vaccine that year, mostly because they do not worry about flu. The survey of 1,000 adults found that just 48 percent planned to get immunized that year. Of those who did not plan to get the vaccine, 43 percent said they did not think influenza was serious enough to warrant vaccination and 38 percent felt they were not at risk. Flu experts called the findings “disappointing,” and from that point forward, a full-court press has been on to increase the uptake of annual flu shots. No doubt the fear generated by the potential swine flu pandemic is part of the Play Book to make the flu seem serious enough for everyone to get vaccinated. However, it appears the latest Swine flu buzz is fading away as fast as it materialized. Scientists are coming to the conclusion that the new swine flu strain may actually be less dangerous than garden-variety, seasonal influenza. Even though there are positive cultures from 331 people in 11 countries, and 10 have died, even the WHO admits the numbers are “extremely small.” It is estimated that globally between 3 and 5 million people experience some level of the flu each year. One has to wonder why this has even made the news.

Something Bigger?

In January, 2009, the out-going Secretary of HHS, Michael Leavitt, released a report called “Pandemic Planning VI,” a summary of all the steps that have been completed to date in preparation for the next global pandemic. That document has become a suggested a check list for Janet Napolitano, President Obama’s Secretary of HHS, to complete. If you haven’t seen it, it is worth reading, even though it may keep you up at night, knowing what is coming in the form of vaccines, vaccine types and new vaccine adjuvants.

We have had three warm-up rounds: SARS, H5N1 bird flu and now, a “novel swine flu” from Mexico. Is there something bigger in store? There is no way to know for sure, but it is highly suspect. What we can say for sure is that another pandemic test round has passed muster. The media machine did its job, the government handed over billions for more vaccines and vaccine technologies, and, of course, many of the sheep obediently put on masks and fearfully ran off to doctors to be tested. When this has run its course, bureaucratic agencies will be slapping themselves on the back, affirming that all the systems worked ‘as planned.’ They turned the crank; the world danced to their tune.

For those who hope that one day, an informed citizenry will undertake a serious blow back against the continually escalating government propaganda and media manipulation, I hope most of you find the reports of runs on emergency rooms and the optional mask- and glove-wearing to be somewhere between amusing and annoying. Fear runs this country and when the great “What If” boogey man shouts, a large number seem to listen. As I write this, I am on a completely full, 737 airplane about to complete a three-hour flight from Houston to San Diego. Not one person came on the plane with a mask and I have not heard a single sneeze or a sniffle. I’m glad to see that many are going about their lives, business as usual.

The information in my book, FOWL!, is as timely now as when it was written. In 2006, I reported that the Director General of the WHO had said in 2005, “It is only a matter of time before an avian flu virus—most likely H5N1— acquires the ability to be transmitted from human-to-human, sparking the outbreak of human pandemic influenza. We don’t know when this will happen. But we do know it will happen.” (He didn’t say “might” or “maybe” – he said a pandemic “will” occur).

And if he is right and we do see another sizable pandemic –whether the virus is man-made or created by some natural, random reassortment of viral genes – my hope is that everyone will take a deep breath, exercise normal health precautions, increase their Vitamin D, A and E intake, get lots of extra sleep and remember the lessons from history so we do not repeat them.

source: http://drtenpenny.com/a_plan_comes_together.aspx / http://blogs.healthfreedomalliance.org/blog/2009/07/16/a-plan-comes-together-the-sheep-obey

Osteoporosis in our Seniors

Nutritional Factors in Osteoporosis

The incidence of osteoporosis increases with age, and is develops at an earlier
age in woman than in men. About 55 % of Americans, women more so than men, are
at risk of developing osteoporosis. This disease is characterized by a
demineralization of the bones, which become porous and fragile, this causing a
higher susceptibility to fractures.

Bone is largely calcium in nature, but it is only now becoming more obvious that
calcium intake is but one of many nutritional concerns that must be addressed in
order to effectively treat osteoporosis.

FACT #1: The human adult requires approximately 200 mg of elemental calcium per
day, requiring a nutritional allowance is approximately 1,000 mg per day. Too
much calcium causes malabsorption of other nutrients. With calcium intake, more
may be less.

FACT #2: Taking a properly balanced mineral supplement minimizes the danger of
taking too much calcium.

FACT #3: Most commercially available vitamin/mineral supplements are worthless
because they present the minerals in a poorly absorbed, inorganic form. It is
better that you should keep your money in your pocket than to purchase this
junk.


Dietary Phosphoric Acid Accelerates Osteoporosis

Diet influences development of osteoporosis. Intake of phosphoric acid can
dramatically accelerate the development of osteoporosis. Cola beverages are the
greatest dietary/environmental risk in this regard. Phosphoric acid is present
in high concentration in cola beverages, and consuming phosphoric acid will
worsen calcium deficiency and weaken bone.

FACT #4: Phosphoric acid intake, in the form of carbonated soft-drinks can
hasten the development of osteoporosis.

Vitamin K-2

Vitamin K-2 is member of a lesser known vitamin group. Vitamin K-2 stimulates
bone formation by way of hormone-regulation, and Vitamin K-2 reduces the
incidence of vertebral fractures, despite having only modest direct effects on
the bone mineral density. Vitamins K-1 and K-3 are inactive in this regard.

Vitamin K-2 is found in certain vegetables, but it is absorbed best if injested
simultaneously with butter. Further, the production of Vitamin K-2 is
accomplished through ‘normal’ gastro-intestinal bacteria.

NOTE WELL: Supplementation of vitamin K-2 can prevent the development of
osteoporosis and reduce the risk of lumbar compression fractures from
osteoporosis.



FACT #5: GI bacteria are important to the production of Vitamin K-2.
Anti-biotics kill off the ‘good bacteria’ right along with the pathogenic
bacteria. Loose use of antibiotics alter GI flora, crippling our ability to get
VitaminK-2.

FACT #6: Taking the wrong form or formulation of Vitamin K, or Vitamin K-2 is
worthless in therapeutic benefit.

Vitamin D-3

Cholecalciferol (Vitamin D-3) is necessary for the absorption of calcium from
the gut as well as for deposition of calcium in the bone. Vitamin D-3 deficiency
leads to Osteoporosis. [editors note: Vitamin D is actually not a vitamin in the pure
sense by definition as our bodies make this compound when exposed to sunlight, however by
convention it is still referred to as a "vitamin". (Saleeby)]

Vitamin D-3 is really is not a vitamin, at all, but it is a hormone. Its
metabolic product, calcitrol has genetic receptors in over 200 genes in the
human body, and vitamin D deficiency is a major factor in the pathology of at
least 17 varieties of cancer as well as heart disease, stroke, hypertension,
autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis,
osteoporosis, muscle weakness, muscle wasting, birth defects, and periodontal
disease.

FACT #7: Vitamin D-3 supplementation reduces the risk of breast cancer,
prostate and colon cancers by as much as 50%, and reduces the risk of developing
multiple sclerosis (MS) by as much as 40%.

Strontium

Strontium is an element necessary for the maintenance of calcium matrix.
Strontium supplementation decreases the risk of vertebral fractures, by 49%
within the first year of treatment. Further, this risk of non-vertebral
fractures is decreased by 16% and, in patients at high risk for such a fracture,
the risk of hip fracture is decreased by 36% over 3 yrs.

Other Important Nutrients



However, there are other vitamins and minerals needed for metabolic processes
related to bone, including manganese, copper, boron, iron, zinc, vitamin A,
vitamin C, and the B vitamins. The diet must be sufficient in balanced protein
as well as balanced with the appropriate fats and oils.

Deficiencies in zinc, magnesium, manganese, strontium, vanadium and chromium,
result in many disease states ranging from obesity and diabetes to Alzheimer’s
Disease and cancer.

To this end, I find it easiest to start my patients on a balanced mineral
supplement, separate and distinct from the vitamin and hormonal supplement
requirements. This permits adjustment for age, gender, and disease state. If
these products were presented in one capsule or packet formulation,
customization would be difficult if not impossible.



Summary

Bone is a dynamic organ system. Physiologic forces promote bone deposition and
production, while others promote resorption and destruction. Nutritional
influences are extremely important, both in positive and negative terms. It
takes a wide variety of essential substances, mineral, vitamin, protein, and
hormonal to maintain the health and integrity of each and every organ system,
including the musculoskeletal system.



Source: David S. Klein, MD e-mail newsletter

PE a commonly missed fatal disease

CTPA of patient with PE

Pulmonary Embolism

The patient's diagnosis was made based on the CT pulmonary angiogram (CTPA) of the chest, which revealed multiple thrombi extending into the lobar and segmental/ subsegmental branches of the right and left pulmonary arteries. Venous Doppler ultrasonography of both lower extremities was negative for deep vein thrombosis. A CT scan of the abdomen and pelvis with contrast did not reveal any thrombi in the pelvic veins. Venous Doppler ultrasonography of the upper extremities was not performed, as upper extremity thrombi are less common than lower extremity deep venous thrombi.

Pulmonary embolism is a serious and potentially fatal complication of thrombus formation within the deep venous circulation. Pulmonary embolism is the third leading cause of death in the United States, with approximately 650,000 patients developing pulmonary embolism each year. Most cases are not recognized antemortem; up to 80% of cases are diagnosed at autopsy.

The pathophysiology of pulmonary embolus is thought to result from obstructed pulmonary blood flow. Air, amniotic fluid, foreign bodies, parasite eggs, septic emboli, and tumor cells can all embolize in the pulmonary vasculature. The most common embolus is a thrombus, which can form anywhere in the venous system. The most common site for thrombus formation is in the deep veins of the lower extremities. The risk factors for thrombus formation are venous stasis, hypercoagulable state, and vessel wall (endothelial) damage (known as the Virchow triad). Several factors predispose individuals to an increased risk of pulmonary embolism, including an age of over 40 years, obesity, congenital thrombophilia, smoking, cancer, and pregnancy. The risk is also increased by use of oral contraceptives.

Although the presentation of pulmonary embolus can be extremely variable, the typical presentation includes dyspnea, cough, fever, leg pain and swelling, and chest pain. As the thrombus progresses, patients may develop apprehension, diaphoresis, palpitations, nausea, vomiting, chills, and syncope. If patients remain untreated, they may develop syncope, cyanosis, diaphoresis, tachycardia, hypotension, and shock. Less common signs include hemoptysis, atelectasis, wheezing, pleural friction rub, rales, accentuated S2 or S3, tricuspid regurgitation, jugular venous distension, and acute right ventricular strain. Signs of acute right ventricular strain that may be seen on an electrocardiogram include an S-wave in lead I, a Q-wave in lead III, and a T-wave in lead III. Right axis deviation and partial or complete right bundle branch block may also be noted.

The differential diagnosis of pulmonary embolism includes dissecting aortic aneurysm, pneumonia, acute bronchitis, bronchial carcinoma, pericardial or pleural disease, heart failure, costochondritis, pleurisy, pneumothorax, mucus plug, and myocardial ischemia.

Routine laboratory tests have limited value in the diagnosis of pulmonary embolism. Arterial blood gas may reveal hypoxemia, hypocapnia, and respiratory alkalosis with an elevated A-a gradient. A positive D-dimer is not specific for pulmonary embolism, but a negative D-dimer has a 95% negative predictive value; therefore, it is useful in ruling out pulmonary embolism in those with a low pretest probability of disease. Coagulation studies and coagulopathy workup are not useful in the diagnosis of pulmonary embolism, but they may be necessary once the diagnosis has been established to rule out an underlying hypercoagulable condition.
The gold standard for diagnosing pulmonary embolism has been pulmonary angiography; however, CTPA is rapidly gaining in popularity for diagnosing pulmonary embolism, with a sensitivity of 85-94%, and it is likely to become the new gold standard. Spiral CT scanning is less invasive and more available than pulmonary angiography. A ventilation-perfusion scan can be useful in ruling out pulmonary embolism, but it may be less useful in diagnosing pulmonary embolism because many clinical conditions can lead to defects in the perfusion scan as a result of decreased blood flow. A ventilation-perfusion scan is now generally done only when CT angiography is contraindicated. Chest radiography is usually performed, but it is rarely diagnostic and is often completely normal. An ECG is typically obtained to rule out alternative causes of chest pain/dyspnea, but it is also not of much diagnostic value in pulmonary embolism itself. The most common ECG abnormalities in pulmonary embolus include sinus tachycardia and nonspecific T-wave changes. Although the classic S1Q3T3 pattern was noted in hindsight in this patient, especially with return visits, it is not frequently seen.

The treatment for pulmonary embolism falls into 2 categories. The first category includes patients who are hemodynamically stable. For these patients, anticoagulation and prevention of recurrent pulmonary embolism are vital. Anticoagulation is initially obtained with the use of heparin, fondaparinux, or low molecular weight heparin (LMWH). After initial anticoagulation is started, warfarin may be commenced. Bridging with heparin or LMWH for the first 5 days of warfarin therapy, until a therapeutic international normalized ratio (INR; therapeutic range, 2-3) is achieved is necessary. To prevent recurrent pulmonary embolisms, inferior vena cava or other intravenous filters can be placed.

The second category of treatment addresses hemodynamically unstable patients. For these patients, there are 2 major treatment options. The first is direct removal of the clot, through surgical embolectomy or catheter-based extraction by an interventional radiologist. Surgical embolectomy should only be used in patients with contraindications to thrombolytics or failed thrombolytics, or in whom surgery may be the only chance for survival. The second form of treatment is thrombolysis. Although thrombolysis has not been shown to improve mortality, it is often readily available in EDs. Indications for thrombolytic therapy include patients with shock, right heart failure, underlying cardiopulmonary disease, recent pulmonary emboli, or severe pulmonary hypertension. Thrombolytics may cause significant bleeding, including central nervous system bleeding, and they should only be used in appropriate circumstances where the risk/benefit ratio is favorable.

Contraindications of thrombolysis include recent or suspected cerebrovascular accident, intracranial trauma or surgery within the past 2 months, active intracranial disease, major internal bleeding within the past 6 months, uncontrolled hypertension, bleeding diathesis/coagulopathy, recent major surgery within 10 days, recent trauma, infective endocarditis/pericarditis, pregnancy, aortic aneurysm or hemorrhagic retinopathy.

The patient (CT above) was admitted to the intensive care unit and started on LMWH and warfarin. Given the subacute nature of his symptoms and his apparent stability, thrombolytics were not initially administered. The patient's oxygen saturation and symptoms continued to improve during his hospitalization and further laboratory studies, including antinuclear antibody (ANA) , protein C and S, prothrombin mutation, factor V Leiden, lupus anticoagulant, and phosphatidyl antibody, were initiated. He was discharged once his INR was therapeutic at a range of 2-3 and followed up in an anticoagulation clinic to maintain a therapeutic INR. All coagulation panel labs were negative, and he has not had a recurrence of the pulmonary embolism. A CT scan of his chest, abdomen, and pelvis done 1 month after initiation of therapy revealed an approximate 95% decrease in the size of the emboli seen in the left pulmonary artery and an almost 80% decrease in the pulmonary emboli seen in the right pulmonary artery. The embolic source was never identified.

source: http://cme.medscape.com/viewarticle/704438?src=emed_case_nl_0

Takotsubo cardiomyopathy - Stress induced

Watch your stress... you may find yourself suffering from an unusual type of cardiomyopathy (enlargement of the apical aspect of the heart).

(A: Takotsubo Cardiomyopahty scheme with ballooning of the apical aspect of the heart. B: Normal heart cross section)

Takotsubo cardiomyopathy, also known as transient apical ballooning, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, broken-heart-syndrome and simply stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, the condition is also known as broken heart syndrome.

The typical presentation of someone with takotsubo cardiomyopathy is a sudden onset of congestive heart failure or chest pain associated with EKG changes suggestive of an anterior wall heart attack. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap (bowl) in Japan, where it was first described.

The cause appears to involve high circulating levels of catecholamines (mainly adrenaline/epinephrine). Evaluation of individuals with takotsubo cardiomyopathy typically include a coronary angiogram, which will not reveal any significant blockages that would cause the left ventricular dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within 2 months. Takotsubo cardiomyopathy is more commonly seen in post-menopausal women. Often there is a history of a recent severe emotional or physical stress.

source: http://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy

Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory disorder of multiple articular and para-articular structures that principally involves the axial skeleton. It usually affects the sacroiliac joints and the spinal facet joints of the vertebrae. It sometimes involves the appendicular skeleton as well, such as the joints of the greater trochanter, patella, and calcaneum. Other extraspinal manifestations include iritis/uveitis and pulmonary involvement. The basic pathologic lesion of ankylosing spondylitis occurs at the entheses, which are sites at which ligaments, tendons, and joint capsules attach to bone. In the outer layers of the annulus fibrosis of the intervertebral disks, the condition manifests as a formation of new bone. The name of the disease is derived from Greek; "ankylos" means stiffening of a joint, and "spondylos" means vertebra. The disease is classified as a chronic and progressive form of seronegative arthritis. Ankylosing spondylitis affects men 4-10 times more frequently than women, and the symptoms generally appear in those aged 15-35 years. More than 90% of whites with ankylosing spondylitis have the HLA-B27 gene, but 6-8% of those with this gene do not develop the disease.

Symptoms of ankylosing spondylitis include back pain and stiffness, peripheral joint and chest pain, sciatica, anorexia, weight loss, and low-grade fever. The back pain associated with this condition is typically transient at first, but it eventually becomes persistent. It is usually worse in the mornings and resolves with exercise. A typical patient may also complain of waking up with back pain at night. The pain is usually centered over the sacrum, but it may radiate to the groin, buttocks, and down the legs. With time, the back pain usually progresses up the spine and affects the rib cage, resulting in a restriction of chest expansion and diaphragmatic breathing (observed as ballooning of the abdomen during inspiration) as the costovertebral joints become affected. The cervical spine is ankylosed late in the course of the disease, leading to restriction in neck movement and head rotation. Without treatment, the spine eventually becomes completely rigid, with loss of the normal curvatures and movement.

On physical examination, the loss of lateral flexion of the lumbar spine is the earliest objective sign of spinal involvement. The sacroiliitis may be detected by eliciting a tenderness response during percussion over the sacroiliac joints. Objective tests to quantify spinal restriction include touching the toes, the Schober test, and measurement of chest expansion. Additional physical findings include restriction of motion in the peripheral joints and tenderness over the enthuses. The physical exam should also include evaluation for signs of potentially serious cardiovascular and pulmonary complications, such as aortic incompetence secondary to aortitis, conduction defects of the heart, cardiomyopathy, pericarditis, apical fibrosis of the lungs, bronchiectasis, cavitation of the chest, and development of a restrictive ventilatory pattern. Other associated conditions include the development of inflammatory bowel disease, uveitis (in up to 20% of patients), radiculitis secondary to inflamed nerves, and, rarely, amyloidosis.

Specific criteria for the diagnosis of ankylosing spondylitis include the Rome criteria (developed in 1963) and the New York criteria (developed in 1968). Although these criteria have been generally accepted as useful, limitations are recognized and overlaps exist among the clinical and radiologic features of various seronegative spondyloarthropathies. Sacroiliitis is the hallmark of ankylosing spondylitis and is a requisite for the diagnosis under both sets of criteria. Other conditions, such as psoriasis, Reiter disease, enteropathic arthropathy, hyperparathyroidism, and osteitis condensans ilii, may also result in bilateral symmetric sacroiliac joint disease and should be considered in the differential diagnosis. Ankylosing spondylitis may also present with asymmetric sacroiliitis, which may be more characteristic of other conditions, such as psoriasis, Reiter disease, rheumatoid arthritis, and gouty arthritis. Radiographically, diffuse idiopathic skeletal hyperostosis (DISH) has a similar appearance to ankylosing spondylitis; however, DISH typically occurs at a later age and does not involve the sacroiliac joint.

The radiographic changes usually first appear in the sacroiliac joints, followed by the thoracolumbar and lumbosacral spine; this is in line with the natural progression of the disease. The disease then proceeds cephalad up the spine; however, the cervical spine may also be affected without involvement of the thoracic or lumbar spine. Radiographically evident peripheral-joint abnormalities are seen in more than 50% of patients. Abnormalities can also be seen in the symphysis pubis and in the manubriosternal, sternoclavicular, and temporomandibular joints. Spinal findings include osteitis, syndesmophytosis, diskovertebral erosions and destruction (Romanus lesions), and disk calcification. Radiographically, joint involvement appears as joint-space narrowing, periostitis, osseous erosion, and minimal periarticular osteoporosis (less than that seen with rheumatoid arthritis). Sacroiliac joint involvement is usually bilateral and symmetric.

Common laboratory findings are an elevated erythrocyte sedimentation rate (during the acute phase), a positive HLA-B27 histocompatibility antigen, mild leukocytosis, normochromic normocytic anemia (anemia of chronic disease), and negative results for rheumatoid factor.

The general principles of managing chronic arthritis also apply to ankylosing spondylitis. Among the various nonsteroidal anti-inflammatory drugs (NSAIDs) available to treat the disease, indomethacin may be the most effective. The lowest dose that provides pain relief should be used in order to avoid potentially serious complications, such as gastritis, peptic ulcer disease, and renal insufficiency. Sulfasalazine can be useful if peripheral arthritis is substantial, but it may be less effective when spinal and sacroiliac pain are the most prominent symptoms. In the majority of patients, the symptoms persist for life, although in some cases remission does occur.

Physical therapy and exercise can help prevent axial immobility. Specifically, spinal extension and deep-breathing exercises maintain spinal mobility, encourage erect posture, and promote chest expansion. Maintaining an erect posture and sleeping on a firm mattress with a thin pillow can help reduce thoracic kyphosis. Severe hip or spinal involvement may require surgical repair. Antitumor necrosis factor (anti-TNF) agents, such as infliximab and etanercept, are relatively new but often very effective therapeutic agents that may be considered for patients with pain refractory to other interventions.

source: http://cme.medscape.com/viewarticle/703652_2

More on Hypothyroidism

Hypothyroidism:  The Silent Epidemic

Hypothyroidism can be loosely defined as a medical condition that results from
the under-secretion of Thyroid Hormone.  The difficulty with this traditional
approach to diagnosis of hypothyroidism is that it relies on ‘normal values,’ or
reference ranges that are defined by the population itself.  It has been
estimated that as many as 50 million American suffer from undiagnosed
hypothyroidism.

Fact #1:  Thyroid hormone is necessary to maintain basal metabolic rate, or the
amount of fuel that is consumed to sustain health.  The manifestation is that of
temperature. 
a.  When a person is generating too little thyroid hormone, or if the individual
has an imbalance that involves thyroid metabolism, body temperatures will fall. 

b.  These persons may be told that they ‘normally have low temperatures.’ 
c.  This bit of nonsense is causing tremendous problems for society.
d.  The result is weight gain, depression and elevations in cholesterol levels.

Fact #2:  The traditional approach to the diagnosis of hypothyroidism involves
measurement of a hormone released by the pituitary gland, TSH.   If the central
nervous system senses that there is inadequate thyroid hormone in the blood
stream, TSH levels will increase.  Increase in TSH should lead to increases in
the release of Thyroid Hormone from the Thyroid Gland.  As levels of Thyroid
Hormone reach adequate levels, TSH release decreases.

Problem #1:  Unfortunately, a lot can go wrong between the brain, pituitary
gland and the thyroid gland, itself.  Inadequate levels of thyroid hormone can
persist, and the brain will ‘reset’ to new and lower levels of this hormone. 
Factors that can cause this include: 
1.  chronic stress
2.  pregnancy
3.  trauma
4.  chronic disease states.
5.  autoimmune conditions
6.  fasting or famine conditions.

As TSH levels drop back to normal, the diagnosis of hypothyroidism becomes more
difficult, if all the practitioner relies upon is the TSH level.  Unfortunately,
this is the case more times than not.

Problem #2:  Thyroid Hormone does not work alone.  It requires adequate levels
of estradiol, estrone, progesterone, testosterone, cortisol, insulin, DHEA and a
host of other hormones, peptides, fatty acids and humoral elements.  If any one
of these necessary pieces are missing, out of balance, or in excess, thyroid
hormone may not work properly, leading to a state of ‘functional
hypothyroidism.’ 

TSH levels, thyroid hormone levels are ‘normal,’ but the body does not function
properly and resembles the hypothyroid condition.

Problem #3:  Thyroid Hormone replacement may be inadequate or improper for the
patient.  That is, not all thyroid replacement works for all patients.  There
are chemicals in some of the commercially available thyroid preparations that
cause all manners of problems.  One such substance is ‘Acacia,’ which is a
family of shrubs and trees, and portions of this plant are used in some
medications to provide form and shape to tablets.  Lactose is also used in the
most popular of the Thyroid Replacement Hormones.  Not only is Lactose an
allergic trigger for people with lactose intolerance, but it may actually block
the absorption of the thyroid replacement, itself. Signs of lactose intolerance
include nausea, cramps, bloating, gas, and diarrhea.

It is very common to hear patients tell the doctor that the thyroid medicine
that they are receiving is ‘making me sicker.’  Unfortunately, the practitioner
does not often make the effort to figure out why this might be the case.

Problem #4:  Certain foods make thyroid conditions worse.  Patients with
auto-immune disorders may be more sensitive to soy-protein than other persons. 
Soy contains two chemicals that inhibit an important enzyme that is necessary
for thyroid hormone replacement.  If a person is already ‘on the edge,’ taking
soy protein can make the condition worse.  To a lesser extent, peanuts, pinto
beans do this, as well.

Recommendations: 
1.  In order to sort through the diagnosis of thyroid related problems, it is
important to determine not only the levels of thyroid hormones and TSH, but it
is important to determine the presence of antibodies to the binding protein and
converting enzymes.
2.  If you suspect that you have hypothyroidism, it is necessary to cease eating
anything that contains soy, soy lecithin, peanuts and pinto beans.
3.  Replacement of thyroid hormone should be accomplished with products that do
not contain lactose, Acacia, and artificial colorations.
4.  Thyroid hormone must be taken on an empty stomach.
5.  Determination of hormone imbalances that affect thyroid metabolism must be
accomplished.

email from David S. Klein, MD, FACA

Thyrotoxicosis & Thyroid Storm

Thyrotoxicosis refers to an elevated concentration of thyroid hormone as well as the related clinical manifestations. This is differentiated from thyroid storm, a life-threatening manifestation of thyrotoxicosis in which a markedly hypermetabolic state is present. Hyperthyroidism most commonly results from uncontrolled Graves disease, in which autoantibodies to the TSH receptor are produced. This leads to excessive thyroid hormone production from the thyroid gland and a reflexive inhibition of TSH release from the pituitary gland. Other etiologies can include a solitary thyroid adenoma, toxic multinodular goiter, hypersecretory thyroid carcinoma, thyrotropin-secreting pituitary adenoma, struma ovarii, and iodine or amiodarone administration. A precipitating event, such as surgery, trauma, myocardial infarction, pulmonary embolism, diabetic ketoacidosis, childbirth, severe infection, discontinuation of antithyroid medication, or thyroid surgery on a patient with uncontrolled hyperthyroidism, is often needed to push a patient with hyperthyroidism into thyroid storm.

The incidence of hyperthyroidism in the United States is 0.05% to 1.3%, most of which remains undiagnosed. Approximately 1-2% of these patients will progress to thyroid storm at some point. The prevalence is slightly higher in women compared with men and in white and Hispanic populations compared with black populations. Thyroid storm is most common in the third to sixth decades of life, although it can occur at any age.

Thyroid storm is a clinical diagnosis and, considering the acuity of this life-threatening condition, patients with thyrotoxicosis should be treated empirically when the diagnosis is suspected. Symptoms of thyrotoxicosis include weight loss, palpitations, hair loss, diplopia, chest pain, oligomenorrhea, or confusion. The physical examination reveals a hypermetabolic state, with abnormalities involving multiple organ systems. These findings commonly include hyperpyrexia, tachycardia, tachypnea, and hypertension. Other findings may include fine tremor, exophthalmos, ophthalmoplegia, pretibial edema, congestive heart failure, thyromegaly, thyroid bruit, and hyperreflexia. Laboratory studies show a low TSH level and elevated T3 and T4 concentrations. TSH is the most precise indicator of thyroid function because of the very high sensitivity of the thyroid-pituitary feedback loop, and current assays are able to detect levels of 0.02 mIU/L or less. As such, a normal TSH level largely excludes significant thyroid disease. Other laboratory findings seen in thyrotoxicosis may include hyperglycemia, hypercalcemia, leukocytosis, and elevated liver enzymes. Further testing may be indicated as part of a search for the precipitating cause of clinical decompensation, such as infection, myocardial infarction, or diabetic ketoacidosis. Electrocardiography most often reveals sinus tachycardia or atrial fibrillation. Although thyroid storm requires more rapid and aggressive therapy than thyrotoxicosis, differentiating between the two can sometimes be difficult, as it was in this patient. Burch and Wartofsky developed a scoring system to assist in making this distinction that takes into account thermoregulatory dysfunction, central nervous system effects, gastrointestinal dysfunction, the degree of tachycardia, the extent of congestive heart failure, the presence of atrial fibrillation, and the presence or absence of a precipitating event.

Cardiac complications from thyrotoxicosis include arrhythmias, congestive heart failure, and pulmonary hypertension. The most common arrhythmia in thyrotoxicosis is sinus tachycardia; however, atrial fibrillation occurs in 10-20% of patients with thyrotoxicosis, most often in patients who are older than 60 years. Risk factors for atrial fibrillation in these patients include male sex, increasing age, coronary heart disease, heart failure, and structural heart or valvular disease. Congestive heart failure in thyrotoxicosis is predominantly caused by either persistent tachyarrhythmias (tachycardia-induced cardiomyopathy) or uncontrolled hypertension as a consequence of thyrotoxicosis. Systolic dysfunction can occur as a consequence of the persistent cardiac arrhythmias, but it usually resolves once the hyperthyroid state is treated. Pulmonary hypertension can also occur in thyrotoxicosis, either as a result of a primary effect of thyroid hormone on pulmonary arteriolar resistance vessels, decompensated left heart failure, or via increased pulmonary arterial blood flow (high-output).

The differential diagnosis for thyrotoxicosis and thyroid storm may include anxiety, congestive heart failure, heat exhaustion or heatstroke, factitious disorder, neuroleptic malignant syndrome, panic disorder, septic shock, serotonin syndrome, anticholinergic or sympathomimetic toxicity, and alcohol or benzodiazepine withdrawal syndromes. Because infection is a common trigger for thyroid storm, an initial misdiagnosis of sepsis is not uncommon because of similar characteristics, such as tachycardia, fever, and altered mental status.

Management of thyrotoxicosis consists of a 5-pronged, ordered approach, targeting each step in the biosynthetic pathway of thyroid hormone and its activity on target tissues. Treatment begins with administration of propylthiouracil (PTU) or methimazole, both of which act by inhibiting new hormone synthesis. PTU has the added effect of decreasing peripheral T4 to T3 conversion. Beta-blockers are then employed to inhibit target activity of thyroid hormone. Propranolol is the preferred agent because it also blocks peripheral conversion of T4. When cardioselective agents are preferred, atenolol or metoprolol may be used. At least 1 hour after administration of PTU or methimazole, the patient may be given iodide to inhibit further thyroid hormone release. It is imperative that iodine be given only after synthesis of new hormone is blocked because iodide administration can have the undesired effect of increasing new hormone synthesis. Potassium iodide or Lugol solution of iodine is recommended. Peripheral conversion of T4 to T3 is blocked, as noted above, and dexamethasone may be used as well. Further treatment is supportive and may include acetaminophen for fever and hydrocortisone if the patient is hypotensive as a result of adrenal insufficiency. Salicylates are contraindicated because they displace bound thyroid hormone in the blood.

With regard to the management of cardiac symptoms related to thyrotoxicosis, treatment is focused on reducing adrenergic drive to the heart and restoring normal cardiac rhythm. As mentioned above, beta-blockers are very effective for rapid hemodynamic improvement. Either propranolol or metoprolol given intravenously can be used to improve heart rate control either in sinus tachycardia or atrial fibrillation. In severe cases, a continuous infusion of esmolol may be required for rate control. Amiodarone should be avoided when treating atrial fibrillation from thyrotoxicosis because of its high iodine content, which may induce or exacerbate thyroid storm. If a patient is hemodynamically unstable from atrial fibrillation, direct current cardioversion should be employed. If symptoms of pulmonary congestion appear, diuretics may be used. Other drugs for heart failure (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or aldosterone receptor antagonists) are reasonable agents in patients who have depressed left ventricular systolic function. Anticoagulation is recommended for patients in atrial fibrillation secondary to thyrotoxicosis. The 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) guidelines recommend anticoagulation with warfarin to an international normalized ratio of 2.0-3.0 until the patient is euthyroid, after which recommendations and risk stratification are the same for atrial fibrillation without thyrotoxicosis. Of note, PTU, methimazole, and iodide solutions are all classified as pregnancy class D and, as such, should not be used in pregnancy.

Source: Medscape CME Online

Population Clock for the USA

http://www.census.gov/population/www/popclockus.html

Really this is ONLY A JOKE

I love this Doctor

Q: Doctor, I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart is only good for so many beats, and that's it.... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?
A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?
A: Well, if you have a body and you have fat, your ratio is one to one. If you have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of a single one, sorry. My philosophy is: No Pain...Good!

Q: Aren't fried foods bad for you?
A: YOU'RE NOT LISTENING!!! ..... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?

Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?
A: Are you crazy? HELLO Cocoa beans ! Another vegetable!!! It's the best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whales to me.

Q: Is getting in-shape important for my lifestyle?
A: Hey! 'Round' is a shape!

Well, I hope this has cleared up any misconceptions you may have had about food and diets.
AND.....
For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting nutritional studies.

1. The Japanese eat very little fat
and suffer fewer heart attacks than Americans.

2. The Mexicans eat a lot of fat
and suffer fewer heart attacks than Americans.

3. The Chinese drink very little red wine
and suffer fewer heart attacks than Americans.

4. The Italians drink a lot of red wine
and suffer fewer heart attacks than Americans.

5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than Americans.

CONCLUSION

Eat and drink what you like.
Speaking English is apparently what kills you.

AND REMEMBER:
'Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - body thoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride'

Warning: This is only a joke. Anyone who takes this advice seriously needs a mental health evaluation. It is funny because it truly goes against common sense and scientific studies.

Mediterranean Diet Pyramid

Source: Oldways

Metabolic Syndrome, Chromium & Vanadium

Weight Gain, Insulin Resistance and Metabolic Syndrome “X”

Insulin Resistance Syndrome (IRS), sometimes referred to as Metabolic Syndrome
“X” is a medical condition affecting as many as one in four Americans.
Considered to be a ‘pre-diabetic’ state, IRS precedes the development of
diabetes by as much as 10 years.

Insulin is a hormone, secreted by the pancreas.  Insulin has two principal
functions: (1) control of blood sugar, and (2) deposition of free fatty acids
into the fat cells.  If the insulin receptor becomes dysfunctional, it takes
more and more insulin to maintain normal blood sugars.  Unfortunately, the
increase in the Insulin level results in fat deposition, mostly in the abdomen.

As more and more insulin is needed to maintain blood sugar levels, the fat cells
respond to the situation by becoming ‘fatter.’  This in turn results in even
higher insulin levels.  Eventually, blood sugar levels cannot be maintained,
even with the very high insulin levels, and ‘diabetes’ is diagnosed.  Clearly,
the animals were well out of the barn by the time ‘diabetes’ was finally
diagnosed.

The key to diabetes prevention is detecting ‘insulin resistance’ before things
get totally out of control.  In order to do this, serum insulin levels should be
determined simultaneously with blood glucose.

NOTE:  Healthy blood sugar to insulin ratio should be greater than 10 to 1.

The first step to restore more normal, lower insulin levels is to treat with a
combination of trace minerals.  The key here is balance.  Chromium and vanadium
are associated with insulin receptor dysfunction, but these should not be taken
without adequate intake of zinc and selenium. Many patients will
experience some weight loss. Typically, patients will
lose 4-8 pounds over the course of 6 to 8 weeks.

After 1-2 weeks of mineral use, blood sugar levels can be expected to drop.
When weight loss ends, additional chromium is administered.  Typically chromium
200 mcg, taken twice daily is added to the a typical regiment of chromium and vanadium.
Alpha Lipoic Acid(ALA) 500 mg taken twice daily will further sensitize the cells to insulin.

Source:  Email from David Stephen Klein, MD, FACA, FACPM, FACMIMS

Letter from President Obama

May 13, 2009

Good afternoon,

You are receiving this email because you signed up at WhiteHouse.gov. My staff and I plan to use these messages as a way to directly communicate about important issues and opportunities, and today I have some encouraging updates about health care reform. The Vice President and I just met with leaders from the House of Representatives and received their commitment to pass a comprehensive health care reform bill by July 31. We also have an unprecedented commitment from health care industry leaders, many of whom opposed health reform in the past.

Monday, I met with some of these health care stakeholders, and they pledged to do their part to reduce the health care spending growth rate, saving more than two trillion dollars over the next ten years -- around $2,500 for each American family. Then on Tuesday, leaders from some of America's top companies came to the White House to showcase innovative ways to reduce health care costs by improving the health of their workers.

Now the House and Senate are beginning a critical debate that will determine the health of our nation's economy and its families. This process should be transparent and inclusive and its product must drive down costs, assure quality and affordable health care for everyone, and guarantee all of us a choice of doctors and plans.

Reforming health care should also involve you. Think of other people who may want to stay up to date on health care reform and other national issues and tell them to join us here: http://www.whitehouse.gov/EmailUpdates Health care reform can't come soon enough. We spend more on health care than any country, but families continue to struggle with skyrocketing premiums and nearly 46 million are without insurance entirely.

It is a priority for the American people and a pillar of the new foundation we are seeking to build for our economy. We'll continue to keep you posted about this and other important issues.

Thank you,

Barack Obama

P.S. If you'd like to get more in-depth information about health reform and how you can participate, be sure to visit http://www.healthreform.gov/.

This email was sent to jpsaleeby@aol.com Privacy Policy

The White House · 1600 Pennsylvania Ave NW · Washington, DC 20500 · 202-456-1111

Zinc (Zn)

Zinc: An Essential Element for Health

by JP Saleeby, MD

Zinc is an important element for human metabolism and health. After Iron (Fe) it is the second most abundant element in our body. The importance of this element covers many body processes from the regulation of gene expression to protein synthesis and structure. Zinc is the co-factor in as many as 100 enzymatic reactions in the human body. If we have a well rounded diet we acquire Zn naturally from beef, poultry, seafood and grains. In a 2002 survey some 2.5 percent of those adults surveyed stated they took Zn as a dietary supplement daily. Also noted in epidemiological studies is that zinc deficiency accounts for a global death rate of 1.8-million individuals each year. This is mostly seen in the severely malnourished. Other symptoms of Zn deficiency are growth retardation, delayed puberty, erectile dysfunction, loss of hair, nail dystrophy and hypogonadism in males.

Zinc has been used to treat childhood diarrhea, age related macular degeneration, prevention of upper respiratory infections and in wound care. Zinc with the co-factor of Vitamin C is intricately involved in the process of development of collagen and connective tissue repair. Additionally, it has been associated with reduction of rapid progression of HIV disease in those who are Zn deficient and in treating those with Wilson disease (a Copper (Cu) metabolism disorder) as it competes for protein binding sites with Cu. Zinc is important to T-cell maturation (a component of our immune system) as it is a co-factor in the production of thymulin a thymic hormone essential for T-cell production and function. There is some controversy as to whether Zn lozenges help treat upper respiratory infections (URI) already acquired versus preventing them, but more research is needed.

There are issues with taking too much Zn. A safe dose is around 20 to 30 mg per day. The upper limit being 40mg/d for most people for long term use. Too much zinc can inhibit the absorption of copper as it competes for its absorption in the body, it can suppress the immune system, decrease HDL-C (good cholesterol) and cause a hypochromic microcytic anemia. It can also result in nausea, vomiting and abdominal cramping. Zn absorption is inhibited by concomitant administration of iron (Fe) and large intakes of phytates found in grains and legumes. So these should be taken separately when Zn supplements are taken.

Not all Zn supplements are equal. For example Zinc acetate has only 30% of the elemental zinc by volume where Zinc sulfate has 23% and Zinc oxide has 80%. So of you take 25 mg of Zinc acetate you are only getting 7.5 mg of elemental Zn, but if you take 25 mg of Zinc oxide you receive 20mg of Zn. So read labels carefully on your selection of zinc supplements.

To slow the progression of Age Related Macular Degeneration (ARMD) a study show effectiveness in people over 55-years of age with the combination of 80mg of Zn, 2mg of copper and in combination of Vitamin C (500mg), Vitamin E (400IU), and Beta-carotene (15mg) acting as antioxidants. Incidentially, zinc holds antioxidant properties in and of itself.

Zinc containing foods

There are studies to show the importance of Zn in human reproduction. Zn in important in females for fertility as well as males. Zinc can aid in the production of testosterone, increase sperm cell counts and help in the uncoupling of testosterone from binding proteins. Additionally Zn can act to prevent the aromatization of testosterone to estrogens and conversion of testosterone to DHT (undesirable in men).

(c) 2009

References:

Saper, RB, et, al. Zinc: An Essential Micronutrient, Am Fam Physician. 2009;79(9):768-772

http://cat.inist.fr/?aModele=afficheN&cpsidt=3046105

1918 Children's Rhyme

I had a little bird
Its name was Enza
I opened up the window
And in-flu-enza


A human "bird house"
Little House Society

A Call for Calm

Lets Reflect Calmly on the Flu Outbreak

-JP Saleeby, MD

Swine Flu vaccine being administered in 1976

Lets put things in perspective. We need a call for calm and rational thinking. Today is not the day for irrational fears, panic and alarmism. Today's report from the CDC on this years "Swine Flu" in this country amount to cases in 41 state with 642 confirmed cases and only 2 deaths so far. The impact on the health care system far exceeds the true threat this illness is having on our population. We must remain calm and rational.

Of course with the memories of the devastating effects of the post WWI flu pandemic of 1918 with the worldwide death rate somewhere between 30 and 40 million people (only 0.5 million deaths in America) we have a right to be concerned and implement effective action. We don't have the right however to become alarmists and panic mongers. This serves neither our patients or our health care system. We can take concerted efforts to control the spread and handle cases that present to our EDs, but we don't have to strike panic in the hearts of the public. Lets take lessons from the 1976 Swine Flu debacle as well as those pearls of wisdom learned from 1918. Lets also put into perspective the death rates of more "mundane" or less sexy health / medical issues our nation / world faces each day.

The Spanish Flu pandemic of 1918 cost the world some estimated 40-million people. Those at the CDC in 1976 estimated some one-million deaths from that years epidemic. In reality there were only 200 cases confirmed with only one death. There was actually more death and destruction that occurred in the process of containment. With the vaccination program in 1976 some 500 cases were reported of the devastating consequence of viral immunizations called Guillain-Barre syndrome which resulted in 25 deaths. So here we have a clear example of where the American public was herded down the wrong path due to irrational panic and the "treatment" was actually worse than the disease. It was also reported in Pittsburgh that three elderly people standing on the long lines for their flu vaccines died of acute heart attacks succumbing to the stress of it all. Again panic claimed three-times the lives of the virus itself. Lets not repeat that in 2009.

There are other things to consider as caution must be taken when reporting and discussing this years flu epidemic. Economic impacts on the travel industry, aviation, travel agencies, hotels, and restaurants for example are feeling the heat quite possibly unnecessarily. Even the lowly pig farmer is suffering mostly due to the misunderstanding of the disease process. The debacle of the Swine Flu epidemic of 1976 which just didn't pan out embarrassed our federal government and cost the job of the director of the CDC. So let us proceed cautiously.

Putting things in greater perspective lets look at other issues that are maybe less glamorous today but still impact our health care system. Possibly this will give us reason to become more interested in conquering these great threats. Lets take world-wide malaria. Malaria kills almost 3000 people a day in sub-Saharan Africa (mostly children) that amounts to almost 1.1-million deaths a year. Those are numbers we should be ashamed of and they just don't make the headlines today. Lets look at the impact of auto accidents on our highways. Some 115 deaths occur each day as a consequence of motor vehicle accidents and that come to 42,000 deaths a year. Many of those deaths are caused by drunk drivers. Alcohol impaired drivers make up some 32% of deaths on the highway (13,500 motorists per year die at the hands of the drunk driver).


So before we get crazy over a "flu pandemic" that may not even pan out, lets take some quiet time to reflect on the facts and reality and realize what we are truly facing and handle it with poise and rational behavior.

-JP Saleeby, MD is medical director of the ED at MPH in Bennettsville, SC.