new from HealthSpanLife.com: OPTIMIZING THE ACCURACY OF WIKIPEDIA IN MEDICAL THERAPY OF THE COMMON MAJOR DEGENERATIVE DISEASES OF AGING:

Wikipedia has become the number one general reference source; and has tightened up considerably on accuracy and objectivity  the past two years, as far as one can judge for topics within one’s own in- depth knowledge. But then Wiki is only as good as the experts who bother to check & upgrade entries in their field.

 

For Bipolar Disorder Wiki indeed defies the Drug Industry and still lists the natural element lithium carbonate first  as the recommended drug for maintenance therapy, ahead of dozens of new competitors for that $multibillion market.. that’s a good precedent for a natural element  used  as a drug the past >150 years.,

 

For eg aspartame,Chronic Fatigue,  Hormone Replacement Therapy, Menopause; the Womens’ Health Initiative and andropause- androgen decline in aging males-  the respective Wiki articles pretty accurately sum up the opposing views and evidence without apparent bias.

 

eg overweight  it sensibly  defines  as BMI above 25kg/sqm, and obesity above 30kg/sqm.  It notes that obesity is already the second leading cause of death in USA, reducing life expectancy by 20% in men and 5% in women-  the causes including the pervasive endocrine disruptors (estrogenic and insulin –desensitizing) – that saturate our homes, offices and food chain; and only 20%  of Americans successfully maintain longterm weightloss with diet and exercise.

    It notes under Biguanides that they were found in the 1920s to lower high blood sugar, but were then ignored due to the simultaneous commercial production of insulin.

 

But in the field of $trillion competitive drug marketting for the most common chronic diseases, Wikipedia articles still appears dominated by those with the biggest commercial interests ie the Disease Industry… 

.

Under weightloss drugs it’s Obesity entry (updated to this month) lists only the antiobesity drugs recommended by the now-ancient 2005 (Am Coll Physicians) position paper: sibutramin, orlistat, diethylpropion, fluoxetine, bupropion, amphetamines- even though there are no even medium-term let alone longterm trials validating these for high benefit to risk ratio, they are all (now including rimonabant)  severely limited if not contraindicated by major adverse effects.

 

Metformin is dismissed in one line: “to treat diabetes..  Metformin may lead to mild weight loss in comparison to sulfonylureas and insulin..  in obese type 2 diabetics”. And the Wiki metformin entry does not even mention it’s overwhelming benefits in treating overweight- prediabetes and in reversing obesity in longterm use (up to 4 years reported so far in primary trials)- that we have been publicising for the past decade.

 

Similarly with another trillion-dollar industry – hypertension:

Under Reserpine, wikipedia correctly says “Reserpine is one of the few antihypertensive medications that has been shown in randomized controlled trials to reduce mortality..”

So WHY under the Wiki hypertension entry  treatment is “Reserpine listed as a second line choice by the JNC 7”? It has been common cause for some years now that so many mechanisms are at play in increasingly common “essential” hypertension, that once antihypertensive drug therapy becomes advisable, it is best to start with a combination that addresses as many of the causative mechanisms as possible for the lowest risks. The evidence, and daily experience, continue to grow that combined lowdose reserpine plus lowdose amiloride + thiazide amilothiazide (ie three drugs) is remarkably effective for the great majority of mild to moderate hypertension patients, at a (South African) retail cost of perhaps $6 a year, without any of the risks and costs of  all modern heavily marketed antihypertensive drugs (see wiki entries for each of these!. It is noteworthy that UK and EU authorities have removed reserpine from formularies – , as have the RSA state clinics and Hypertesion Society – without giving scientific reasons since there are none – but as in USA and most other countries, where reseprine is still available, experts agree that  the triple combination of these three is the best bedrock antihypertensive therapy there is.

 

Similarly, under analgesics  and non-steroidal antiinflammatories NSAIDS: because there is none, Wiki (like the Drug Industry) can quote no evidence to justify acetaminophen- paracetamol or any  other NSAIDs including aspirin as the drug of first choice for mild pain, since these drugs  are notorious for potentially lethal adverse effects. There are no trials to show  that, safety aside, NSAIDs are any better than many natural drugs available in simple combination orally and topically  eg fish oil, MSM, cat’s claw, arnica, boswellia, bromelain, capsaicin  etc, and proven by centuries of common and safe effective use..

 

On erectile dysfunction ED  Wiki  is even less reliable, stating incoherently (“last updated 30 December 2008”  that “It is rare, but some men receive hormones for their erection problem” . This appears either  to underestimate the percentage of ED cases around, or denigrate  the many in whom  testosterone deficiency plays an important role. The rule of medicine is, don’t be rigid about “normal ranges”- for especially the common hormone deficiencies, be aware of both hormone resistance and relative deficiency/ imbalance. And it ignores the fact that many using eg Viagra (which can occasionally kill, maim or blind) do not need Viagra, which trials show  does not work without enough testosterone around- and appropriate testosterone does vastly more global good.

   Wiki fails to point out the glaringly obvious that, having created a new common disease of Erectile Dysfunction, Pfizer has worked hard to cover up  the risk, and low need for, Viagra. Pfizer  flatly refused our request to disclose let alone publish the serum  testosterone mean and range  in the men who were enrolled in their vast Viagra trials-  they and FDA at first claimed privacy! Then when we invoked the freedom of information principle, they concocted a new blockade, that such info could only be made available on an institutional application…  but since institutions depend on Industry for research funding, a couple of local and USA institutions backed off submitting the formal applicatiion Pfizer and the FDA demanded. So whats new?.

 

As Wiki says, “Viagra  soon became a great success: annual sales of Viagra in the period 1999–2001 exceeded $1 billion.^{[citation needed]”} ..but Wiki does disclose the many major complications that Viagra  can cause, although it does not mention  that Pfizer and the FDA summarily shut down the reporting of deaths on Viagra in about 2000/2001, by when reported sudden deaths (let alone strokes, heart attacks, blindness etc) on Viagra  had passed 1000. Pfzer blithely ignores the hard fact that appropriate use of testosterone replacement (let alone anabolic steroid abuse) has never been associated with increase in sudden death the past 70 years – quite the contrary since it suppresses class 3 arrhythmia- the opposite of Viagra .  And Wiki reports that even a diehard antagonist of anabolic steroid abuse at the FDA Dr Gary Wadler  admitted under interrogation that there is no evidence that anabolic steroids are “highly fatal”, when  in UK this year “anabolic steroids are classified as class C drugs for their illegal abuse potential, which puts them in the same class as benzodiazepines and canabis”- addictive drugs but vastly  safer than the addictive sugar, cigarettes and alcohol ) . http://en.wikipedia.org/wiki/Anabolic_steroid .

 

Probably most users of the internet include Wiki in any subject search, but Wiki should always be verified by primary sources if available, since a lot  of what Wiki publishes is simply opinion. We know only too well that a lot of belief in medicine is simply that- dogma unverified by either hard longterm  observational or trial data, Shaughnessy and Slawson’s gold standard “Patient Orientated Evidence that Matters”. www.annals.org/cgi/content/full/126/8/667

 

So we all owe it to Wiki to check topics in which we believe we are experts, and contribute to veracity with verifiable refereces where we can. For the Disease Industry and the inexhaustible media they fund for their benefit, ignorance (in patients let alone doctors) is bliss when it prevents the public- lay and health-  from seeing through marketing deceptions.

 

Best wishes for a better new year,

 

new from HealthSpan Life: Poll: OBLIGATORY METFORMIN (or equivalents) FOR OVERWEIGHT?

 For the reasons – the irrefutable study evidence- of the past century detailed  over the past year below, we need to canvass the pressure of  mass votes to direct regulators to make the appropriate prescription /recommendation  of metformin obligatory for overweight

 

The next step will be to have legslation  changed to make metformin freely available at health counters at food stores, not just at pharmacies and health shops.

 

The alternative in the meantime  is simply to encourage use of the freely available metformin parent galega officinalis to tolerance-  together with the hundreds of other food insulin sensitizers eg vitamins, minerals, fish oil,  human biologicals like n-acetylcysteine,  inositol, alpha-lipoic acid, arginine, carnitine, CoQ10, ribose, taurine; the herbs/plants cinnamon; garlic; indigoflora; feugreek; ginseng, psyllum et al;  and appropriate replacement in deficiency states of thyroid, melatonin, testosterone and  estradiol;

     

 with discouragement of the many insulin resistance-obesity promoting agents listed below.

 

Can it  be difficult to find at least 2 honest US senators or members of Parliament– David & Saul- prepared to stand up to the massive vested interests – in the Disease industry- that oppose such radical disease prevention?

 

Society (the great majority of us)  and the tiny health promotion industry  have to make the effort and recruit  professionals to oppose the mass media controlled by the $quadrillion global industry complex  increasingly promoting pernicious wars, fast- and GM- foods, couch potatoes, alcohol, smoking, sex and other racketeering – and fall-back patent dedicated but risky non-curative drugs and designer cosmetic/ vascular/ bariatric surgery to patch up the avoidable crippling disease consequences if these diseases do not kill or maim suddenly, as happens in about half of victims.

 

For those who want the evidence favouring metformin- don’t ask the original manufacturers/ patent-holders (Merck and Bristol-Myers-Squibb BMS)- they do their best to hide it since they want us to believe that their costly newer patented designer but non-curative chronic  drugs are better. After they had repeatedly ignored my requests the previous 5 years for consolidated references on metformin, I was trawling the endocrine-metabolism shelves at the Bodlian library in Oxford in 2004  when I stumbled on the following volume under diabetes: Handbook of Experimental Pharmacology: Oral Antidiabetic Drugs: Recent Review of Metformin Pharmacology: 1996:119:263-407. (which is mysteriously not listed on Medline, nor directly indexed on Google).

    These 144 pages are a gold mine on the hundred-year old history of and research on the biguanides and thus metformin (1922) if not of the parent plant galega officinalis- which is a native of the middle east but has spread around the northern hemisphere.  

It took me hours of trawling the web to find a url for at least the full contents of this reference work. It seems that Springer-Verlag – and the metformin manufacturers Merck-BMS- are determined to conceal whats in this major reference journal unless one buys it- which very few medical libraries apparently have.

      Cliff Bailey and team have just published a little book on Metformin: The Gold Standard -which will greatly help in our crusade to get metformin more widely used before obesity, metabolic syndrome, diabetes and fertility problems develop.

 

So lets have your votes as comments.

Best wishes for a better new year,

HealthSpan Life! Update: TEN NEW STUDIES CONFIRM THE OBLIGATION TO START METFORMIN EARLY:

It is obvious everywhere that, however one may arbitrarily and numerically define them, overweight let alone prediabetes  and obesity impairs health and function.  

 

 The Importance of Treating Overweight and Prediabetes has been repeatedly stressed in this column.  

More than ten new studies published the past month or so  are further mandate  for early and permanent  metformin  use to tolerance for major reduction of both infertility and pregnancy loss, overweight and new prediabetes/ metabolic syndrome, early hypertension,  lipidemia, and  thus cardiovascular disease,  cancer, arthritis, depression, sexual dysfunction, hirsutism and cancer;  as well as managing established diabetes of either type.

Metformin in sensible use never causes more than nuisance symptoms easily prevented by gradual upwards (and if necessary downwards) dose titration; and perhaps reduces   risk of death even if (like any other drug)  it is foolishly continued without reduction and consultation in the face of worsening illness.

Thus like often lethal aspirin, it should simply be available at health counters and pharmacies, in contrast to statins or black cohosh which can insidiously cripple; and alcohol and tobacco smoking which are the most lethal chronic d yet unscheduled recreational addictive  drugs which actively and passively kill thousands every day.

And (never mind cigarettes) unlike the invaluable metformin, there is no indication for manufacture and marketing of paracetamol acetaminaphen with which  the slightest overdose- 6 tablets at once- can kill, when there are many perfectly safe natural mild analgesic-anti-inflammatory substitutes for it. 

IN RETROSPECTIVE STUDIES 

Tian ea Beijing 2008 found that “metformin use for a mean of 6.6years is safe even in elderly diabetics”.

 

Monami ea Florence Italy 2008  found that “metformin  use for more than 3 years for diabetes associates with 72% reduction in cancer”..

 

Fronstin ea  USA  2008: “analysis of 63,000 patients in a  USA 2007 Health  Survey showed major impact  on quality of life -  loss of work productivity of  5.6 weeks per year for prediabetic patients compared to their healthy counterparts. Less than 40% of all prediabetic patients are even aware of their condition and therefore can’t take the steps necessary to prevent it from progressing to a full diabetes diagnosis.” This stigmatizes the overweight as patients, but the stark loss of productivity (in all spheres of life disussed below) requires this to bring home the obligation on health carers, families, parents  and employers  let alone the public to take early and sustained action.

 

IN  TRIALS:

In mice,

 Gundewar ea 2008  New York & Harvard  show that “lowdose metformin given from the time of myocardial ischemia halves mortality from heart failure”.. as was shown in Canadian diabetics on metformin, whose mortality was halved;

 

Wang ea  Shanghai China 2008  show that  ”Metformin significantly inhibits cell proliferation and apoptosis in all  human pancreatic cell lines”;

 

in humans

CARMOS (Greece  2008) was not a double-blind but an open randomised RCT “in 366 overweight / obese middle-aged subjects around 53yrs, BMI 32kg/sqm, bloodpressure around 140/89 but without cardiovascular disease CVD. Metformin just 850mg/day  compared to standard management for 1 year lowered the incidence of new diabetes from 8.1% to 1.1% ie by 86%; lowered the incidence of new prediabetics from 18.5% to zero; and the incidence of metabolic syndrome from 15.5% to 2.6% ie by 83%; and significantly lowered LDL cholesterol.  There was no significant fall in body mass index BMI compared to the controls.” The average tolerated Western dose of metformin in diabetics is 2.55gm/d, which in the obese produces a sustainable loss of about 6kg – up to 20kg; but in perhaps more out-door living Greeks on the legendary Mediterranean diet, even that moderate dose of metformin did wonders, so presumably their previous experience with it must have justified that dose. And of course, without some measurement of relative fat/lean mass,or of  subcutaneous fat and waist girth, one cannot say if they showed meaningful fat loss with gain of lean mass. .

 

By contrast, in a Dumlupinar University trial 2008 in Turkey   “324 mostly overweight patients [with white coat hypertension WCH, mean 47yrs (15 to 70yrs) , 42% overweight and 44% obese] self-selected themselves for a 6month open trial of standard care with or without metformin  metformin  up to 2.55gm a day. Compared to controls, those on metformin lost 6.6kg weight vs 2.1kg(C);  WCH resolved in 69% (M)vs 26%(C); lipidemia in about 50% (M)vs 17%(C); normalization of fasting bld glucose  occurred in 44%(M) vs 9%(C); and improvement from obesity to overweight or overweight to normal weight in about 20%(M) vs 4.5%(C).” Thus metformin at standard dose was 3 to 5  times as effective as standard therapy alone in reducing  obesity, WCH and lipidemia. 

 

Toronto University   gave metformin 1500mg/day to 32 nondiabetic women with raised insulin and breast cancer for 6 months, showing that it significantly lowered  risk factors for both CVD and cancer  - insulin resistance, lipidemia and obesity.

 

A Johns Hopkins review  (Nicholson 2009) confirms that, while metformin greatly improves fertility and pregnancy outcome, in gestational diabetes metformin gives far lower rates of neonatal hypoglycemia than insulin .

 

Resvanian ea Isfahan Iran 2008 show that metformin 1500mgday greatly enhances Intense-Pulsed-Light-Assisted Hair Removal in Patients with Polycystic Ovary Syndrome.

 

Ratner ea in the USA DPP 2008  show that after pregnancy diabetes, metformin halves the occurrence of later diabetes.

 

 

These studies thus add weight to the previous gold standard evidence making obligatory the  early and permanent use of metformin to tolerance  at any age in all  who cannot keep their weight and waist girth within normal limits:  ie estimated body fat  (by bioimpedance analysis BIA scale, by Harpenden calipers or by calculation from BMI) below about 15kg (Knapik 1983), or waist girth below about 80cm in men, 75cm in women. Absolute body fat is more realistic than relative ie percentage fat since those who exercise regularly may have far higher lean mass %. Obviously 15kg of fat will be less obvious on a 2m tall 90kg person (ie 16.67% fat) than one of 1.5m (ie 30% fat).

 

     While the average “first-world” middle-aged woman today measures a hefty ~33% body fat, and while no more than about 5kg of body fat seems essential for health (except in freezing climates), the exception (apart from a to-some desireable feminine full figure) is  women trying to fall pregnant, in whom body fat of about 12-15kg ie 20-22% seems optimal for fertility (Rose Frisch’s hypothesis; debated by van der Spuy  ea). At much above or much below this fat level, hypothalamic-pituitary- adrenal– gonadal regulation understandably  skews away from fertility.   There is obviously heavy controversy over whether mankind  acquired it’s capacity for limitless adipocyte growth (and thus suicidal obesity) due to evolution via aquatic apes, as opposed to extended survival in ice ages- which except for eg the Esquimeaux, polar bears and walrusses, ended some 20 000 years ago - and the ice caps (and their obese denizens) are fast disappearing with global warming. 

 

 

But the plant extract metformin  is the only drug proven by centuries of use and 80 years of research that with sensible use to tolerance (like all other foodstuffs) if started early and permanently,  reduces all common major chronic degenerative diseases by about half – and new diabetes by up to 90% – as reviewed repeatedly in this column, – other  new studies  from St Petersburg Russia (Anisimov ea), 80), Tennissee  (Gosmanova ) , and UK -  Bodmer,  Holman  UKPDS and Bailey  about Metformin: A multitasking medication.

 

The 1-year CARMOS trial joins the three ±3year  landmark  (China - Wenying: Chin J Endoc Metab, 2001,17,131-6;  USA  2002; & Indian 2006) Diabetes Pevention  Program DPP trials showing  what we see in Africa, that in very different races and regions (ie on all continents),  metformin reduces the incidence of new diabetes (depending on baseline body build,  energy intake /expenditure, and  startup and final metformin dose) compared to placebo – by 27% in India (metformin 0.5gm/day) to  31% USA  (1.7gm/d) to 60% China (0.75gm/d) to 83% Greece (0.85g/d). Thus in full tolerated dose (mean 2.55gm/d in the UKPDS) which none of these trials claim to use), metformin  must add decades to health.

 

Both evidence and common sense show  that:

i. there is much genetic variation in human metformin metabolism, and

ii. there is some metformin dose:body mass proportionality; and

iii. metformin complements, but does not replace the need for sensible diet and exercise, and

iv. metformin does not do away with the need for minimization  of any drugs which reduce insulin sensitivity eg salt, cooked fat, alcohol, oral estrogen especially with progestin, sugars,  betablockers, cortisones, psychotropes, diuretics, antidiabetics, and smoking/snuff (and arguably even aspartame- the infamous Canderal). Like tobacco use, refined sugar and cooked fats are anything but necessary and healthy foodstuffs – with alcohol overuse, they are the prime causes of the saccharine diseases -especially if combined with each more than about 10gms a day.. .

 

 So to avoid early drop-out (25% in the USA DPP),  metformin  HCl - easily  buffered by eg calcium carbonate- must always be started low eg at  125mg (1/4 tablet)  twice a day, and built up to comfortable tolerance (by perhaps  25% increase in dose each day) over a few weeks;   with  in case of new symptoms,  the dose temporarily stopped for a few doses till symptoms subside, and then resumed with slower upwards dose adjustment;

 

It is common cause that sexual and erectile function never mind reproduction are progressively impaired by increasing obesity and thus insulin- glucose intolerance,  and glycation.

Thus it is obvious that the earlier metformin is added  to tolerance to prevent increasing overweight, the better both sex and reproduction  and erectile function will work.

 

And even in diabetics let alone prediabetes, metformin with sensible use has zero adverse effects that are not easily avoided/ reversed by dose reduction- as shown in both giant metformin trials in type 2 diabetics that were completed  a decade ago:  the almost 20 year long UKPDS (Holman ea)  - about 12000 patient years; and the year -long landmark American COSMIC trial (Cryer ea at Bristol-Myers-Squibb BMS 2005 )  some 9000 patient years- mean age 58yrs.

When we asked, BMS refused to explain why the results of the  COSMIC trial – done on USA volunteers-  were scandalously not published for some 7years. While the numbers were too small to reach statistical significance, the table of adverse events in their trial showed that especially in the 2/3  over 65yrs, gastrointestinal, infection, neoplastic and vascular adverse effects were 25% to 66% more common in the control group than on metformin. The only paper apparently ever published on the COSMIC trial did not mention the changes in blood sugar / other markers achieved; but did show the remarkable superiority of metformin: “By study end, 90% of the metformin group and 77% of the usual care group were still receiving their initial study treatment, while 5.4 and 19%, respectively, had switched to the alternative treatment arm. Apart from adverse events, the most common reason for switching from initial treatment (<1% of patients) was lack of efficacy (1.5 % vs 4% respectively in the metformin and usual care groups).

       

In fact, when we asked for the paper, BMS and their parent metformin patent-holder Merck actually denied knowledge of this biggest-ever planned metformin  ab initio trial in diabetics (mandated by the FDA and started in 1996 as a condition of registration in USA)  even in 2005 after the results had first been presented at a diabetic congress.

 

This inexusable delay in publication may or may not be due to the fact than these metformin-partner companies first wanted to see the successful launch of their new patent combination Glucovance  (metformin plus a sulphonylurea- either glyburide or glibenclamide), on which the first human RCTs were published only in 2002 -and which have been increasingly  discredited except as last-ditch therapy due to the serious risks of sulphonylureas. “One already-marketed combination diabetes pill, Glucovance, a combination of metformin and glyburide, generated sales of $330 million in 2001″. “Glucophage (metformin), which had more than $1.3 billion in sales in 1999 (presumably in USA), loses patent protection in September (presumably in USA, in 2000). The economics of antidiabetic drugs are staggering:  ”Diaßeta glyburide in the U.S. and Canada; glibenclamide in most of the rest ….. World-wide sales of oral diabetes medications reached $7.8 billion in 2003″.

 

So antidiabetic drugs alone generate sales of around $10billion a year?

 The $multibillion smoking-alcohol  industry aside, overweight is the main natural gateway to diabetes, hypertension, lipidemia, ischemic and hypertensive heart –brain- kidney and peripheral vascular disease, dementia, arthritis, cancer and thus decades- premature disablity and death. So the global market for high technology created by the epidemic of overweight plus smoking (including cosmetic and cardiovascular procedures) must already have passed $trillions a year.

             

And a cheap safe plant derivative like metformin or galega, combined with other panaceas like vitamins, minerals and plant and animal biologicals can reduce this epidemic by up to 90%.

 

No wonder Merck, BMS, Pfizer, Bayer  and their fellow Big Pharma  and research and political connections including Regulators and Governments do everything in their power to cover up, suppress, regulate  non-patentable supplements (including galega) that can eliminate the profitability (and most jobs)  of the disease industry, and largely do away with research for new remedies for the chronic major degenerative diseases.

 

A Medscape review    now reminds us in  ”Diabetes and Cardiovascular Disease Among Older Adults: An Update on the Evidence” that “Treatment should be individualized with consideration given to patient preference and quality of life.”   But this is not licence for regulators, doctors  and medical schemes to disparage and delay preventative metformin use, or people to continue reckless obesogenic diet and lifestyle, which takes decades off  life and, worse, off healthspan; and the sooner makes them (or their dependents) unnecessarily needing the support of others.

Metformin is the only chronic preventative drug that in tolerated (and low cost) dose - alone but especially combined with appropriate other supplements (vitamins, minerals  and biologicals including fish oil and   hormone replacement-   reduces ALL risks of the major chronic degenerative diseases from conception to death. Contrary to the vested interests that promote disease and newer synthetic drugs, there is never an absolute contraindication to metformin – merely appropriate dose adjustment.

Thus metformin is the necessary obligatory first drug to prescribe permanently for all with overweight/ excess body fat; let alone those  with tobacco/alcohol use, suspected polycystic ovary syndrome; (pre)hypertension; lipidemia; vascular disease;  and prediabetes/ diabetes.

Until metformin is made available without prescription, it is  freely available as the parent herb galega officinalis – even if retailers have to be forced to order the standardized herb extract to US/UK/Japanese pharmacopoea standard on request. Like metfomin and antihypertensive and most other drugs, the dose of galega is simply cautiously built up to tolerance and effectiveness – in this case appetite reduction and gradual weight loss.

 

UNPROVEN LONGTERM BENEFIT OF BOSWELLIA: Missing The Boat on Reversing Arthritis:

the  current (perhaps  whimsical- seasonal fayre) BMJ review  of frankincense – boswellia - by Prof Ernst  concludes: “Out of 47, three studies were of good methodological quality.. The evidence for the effectiveness of B serrata extracts is encouraging but not compelling”. It is thus hardly an advertorial for boswella or it’s extracts, as patentholders of extracts would wish…

 

In published trials the past decade, boswellia gives  anti-inflammatory (pain and stiffness) benefits in arthritis  and in colitis and asthma.

 

But only one trial of boswellia or an extract (Sengupta 2008)  apparently  mentions cartilage- and that one is only a 90 day study, did not measure cartilage width change by any method – ie it measured simply symptom response as to an anti-inflammatory. The clinical significance if any of the halving of matrix metalloprotein 3 MMP3 levels in synovial fluid is uncertain. This trial shows  short term benefits  compared to placebo -but even on placebo there was significant steady improvement in symptoms over three months. As this trial shows, the natural history of pain in recent-onset “osteoarthritis” (whatever pathology that umbrella covers) is spontaneous improvement anyway. 

 

 

But the gold standard  question for osteoarthritis OA is, does anything reverse cartilage loss,  rebuild the worn cartilage, as opposed to merely masking cartilage destruction by supressing symptoms? Only chondroglucosamine CGA  unquestionably does so if taken permanently for more than about 3 months. So CGA is the gold standard – see previous reviews below. .

 

This crucial issue – reversal of cartilage loss-  seems to have been ignored so far for boswellia, since there are no more than short term trials (up to 3 months) in the literature.

 

Unlike the dire hazards of aspirin and synthetic nonsteroidal NSAIDs, we see excellent analgesic benefits and minimal adverse symptoms for eg arthritis with some appropriate safe combination of fish oil, boswellia, MSM, curcumin, cats claw, proline, nicotinamide, arnica and  bromelain;

 

     but is it ethical, or negligent,  to treat deadly disabling arthritis  with Christmas jocularity  just with analgesics, without remittive agents eg CGA for OA, or  for rheumatoid arthritis combination of eg methotrexate, prednisone chloroquine gold  and  salazopyrin ?

     Its like sex and religion: Some can take  religious tolerance, sex and freedom from disability for granted. The painless fun bit is usually too easy while it lasts. But like painful joints and religious intolerance,  sex becomes serious eg  when fun or fertility is lost, or infection or unplanned pregnancy occurs- or we are treated as criminal deviants if we prefer same-sex intercourse in countries with intolerant churchmen or leaders, like South Africa and Zimbabwe. Dismissing painful arthritis or painful sex  with painkillers (and the two are often related) may be as dangerous because it may miss the window of opportunity for cure.

 

KILLING PAIN AND FEVER, NOT THE PATIENT

 The BBC trumpets Edinburgh scientists’ attempts to find an antidote for paracetamol/ acetaminophen overdose.

 

But why  is  marketing  of such synthetics allowed, when they are both weak and potentially fatal at  a dose of as little as 4 to 6 tablets? And when they are no better than safe natural equivalent analgesics?

 

The Politicians and Regulators who allow the marketing of paracetamol should be prosecuted for gross negligent homicide – according to the BBC report, they are responsible annually for some 200 deaths and 20 liver transplants  due to paracetamol.

The regulatory tolerance of paracetamol absolves manufacturers and distributors of  culpability-  but does  not morally justify sale of such poison by any trader.

Why allow sale of an unnecesary analgesic that permits such painless slow suicide?

So why do we need more antidotes when there is no reason to market paracetamol?

Just as why do we need an antidote to the gross toxins sugar and tobacco smoking  and liquor when there is no need to market and (ab)use them?

 And where is the need for a better antidote to paracetamol than the long-proven natural N-acetyl cysteine  and activated charcoal. More practical would be to simply include a little Nacetyl cysteine, lipoic acid  and eg milk thistle in paracetamol.  We easily include some calcium carbonate and B12 in metformin  to minimise it’s negligible adverse effects; but then metformin is the cheapest most multisystem- beneficial and longest proven medicine- a veritable panacea- ever discovered; whereas paracetamol is anything but.

 

Remember that pain, fever, fatigue are symptoms, not a disease.

Synthetic painkillers and anti-inflammatories can and do  all kill –

      - but they never cure..

 

So for common pain, we should recognise and treat the disease , not mask the pain/fever

Eg toothache  - dental care;

     Other Face pain- sinus-mucolytics; neuralgia eg shingles;

     Headache- tension ; migraine; check bloodpressure; eyes; posture; physical therapy*.

     Backache- posture; weightloss; chondroglucosamine; physical therapy*

     Muscle/joint pain- weightloss; seek cause of referred pain;  physical therapy*;

                       In older people- tesosterone-estrogen deficiency.

     Depression – counselling; natural antidepressants eg 5HTP; StJohn’s wort.

     Heartburn, irritable bowel- diet; antacids; glutamine.

     Osteoporosis- supplements (minerals, vits, HRT);  exercise.

     Fever- pinpoint the cause; boost immunity.

     Dehydration- drink 2 litres fluid a day, without sugar, aspartame or caffeine!

     Lateral chest pain – most commonly simple root pain from the back;

     Shingles- boost immunity; topicals; perhaps brief course of cortisone.

     Pelvic pain  (other than menstrual) – infection/ cancer- see a doctor;

    Colic, central chest/ abdominal  pain -  see a doctor.

 

PHYSICAL THERAPY* includes:

     Massage with or without natural anti-inflammatory ointment;

     Stretching;  manipulation; Acupuncture, pressure points;

     Progressive exercise and posture improvement.

 

ORAL “PAIN KILLERS” include:

A natural mix of: MSM, catsclaw; curcumin; bromelain; boswelia;

             vits B 3,5,6,C,D  plus  calmag;          plus fish oil 2 – 4gm/d.

    This safe combination has none of the serious (potentially fatal)  risks of

  -synthetic painkillers eg paracetamol, aspirin, codeine, brufen- voltaren(NSAIDs);

  -risky (allergenic) natural analgesics eg willow, devil’s claw.

  -alcohol combined with synthetic drugs.

 

And all trials show that synthetics

     eg aspirin, paracetamol, NSAIDs, antidepressants

     -  have no advantage or benefits over the natural ones – just more risks.

           

  For localised pain eg  AROUND A JOINT ,  a targetted injection of

    Cortisone with local anaesthetic is often the best solution of both pain and cause.

 

Progressive pain requires medical investigation of the cause.

 

Prevention, Inaction and Mugabe’s Cholera Epidemic

This Day of Reconcilation in South Africa was under Apartheid a day of infamy, of Dingaan’s treachery. That Zulu  ”infamy” against  threatening European colonizers pales into insignificance in comparison with genocides committed by “first-world” governments through the  19th into the 21st centuries.

Growing passive (let alone active)  genocide orchestrated by the electorally defeated “Government” of Zimbabwe  mounts – that has turned what was  once a highly productive country into a literal deathpit cesspool of cholera, just as the ANC government has by denial allowed genocide in RSA from untreated AIDS, including violence repeatedly encouraged – by example and exhortation- by the leader of the ANC.

And yet the ANC government, the other Southern African countries being burdened by contagious dying refugees, and the “United Nations” of the world  sit by and mouth futilities over Zimbabwe’s dissolution.

Like Apartheid’s and the ANC’s gangs, Mugabe’s gang reputedly has stolen fortunes  stashed in banks around the world. But world leaders do  nothing, while China recently airfreighted arms into Zimabwe to fortify the government gangsters.

But Government gangsters have solid precedent. The USA (and UK) only 6 years ago launched, and continue to wage,  the biggest assault ever on a single country- Iraq- for the sole purpose of control and theft of black gold. And during that genocidal unilateral  war,  the electorates of USA and UK  re-elected their govenments to continue their  warmongering- for- profit of  the past forty years under the  malignant inspiration of Henry Kissinger, Milton Friedman and his Chicago Boys – the hawkish Kissinger’s vulture disciples from that “cold war” era – Rumsfeld, Cheney, Wolfowitz and the Bushes-

the same disaster- capitalism  gang that has since then oppressed  the masses globally including  in Africa – especially South Africa under both the Apartheid gang and Mbeki-Zuma ANC gang they cut  deals with, and now Zimbabwe, where the new capitalists are Mugabe’s Gang.

While surplus people die en mass.

As President Mbeki said infamously  and effectively of  his role model President  about 2 years ago: “Dear Mr Mugabe, please do the right thing – whither thou leadest, we must follow.”

And lo, it happens-  the next, ie current, President of  the ANC  (and thus South Africa, since the interim president Motlanthe cravenly does  what the ANC dictates- ) this very week has his  country’s  UN delegate  veto otherwise universal condemnation of Mugabe, while hundreds of Mugabe’s  former supporters die daily of easily preventible cholera  and starvation, for want of water treatment  let alone jobs and thus currency, food, drugs, doctors, nurses, electricity.

weekly HEALTHSPAN LIFE update: MANAGING COMMONLY CONCURRENT HYPERTENSION, LIPIDEMIA, INSULIN RESISTANCE AND INFLAMMATION in primary care: new controlled trials.

Four  recent group trials in human hypertension HBP highlight the importance of appropriate safe drug combination for the commonest condition of the better-off middle-aged:  the metabolic-inflammatory syndrome involving increasing adiposity-insulin resistance and thus hypertensive – lipidemic- vascular -inflammatory disease.

 

A team from Split University    did an elegant trial showing the significant hypertensive effect of ibrufen and piroxicam when combined with an ACEI (lisinopril) even with some diuretic, but not with amlodipine; and not with acetaminophen paracetamol.

 

a team trial  from a Korean University  shows yet again that other classes of antihypertensive drugs are better than the long-known adverse effects of highdose atenolol 100 mg and hydrochlorothiazide 50 mg.

 

By contrast, yet another trial  (ATTEST) at Saitama University Japan  in hypertensive diabetics shows that combining an ACEI  and CCB controls HBP in only half of subjects

 

a team trial at Helsinki University  again shows that central sympatholytic therapy has anti-inflammatory properties in hypertensive postmenopausal women.

 

This raises again the questions regularly posed in this column:

why use patent NSAIDs like ibrufen, piroxecam, diclofenac?  when they have many serious risks and no clearcut compelling indication as opposed to relatively safe analgesic antiinflammatory combination of eg  fish oil; paracetamol, cat’s claw, MSM, bromelain, arnica etc; and

 

why use for mild to moderate HBP modern drugs  like ACEIs and ARBs  which have  (like betablockers) infrequent  but troublesome risks?  when  the proven and gold standard first line therapy for common HBP is totally safe and effective lowdose co-amilothiazide plus lowdose sympathicolytic reserpine

 

Hence the latest update of wikipedia today still says:  “Reserpine is one of the few antihypertensive medications  shown in  trials to reduce mortality: Reserpine is listed as a second line choice by the JNC 7. for patients  uncontrolled on a diuretic.  refs: The Hypertension Detection and Follow-up Program,^[5] the Veterans Administration Cooperative Study Group in Anti-hypertensive Agents,^[6] and the Systolic Hypertension in the Elderly Program.^[7] ]“

 

Recent trials from Royal London Medical School (Shafi,  Born ea 2000, 2002)  confirm in rat and rabbit what has long been known in humans, that lowdose reserpine significantly reduces lipidemia and atheroma.

 

Thats why the lowcost multisystem protection combination of fish oil and lowdose amilothiazide (reserpine – hydrochlorothiazide HCT- amiloride) is optimal for common hypertension, backed up for common adiposity /lipidemia  by metformin;  and for  seldom-resistant HBP by amlodipine.

new from HealthSpan Life! UNFAIR TO WOMEN: STILL THE WRONG SPIN ON APPROPRIATE HRT – IT’S NOT CRICKET!

Kathy Martin &  JoAnn Manson’s excellent review The Patient with Menopause Symptoms   stresses the importance of not initiating oral hormone therapy  OHT many years after menopause; and the grave doubts about continuing Wyeth  HT (premarin +-  progestin) long after age 60yrears ie for much more than 12 – 15years. .

 

But  while they emphasise the benefits of  progesterone over synthetic progestins; and  of  starting HT for menopause symptoms early rather than late  (the timing hypothesis), and the  numerous greater risks of oral estrogen therapy OET (versus parenteral estrogen replacement ERT), they do not point out  the latter risks in their abstract, 

the far fewer benefits of  oral ET  (pop-a-pill convenience; marginally better HDL/LDL ) - ie two benefits;

 versus

physiological parenteral ERT :  less adverse effects than OET :.- ie at least a dozen  extra benefits parenterally versus orally:..

risk of OET on SHBG; triglyceride; CRP; fibrinogen; factor VII; PAI1; testosterone, uterus; endometrium; breast density; collagen dissolution ); 

 and thus greater risk of  OET (compared to parenteral ERT) overall for :

fluid retention, hypertension, deep vein thrombosis, coronary artery and cerebrovascular thrombosis, dysrhythmia,  heart failure (Mercuro 1999; Regitz-Zagrosek 2007); biliary disease, libido, depression, adiposity, and thus urinary incontinence, insulin-glucose intolerance, breast cancer ; and skeletal muscle frailty.

 

This Harvard review thus bypasses the prime reasons for not extrapolating  the uniquely valuable WHI Womens’ Health Initiative -notwithstandng it was misguidedly planned, gave overhasty initial  wrong  statistics, and caused foolish sometimes hysterical generalizations (“a thalidomide disaster“).

The WHI was not about menopause – it tested mostly elderly obese “asymptomatic” but already high-risk Caucasian women on oral HT with xenohormones- premarin, provera – when xenohormones have for good reason  no longer been used  in any other branch of endocrinology. 

Why should older women be treated any differently for the commonest acquired endocrine deficiency of all, that affects 100% of womankind? Especially when postgonadopausal men (and women)  have already for over a decade been advised to use solely physiological parenteral human HRT?

 

What the WHI was about was assessing the benefits of appropriate  medium  term convenience sex hormone therapy . As in all other endocrinology -restoring physiological hormone balance – the aging woman (and man) requires appropriate balanced HRT (preferably parenteral testosterone +- ERT+-  progesterone) started early and permanently for permanent multisystem protection  against CVD; cancers; fractures;  arthritis; depression;  urinary incontinence; loss of sexuality; dementia; and thus against premature devastating disability and death.

The small under-sixties cohort of the WHI actually confirmed these multiple benefits for up to almost ten years for  solo oral premarin- but ten years is not long term since women  can now live the second (and potentially the best) half of their lives – up to sixty years- post menopause.

And it is common cause that many benefits of HRT eg on bone, skin, sexuality etc are lost as soon as HRT stops.

So it is never too late to start  and never too long to continue appropriate HRT under supervision.

 

See other recent  reviews of appropriate  HRT .

fresh from HealthSpan Life: NEW PROFITABLE ANTIHYPERTENSIVE COMBINATIONS, OR APPROPRIATE LOW-COST BEST LONG-TERM ANTIHYPERTENSIVE DRUGS, FOR THE UNCOMPLICATED MAJORITY?

It goes without saying that (except in more severe or complicated hypertension)  antihypertensive drugs are only introduced  once bloodpressure is not adequately controlled with appropriate counselling including about  exercise, recreation and weight-normalizing diet,  avoiding all tobacco smoking, sucrose and cooked fats, with appropriate  multivitamin- multimineral supplement and low salt   intake, and prudence with drugs (alcohol,  steroids and nonsteroidal anti-inflammatories)  that can aggravate hypertension .

 

Like Norman Kaplan’s book Clinical Hypertension, Marvin Moser at Yale  in his Clinical Management of Hypertension book 2004,  noted  that combined reserpine + diuretic, like all other antihypertensive combinations,  controls BP <140/90 in 70-75% of patients needing drugs.

 

The Seventh Report (2004) of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure put a thiazide diuretic as initial therapy with reserpine as one of the basic add-on options.

 

The American heart Association has recently published guidelines including that  ” An effective multi-drug regimen to reduce blood pressure is essential. Reports from hypertension speciality clinics indicate that treatment resistance is often in part related to lack of or underuse of diuretics.”

 

A  new review this month   Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)  says “blood pressure control has improved much.. Increase in the use of diuretics in the after-JNC 7 cohort follows the recommendation of thiazide-type diuretics as the preferred initial agent in patients without compelling indications”.

 

Yet vast amounts of money continue to be spent on trials and marketting  touting new patentable combinations without diuretics eg  ACCOMPLISH (Jamerson 2008): benzapril plus amlodipine; ADVANCE (Saito 2008)  nifedipine plus valsartan; COACH (Chrysant 2008) olmesartan plus amlodipine, as safer and better- but without comparing them with the gold standard lowdose reserpine plus lowdose amiloretic.

 

The dozens of reserpine trials for 40years to date (the last were apparently the ALLHAT and SHEP trials), consistently showed that, in low dose,  without exception  (except renal failure) combined with lowdose diuretic  is the best  foundation  treatment of all grades of hypertension  because   BP  control is smooth – reserpine  0.0625 to  0.125mg/d average `<0.1mg/d  is the only drug that works for weeks, lowers pulse by about 7beats/min, and has neutral if not beneficial effect on glucose-insulin-lipid tolerance, anxiety and mood;

and the lowdose thiazide-  eg hydrochlorothiazide 6.25 to 25mg/d average 12,5mg/d -  combined with a lowdose potassium sparer- neutralizes both vasoconstriction, volume expansion and increased cardiac output.

 

In South Africa the average retail cost  of this combination once the BP comes under control and the drug doses are reduced to maintenance is about R5 (ie US$0.5)  a month; without a single significant adverse effect- ie without the  rashes, liver, cough/fatigue /  bronchospasm / heartfailure, oedema, coldness, constipation, depression, sexual problems or  dizziness of methyldopa, clonidine,  betablockers, ACEI, ARBs, calcium antagonists, and more modern drugs.

 

While optimisation of hypertension alone is able to  reduce greatly the complications of heart failure and haemorrhagic stroke, it obviously does nothing for the other invariable concomitants of essential HBP ie glucose/insulin/lipid resistance and overweight  – but  in  the coamiloretic combination , amiloride reverses the adverse metabolic effects of the thiazide, resulting in neutral effect.   (Mammarella 1989, Thomas 1983).

 

 In  Systolic Hypertension in the Elderly trial  SHEP (Kostis 1995; 2005  ) compared to placebo,  a thiazide (chlorthalidone 12,5 – 25mg/d) +- reserpine or atenolol as required to control hypertension lowered all-cause mortality by between 13% and 22%- without worsening diabetes, with even greater reduction in all-cause mortality in diabetic hypertensives- but with far lower mortality on reserpine than atenolol.  In ALLHAT  , not only did reserpine prove superior to clonidine, but the thiazide proved superior to all other classes of antihypertensives.

 

If there is renal failure (which is rarely seen  compared to hypertension in  almost 50% of older fatter people)  the diuretic is  ill-advised, so reserpine can be combined  as appropriate with any of the other drugs.

 

But as this column repeats monthly, with increasing scarcity of fish (oil) in the average diet, everyone should be on some fish oil supplement for its major multisystem benefits including reduction of hypertension, thrombosis, inflammation and insulin resistance;

and for the increasing prevalence of rising  weight, insulin resistance and diabetes, the overweight / insulin resistant of all age should be on metformin to tolerance, at negligible risk but 1/3 reduction in all-cause medical premature deaths and almost halving of all-cause mortality, including by reduction of glucose-insulin-lipid resistance, hypertension, cancer, thrombosis etc.

 

What the ACCOMPLISH paper (Jamerson 2008) appears to studiously ignore is that this trial was done in frankly obese patients (BMI 31kg)- who would be most likely to have insulin glucose resistance IGR – yet the paper does not disclose what their weight or HBA1C did,or what % develloped IGR or  new diabetes. Cases  of resusctitation after cardiac arrest were  something like 14  on Benzapril-amlod vs 7 cases on Benzap-HCT. since these patients were a priori at such high risk, 60% diabetes,  would they not have done far better, lost weight, had far fewer arrests and deaths and heart attacks  from the outset on fish oil and metformin to tolerance?

 

The hypocrisy in most Hypertension guidelines is predictable: they acknowledge that most people need drug combinations; and that  diuretics should be first line in the older ie past 60yrs; but in the younger they piously claim that a diuretic should be avoided due to the increased risk of metabolic adversity. Thus they (ie the Regulators, “experts”, deliberately choose to ignore decades of evidence that lowdose thiazide works best of all drugs, especially when combined with amiloride and reserpine, causing no new  metabolic problems.

 

But if authorities promoted $0.50 a month of  the long-time gold standard  triple combination for hypertension ie  the commercially non- viable  old (lowdose reserpine + amiloretic) trio, the “authorities” would lose their massive income from the new-drug industry.

CONFLICTING OPINIONS ABOUT HRT AFTER BREAST CANCER?

 fresh from HealthSpan Life

A  physician asks :  What are people’s thoughts on bioidentical estrogen use in a woman who   has recent history of breast cancer?

answer:

it is now common cause that the main trigger for activating dormant breast cancer nests is not estrogen but  progestin:

in the premarin-only arm of the WHI (2004), there was 28% lower incidence of invasive BRCA in the women aged 50-69 at start (and 44% less CHD, 36% fewer deaths in the women starting under age 60y);  so the feared major ADVERSE endpoints after HRT – athero/thrombosis,  and breast cancer-   are largely related to progestin, age of onset of HT, and dose..

 

Prof Fred Naftolin  of NYU- former head of ObGyn and then professor  in Biology at Yale - has  a (surely not  the)  final word  quoted below- in essence :

dont quibble over the type or route of estrogen for HT, or what has/ has not  been “proven” by big medium-term trials- appropriate ERT is major benefit after treatment of breast cancer.  

  It is easy to see the wood and the trees:

 There have been no long-term controlled trials of any drugs for any condition  except metformin- the UKPDS for  20yrs, a mean of 13.5 years.

 The million-year evolution of “beautiful young people” on  parenteral human testosterone estradiol and progesterone, and 60 years’ careful observation of safe use of appropriate bioidentical and equine estrogen aside,

only  oral estrogen  has been proven (in >5year trials)  to do wonders in reducing morbidity and mortality long-term, even from breast cancer (in the WHI 2004 paper on solo oral conjugated equine estrogen CEE when started appropriately from menopause;   the 1990s Breast and Colon Cancer trial- Dr Bernard Fisher ea; and the Oulu trial 2006 with oral estradiol +- synthetic progestin). Similarly, physiological systemic testosterone replacement has shown if anything an antiproliferative effect on breast tissue in trials in both women (Zhou & Dimitrikakis);  other primates (Clarkson; Zhou & Dimitrikakis); and rodents (von Schultz).

 

The landmark Wake University primate trials (Clarkson ea 1995-2007) show the CVD benefits of early postmenopausal (but not late) systemic estradiol plus progesterone, and oral CEE but not synthetic progestin; but adverse effect of oral  CEE on breast proliferation.

 

Significant medium – and long-term benefit  has not yet been shown in controlled trials  in  postmenopausal women for progestins including progesterone, nor for a single plant-sourced (phyto-)estrogen   - and who is going to fund such a costly trial since both kava and black cohosh have killed when used for menopause symptoms.  

 

The current KEEPS trial under way (Harman, Naftolin ea) will  soon show what balance of benefit and harm  there is between 450mcg a day oral premarin or  50mcg a day estradiol patch or placebo,   (with or without parenteral progesterone) in  young postmenopausal women. This  trial, in  women well under 60yrs, albeit (in comparison with the WHI) small and only for 5 years,  will to  a great  extent  largely resolve  the unwarrantedly acrimonious secondary  debate over oral vs parenteral and human bioidentical vs oral  xenohormone ie horse estrogen. Unlike the obvious difference  (seldom subtle) between good and bad, there are many good alternative  routes to Rome or health, the differences being mostly superficial – like between  man and woman.

 

 ndb (Preventative, Gonadopause) Internist
www.healthspanlife.wordpress.com

 

—– Original Message —–

From: “Naftolin, Frederick” <Frederick.Naftolin@nyumc.org>

To: “Neil Burman”

Sent: Saturday, December 06, 2008 6:44 PM

 RE: Bioidentical estrogen use with breast cancer?

  I agree with your sentiments.  However,  so-called “bioidenticals” have no magical differences from their natural or synthetic counterparts, except they often suffer from lack of quality control and scientifically investigated regimens. 
 
Estrogen has an enviable record in treatment of the post-BRCA subject.  Their prognosis is ~ the same as being one clinical stage lower. 
 
Replacement hormones should not be used in women with active BRCA; rather the hormones should be part of an integrated program of treatment of the post-BRCA subject.
 Regards,

Frederick Naftolin MD, PhD, FACOG, FRCOG
Professor of Obstetrics and Gynecology
Director, Reproductive Biology Research
Co-director Interdisciplinary program in Menopause Medicine
New York University School of Medicine