Healthspanlife - the Official Life! Blog

   As it often does, the BBC health news item (CALL TO  RETHINK CHILDHOOD BMI TESTING  (Sunday, 29 June 200 misses the point.

         While anyone can see if someone is carrying excess fat by inspection of the unclad waist and ideally waist girth measurement, BMI is invaluable as an objective measure of weight-for-height - but how can weight or BMI ever  be a measure of fitness?
          
         Weight-for- height reflects the aggregate of lean mass and fat mass.
Except in body builders, athletes, the lean mass is as much a factor of hormone balance (anabolics- androgens, vitamin D, growth hormone) and water balance as it is of exercise.
Fat mass is far more a reflection of calorie intake than of calorie expenditure - physical excercise.

         So regular measurement of height, weight and waist girth is crucial at all ages  for monitoring both fat mass - the major marker of the risk of the obesity diseases from early puberty, infertility and type 2 diabetes to cardiovascular disease, cancer and weightbearing osteoarthritis - and lean mass. Low lean mass for height (the LMI- lean mass index) reflects reflects low  protein-exercise levels and thus risk of future frailty- fractures.

         Hence the increasing problem of fatness frailty in those who are pampered by abundance of food, transport and physical leisure - especially in postmenopausal women, especially those on oral estrogen-progestin hormone therapy- apparent “normal” BMI but increasing girth and fat mass while lean- muscle- mass declines inexorably. These are the patients we see in practice every day,  in whom weight and BMI is especially misused, in whom doctors dismiss a weight gain of say 1/2kg a year while this may mask a fat gain of 2.5kg a year while 2kg of lean mass a year is being lost.

       These are the patients in which doctors (who should know better)  negligently continue to ignore that the older patient often has  excess estrogenic:androgen balance if not frank androgen deficiency syndrome; and/or  negligently deny the patient metformin prescription until she has frank diabetes and obesity!

          There are thus two distinctly separate imperatives at all ages but especially in young schoolchildren, when habits are being set:  monitoring of fat mass- which must be regulated by prescription of  metformin supplement  (or equivalent natural weight-insulin resistance reducers) to tolerance long term if all else fails so as to halve the inexorable progession to overweight, metabolic syndrome and diabetes;  and enforcement of minimum exercise standards to promote both physical and mental health.

So NICE and the National Obesity Forum have  approved rimonabant Acomplia for use by NHS patients.  UK. 24  June 2008. See article.
 
Why has the USA not approved it? because  “On June 13, 2007, FDA’s Advisory Committee  concluded that the French manufacturer Sanofi-Aventis failed to demonstrate the safety of rimonabantand voted against recommending the anti-obesity treatment for approval”  “The risk benefit ratio on the usage of Rimonabant is not yet established, so better alternates can be chosen.” See reference.

why has EU and the UK National Obesity Forum  NOF given the nod to rimonabant but not the proven metformin?  One need only look at the sponsors listed on the NOF website to guess- drug companies who all market anti-obesity wannabe drugs: Sanofi-Aventis, Abbott, Roche, Canderel.

 It is the same with hypertension and lipidemia drugs: the most effective - metformin,  nicotinic acid, and lowdose reserpine plus amiloretic- are not profitable, so despite heir total safety and great efficacy in appropriate dose,  big manufacturers will not pay for trials and marketing to promote them, so regulators and eg lipidemia / hypertension societies ignore if not delist them, as  has happened to reserpine  in UK, Europe and South Africa.

Why are  Merck- Bristol-Myers Squibb not sponsors of NOF  since they market the original Glucophage metformin?
Perhaps it is because this 85year old plant extract (developed in Scotland)  is too successful, but out of patent: it is the only drug that has ever been tested in a double-blind randomized controlled trial RCT for 20 years, which in new overweight type 2 diabetics reduced all common major degenerative diseases and all-cause premature deaths by almost 40% (which no other patented drug does) without a single serious aderse effect- in fact it greatly reduces deaths from common lactic acidosis which is common in seriously ill older patients  Similarly in three large RCTs in overweight non-diabetics (in USA, China and India), it halved the incidence of new diabetes. It’s primary purpose is to reduce appetite and  insulin resistance and thus improving energy uptake into brain and muscle -and thus improve mood and exercise capacity, and reduce hypertension, lipidemia, cancer, vascular disease, arthritis and fat stores including in the liver.

Thus at any age it is the best drug for treating overweight and obesity, polycystic ovary syndrome PCOS, pregnancy overweight and pregnancy diabetes, type 2 diabetes, lipidemia, vascular disease and thrombosis risk. No other drug reduces obesity safely and sustainably by 20kg over 2 years as we have seen, and by 8% over 4 years as Glueck et al have reported, and halves all-cause mortality over 5 years in type 2 diabetes as it does in Canada.

Since some patients metabolize metformin very slowly and therefore do not tolerate average daily doses (500- >3500mg/day),  metformin should simply be started at no more than about 125mg/day eg  a quarter fragment of a small metformin tablet, and increased gradually to tolerance over weeks- which dose averages about 2500mg/day. Most trials eg the DPP in USA lost 25% of trialists at the outset because they ignored this obvious rule, starting foolishly  at eg 500 and even 1000mg/day.  As with any other chronic drug, the patient must be warned of signs of intolerance (which they should report promptly) -nausea,  bloating, diarrhoea- on which they must promptly halve if not stop the drug till these symptoms settle then rebuild the dose to a  well-tolerated level.

Thus nobody in their right mind would recommend or take any drug except metformin or increasing overweight or obesity let alone diabetes (even the resistant overweight type 1 diabetic). Why use a drug like rimonabant with serious risk of hypertension, anxiety and depression when it is never required?

This is not to say that metformin is essential, since there are a thousand naturalinsulin- and appetite reducing  natural nutritional microsupplements, out of which one can simply safely and cheaply combine  a few dozen in one’s diet twice a day- fish oil, and most others in a powder blend. Naturally these are not patentable, hence they are against the interests of the big drug companies.

Perhaps the biggest fraud of all is to ignore prescription of metformin as an adjuvant to diet and lifestyle until the patient has sustained enormous damage in developing obesity and type 2 diabetes- with long experience that vascular, renal, lipidemia, eye and nervous system disease from this metabolic progression may occur well before obesity or diabetes become obvious. Why otherwise do we continue to see fat elderly patients worsening on glitazones,  statins, sulphonylureas,  and even  highdose insulin, when all they need is optimal titration with metformin and the legion natural alternatives vailable.

Refs on Pubmed and Google.

Eight major new studies (below)  published this year confirm that old is best, and give the lie to costly marketing-hype trials trying to promote newer anti-hypertensive ( beta-, calcium channel- and angiotensin blockers), anticholesterol (statin), antidiabetic and antithrombotic blockbuster drugs. 

So the Veterans, MRC, TOMHS, SHEP, ALLHAT, German Reserpine, Cache County, USA, UK, Indian, Chinese and now Turkish, POISE, Australian and the Eniwa antidiabetes, antihypertension and cardiovascular studies. show that one can achieve unsurpassed prevention and treatment of a range of conditions -

overweight or already diabetic, hypertension, stroke, heart-failure, thrombosis, arrhythmia, lipidemia, diabetes, dementia and all-cause premature death -

using low-dose diuretic - ideally co-amiloretic 7 to 13.5mg/d, (or a buchu-dandelion-calmag-potassium equivalent) plus low-dose reserpine 0.05 to 0.1mg (or the herbal parent rauwolfia extract), plus metformin (or the herbal parent galega with other highly effective insulin sensitizer / appetitie regulators), including fish oil 3 – 4gm/day.

Trials for 30 years have shown that only the plant extract metformin reduces all deaths in type 2 diabetes

-         In the 20year UKPDS (Holman ea) only metformin lowered all major diseases and deaths by 36%;

-         In a Canadian Medicaid Program (Johnson ea), metformin halved deaths in diabetics over 5 years.

Now Servier’s ten-thousand patient ACCORD trial (in North America) confirms that, in contrast to the parallel  but less aggressive ten thousand patient ADVANCE trial in the rest of the world, RELATIVE TO METFORMIN, multiple drugs to lower HBA1c intensively below 6.5% increase deaths by 22% by the 2nd yr, from heart attack, hypoglycemia etc. 

The higher death rate in ACCORD was associated, inter alia, with much higher use (than in ADVANCE) of insulin; glitazone; incretins; sulphonylurea; statin – none of which prevented a mean of 3kg weight gain. (There was no such weight gain in ADVANCE).

Since humans first became aware of the dangers of human indolence and overeating, observation has shown an inexorable link between increasing overweight and morbidity and premature mortality.

Drug companies (and their paid armies of researchers and lay / academic lobbyists) will not or cannot accept the obvious, that lipidemia and hyperglycemia are not the prime causes of disease that need to be suppressed, but are simply manifestations of disturbed metabolism due to excess calorie (and often salt) intake, leading to insulin resistance.

So they keep churning out new data promoting new antihypertensives, statins and hypoglycaemic agents – which massive studies like TOMHS, SHEP, ALLHAT, UKPDS, PROactive and now ACCORD and the Australian antihypertensive metanalysis debunk.

“Authorities” (which as in South Africa, UK and the EU, downplay metformin or lowdose reserpine / rauwolfia and lowdose diuretics) are mostly (it seems) paid panderers to Big Pharma’s (the drug industry’s) zeal to sell newer blockbusters at any cost. They thereby deny the overweight public the best anti-lipidemia, weight-limiting and antihypertensive agents available.

For the Disease Industry, only disease pays - cheap effective prevention does not.

References / Abstracts: (more…)

Neuropathy is depressingly common- whether autonomic, motor and/or sensory nerve dysfunction , -positive (eg pain) or negative (loss eg numbness or weakness). “According to the most widely accepted definition, neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. As much as 3% of the population is affected. Neuropathic pain may result from disorders of the peripheral nervous system or the central nervous system (brain and spinal cord). The definition now includes fibromyalgia.” en.wikipedia.org/wiki/Neuropathy. But as diabetes, malnutrition and alcoholism increase, so will neuropathy.

In 2007 O’Connor ea. University Rochester NY compared treatment with different first-line postherpetic neuralgia (PHN) medications; finding that an antidepressant (desipramine) was more effective and less expensive than an anticonvulsant (gabapentin)- which was more effective than the newer wannabe substitute pregabalin. www.medscape.com/viewarticle/561745

The Mayo Clinic simply lists the many designer (ie prescription) treatments tried, from topical therapies to systemic- pain relievers, antidepressants and anti-seizure medications. www.mayoclinic.com/health/peripheral-neuropathy/DS00131

Wikipedia lists dozens of relatively common causes; but, curiously, the only specific treatment it lists (apart from “symptomatic therapies” ) is the new drug pregabalin. en.wikipedia.org/wiki/Peripheral_neuropathy

Whereas in 2006 Head from Dover, ID USA www.ncbi.nlm.nih.gov/pubmed/17176168 noted that “peripheral neuropathy (PN) associated with diabetes, neurotoxic chemotherapy, human immunodeficiency virus (HIV)/antiretroviral drugs, alcoholism, nutrient deficiencies, heavy metal toxicity, and other etiologies, results in significant morbidity. Conventional pain medications primarily mask symptoms and have significant side effects and addiction profiles. However, widening research indicates alternative ie natural medicine may offer significant benefit to this patient population. Alpha-lipoic acid ALA , acetyl-L-carnitine, benfotiamine, methylcobalamin, and topical capsaicin are among the most well-researched alternative options for the treatment of PN. Other potential nutrient therapies include vitamins (pyridoxine B6, biotin B7, folate B9, E), myo-inositol, omega-3 and -6 fatty acids, glutathione, L-arginine, L-glutamine, taurine, N-acetylcysteine, zinc, magnesium, chromium, and St. John’s wort. In the realm of physical medicine, acupuncture, magnetic therapy, and yoga have been found to provide benefit”.

Also in 2006, Peters ea at Kings College London showed significant improvement relative to placebo with vitamin BCo (B1 250mg, B2 10mg, vitamin B6 250mg and B12 0.02mg with or without B9; p<0.001) in alcoholic neuropathy. alcalc.oxfordjournals.org/cgi/content/full/41/6/636

Alpha lipoic (thioctic) acid ALA (Gunsalus 194 is first listed on Medline as major benefit for hepatitis in 1958 and for diabetic neuropathy in 1961. It is an important human biological anti-oxidant, insulin-sensitizing enzyme cofactor in aerobic metabolism, and a heavy metal chelator. www.en.wikipedia.org/wiki/Lipoic_acid

Now Ruessmann ea in Germany (Diabetes Complications. 2008 Apr show that after 5years treatment with ALA 600mg /day for diabetic neuropathy, “when ALA was stopped, neuropathy relapsed within 2 weeks in 73%; but in those swopped from ALA to gabapentin 1200mg/d, only 42% responded - the other 55% did not respond to gabapentin up to 3600mg/day; on which 45% developed intolerable symptoms.. They found that ALA not only relieves neuropathic symptoms but also neuropathic deficits eg impaired sensory function; with trivial side-effects compared to symptomatic therapies.” www.ncbi.nlm.nih.gov/pubmed/18403218.

Hence there are plenty of natural micronutrient supplements - the chief of which is ALA, in a powder combination (with vitamins A, B, C, D, E, myo-inositol, glutathione, L-arginine, L-glutamine, taurine, N-acetylcysteine, GABA, 5HTP, zinc, magnesium, chromium, and herbs eg galega, gymnema and St. John’s wort), and fish oil- that will reverse/ lessen both the neuropathy and the underlying causes(s) including type 2 diabetes.

It’s tragicomedy that the BBC – the quintessential British spokespersona – laments NHS woes: * UK c.diff deaths ‘rising sharply’ * “The equivalent of one person an hour dies in hospital from clostridium difficile, figures suggest.”

And yet Authorities there and mostwhere are still in denial about enforcing simple safe low-cost multi-system prevention – in this instance to keep people out of bed and hospital, off antibiotics.
Authorities- regulators, politicians, the Tax Man – benefit as hugely from disease as do their fairy godmother the Disease Industry- the Drug conglomerates and their researchers and lobbyists, private hospitals, medical schemes - that pay them handsomely and creates myriad factories and jobs.

So because it is not profitable, Prevention Does Not Pay, no matter that it adds decades to health:

*There is no move to ban smoking, to make it (and sale, and allowance thereof) a criminal offence.

*No move to immediately jail drunken drivers for a long time, and on second offence permanently confiscate their driving licence and ban them permanently from current and future public office and public vehicle driving, be they judges or janitors, cabinet ministers or cabbies.

*The banning of deadly polluting coal-and oil-powered vehicles and major electricity sources has been blocked for decades by the endlessly greedy and ruthless oil-based industry magnates, despite the fact that these finite energy sources are desperately needed for other purposes. Now the world faces immediate famine because the oil-based transport-and energy behemoths (who have blocked investment in natural – solar - energy for decades) are paying bigger dollars for crop and marine resources as energy supplies than most consumers can afford to pay for these finite resources as food.

*No official move to acknowledge that the best drugs for both prevention and chronic treatment are the long-proven natural low-cost vigorous safe daily doses of a few score appropriate micronutrient supplements - vitamins (~15), minerals(~10) and biologicals (human and other species’) that are increasingly inadequate in the food chain in longer-lived increasingly overweight stressed humans facing worsening man-made epidemics and environmental disaster.

*No serious move yet by the US FDA- the chief protector of the new drugs industry of the west -English- Europe- Japan – (against the interests of consumers) to enforce integrity, insist that no chronic designer drugs for the chronic major common degenerative diseases be released for general use until they have been proven both at least as safe and effective as those already existing and effective, in major randomised controlled trials of a mean of at least 8years, head to head against both older designer drugs, and long-proven natural drugs, for similar purpose, in those diseases.

*The past decade alone has seen condemnation of myriad unproven unnecessary and risky released drugs –
on Wikipedia alone at least a dozen - eg Propulsid; cerivastatin; Vioxx; pemoline; benzbromarone; torcetrapib; and the discrediting of the non-steroidal anti-inflammatory drugs as no better - and potentially more hazardous than- appropriate cortisone and micronutrient use, and
newer designer antidepressants and anticlotting agents as less safe and effective than appropriately used older ones;

*the unnecessary anti-osteoporosis bisphosphonates that are increasingly associated with the very long-bone fractures they are supposed to prevent;

*and most especially the wannabe oral anti-diabetic anti-atheroma and anti-obesity drugs – statins, rimonabant, glitazones, meglitanides and sulphonylureas - as inferior to and less safe than metformin, the 85year old plant extract which is the only designer drug ever proven as invaluable panacea in a 20year RCT, tested against sulphonylureas, but not against all other modern designer drugs which (as in more recent studies) have never been shown to meaningfully reduce all-cause morbidity and mortality as does metformin.

The until-recent FDA haste to licence new drugs after scanty trials was reminiscent of the criminal conspiracy between the FDA and industry that licenced the already contested diethylstilbestrol Chicago trial of 1950- and kept that drug on the market another 25years after it was discredited. And it was in stark contrast to the FDA (to protect USA drug companies) blocking drugs already in highly effective use elsewhere for decades, like lithium carbonate, metformin and betablockers.

Since no drug corporations promote the out-of-patent old and proven agents, authorities cannot afford to promote truth - that the only remedies for chronic prevention that lower all-cause disease and mortality by between a third and a half - overweight, obesity, diabetes, cancer, hypertension, arthritis, osteoporosis fractures, vascular disease, acute infections, depression, dementia - are:

-fish oil a few grams a day- which also drastically lowers behavioural and learning disorders;
-a lowcost simple blend of a few score other proven natural micronutrients - the fifteen vitamins, ten minerals and the human / other species’ biologicals including herbs;
-metformin titrated to tolerance about 2.5gms a day, for both prevention and treatment of overweight, diabetes type 2 and most major chronic degenerative diseases; &
-appropriate conservative balanced sex hormone replacement in most older men and women, as proven in the landmark Womens’ Health Initiative and Finnish Oulu randomised controlled trials, and numerous other studies in major centres in North America, UK, Europe, Australia and South Africa, since 1953.

It is a tenet of endocrinology for the past 60 years that all major hormone deficiencies should be replaced permanently and physiologically with the same human hormones, yet there are still those, even medical specialists, who would deny this to those most in need – from middle age onwards, especially women. At least some of these specialists have the honesty to disclose that they are well paid by drug compnies to be advocates and trialists for the wannabe designer drugs to supplant the old.

Recognition of appropriate measured low cost HRT and the other proven listed supplements for all aging people would of course rob the drug industry of perhaps 90% of it’s market for it’s wannabe designer substitutes that the FDA allows to be marketed prematurely until enough people die of their complications or shortcomings.

In fact, while no study shows that any modern drug for common chronic degenerative disease prevention does any overall - mutidisease- good, reduces all-cause mortality, those who promote and practice such published truth – that the old is better - are threatened with prosecution.