Healthspanlife - the Official Life! Blog

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…)

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.

Why is there surprise at the new 4year international study (in NEJM of 3 April 2008 http://content.nejm.org/cgi/content/abstract/358/14/1431 ) that further 26% lowering of average “bad” low density cholesterol LDLC - level (and CRP c-reactive protein) by adding a new designer drug for 2 years to a statin alone makes no further difference to vascular or all-cause outcome? In fact in even this young population there were 46% more cardiovascular CVD events on the statin - ezetimibe combination (10/357 = 1.4%pa) than on simvastatin alone (7/363 = 0.96%pa).

At baseline the subjects at a mean age of 46+- 10yrs (half men) were an average of about 10kg overweight; 28% smoked, only 16.4% were already hypertensive, but 80% already on statins (they had to have had a total cholesterol TC of >5.43mmol/L off lipid-improving drugs – their mean TC off drugs was 10.4mmol). Other than the 5% who had already had heart attack, and perhaps the 2% who were diabetic, why were these average mostly well young people targeted for further cholesterol lowering, when their mean TC was already down to 6.9mmol/L on statin (vs 5.7 on the twin drugs) with HDL 1.2 ? when all they needed to do was lose a few kg fat by sensible eating and exercise, stop smoking and take some safe fat-reducing anti- atheroma antioxidant and insulin-sensitising supplements including fish oil? Why should lowering of blood markers already within the average range give any benefit as opposed to doing harm? According to Sijbrands (BMJ 2001) from Erasmus University http://www.bibalex.org/Supercourse/lecture/lec3191/001.htm, such a cohort of people untreated has a standardized mortality ratio of 1.88- but in this new 2008 Enhance paper, their mortality rate on statin alone was already so low (CVD mortality 0.1%pa) that all-cause mortality was not even mentioned.

So it should be asked why such a trial was undertaken, when there has never been any evidence that drug lowering of mild to moderate TC (ie below 8mmol/L) or LDLC lowers non-CVD morbidity and mortality? – and when there are legion proven supplements that lower morbidity and mortality ? The evidence against cholesterol lowering in those without high CVD risk was already shown over a decade ago by the Sheffield team (Haq 1995), who have consistently stressed that “cholesterol measurement by itself is not a good way to identify those with high coronary risk”, and that there is little advantage (except for anti-cholesterol practitioners and laboratories) in lowering average cholesterol levels unless CVD risk is at least 2% if not 3% a year. The CVD risk of this Enhance trial cohort on statin was only 1% a year.

No statin trial has ever shown that these lipid-lowering drugs drugs lower or even address non-vascular disease or mortality; whereas (except in those at the highest cardiovascular risk) nonvascular degenerative disease is by far the bigger burden in later years. Dr James le Fanu summarised the evidence against universal cholesterol-lowering in mild-to-moderate lipidemia already in The Rise and Fall of Modern Medicine (Abacus UK 1999).

Since according to the lipid-lowering industry, most of us overweight older folk naturally have risky lipid levels to be targeted by zealous drug marketers and prescribers, some British doctors who know better have actually invested heavily in promoting (without evidence of global benefit :risk) a farcial polypill including a statin, an antihypertensive and aspirin for all. http://www.bmj.com/cgi/content/full/326/7404/1419

It is common cause that after 30 years of widespread use, statins do nothing for overweight, insulin resistance, hyperglycemia, other CVD factors, nor for other major degenerative diseases of overweight and aging - infection, osteoporosis, cancer, arthritis, sexual dysfunction - and thus do nothing to lower non-vascular morbidity and mortality. But statins do cause widespread insidious fatigue, myalgia, depression, impotence; and now lung and tendon rupture complications, let alone hepatorenal problems- are being increasingly reported.

By contrast, it is common cause from both trials and observational studies for >30years that APPROPRIATE
1) metformin for overweight/ lipidemia; 2) fish oil; 3) combined hormone replacement; and 4) blend of the other proven >60 supplements (~15 vitamins, ~10 minerals, and the >35 biologicals including herbs), each reduce all-cause morbidity and mortality by one-third to half. Together, the combination is impressively effective in daily practice in the most desperately ill patients already on maximum conventional prescription modern drugs for osteoporosis, arthritis, CVD, type 2 diabetes on insulin with crippling neuropathy etc.

Such is the insidious influence of the global drug industry via Regulators (Elaine Feuer Innocent Casualties: The Fda’s War Against Humanity USA 1996), that we physicians are threatened with prosecution by our own medical defence advisor if we do fair comparative marketing, promote that appropriate well-proven old drugs- the natural micronutrients which drug companies prudently refuse to sponsor to be tested against modern patented prescription drugs - are better for both prevention and treatment of chronic degenerative diseases of aging than the imitator modern wannabe patentable designer drugs that attempt to mimic the original natural drugs- vitamins, minerals, biologicals - evolved and proven over millennia.

We are even threatened with prosecution for using metformin for prevention of diabetes and lipidemia, when it is the only patent drug that has ever been tested in a 20year RCT (Holman ea the UKPDS 1998), and proven to halve all-cause mortality over 5 years in type 2 diabetics, and it halves the incidence of new diabetes in overweight people with metabolic syndrome risks; whereas in trials, sulphonylureas - like all other modern patent designer drugs - had no benefit on all-cause mortality or on decreasing new diabetes incidence in older adults.

Ndb
Refs:

Haq IU, Jackson PR, Ramsay LE ea Royal Hallamshire Hospital, Sheffield, UK Sheffield risk and treatment table for cholesterol lowering for primary prevention of coronary heart disease. Lancet. 1995;346:1467-71 http://www.ncbi.nlm.nih.gov/pubmed/7490996 and Prediction of coronary risk for primary prevention of coronary heart disease: a comparison of methods QJM. 1999 ;92:379-85. http://qjmed.oxfordjournals.org/cgi/content/abstract/92/7/379

J.P. Kastelein ea, for the ENHANCE Investigators http://content.nejm.org/cgi/content/short/NEJMoa0800742 NEJM 3 Feb 2008: 358:1431-1443 Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia

How to Survive a Heart Attack When Alone: coughing and deep breathing?
This email doing the rounds may be inappropriate advice that could cost people their lives. - see http://www.hoax-slayer.com/survive-heart-attack.html and http://www.viahealth.org/body_rochester.cfm?id=329

BUT an apparently reputable cardiologist (apparently ex Vietnam Medic) also recommends it: http://www.karinya.com/cpr.htm

BUT see the notes of caution at http://en.wikipedia.org/wiki/Cough_CPR.

In short, it may save those who have sudden arrhythmia- but it is less likely to save those who are having a huge heart attack.- for whom most interventions are too late. The compromise may be to switch on the vehicle’s emergency flicker, stop the car, start coughing while collapsing visible over the steering wheel with a hand on the hooter to attract attention..

Very very few people recover or survive well long term after spontaneous (ie non-violent, non-toxic) cardiac arrest outside hospital - the studies below from France, Germany , USA & UK indicate that successful survival without impairment is - in the best hands - below perhaps 5%. .

So only primary prevention pays. Fish oil halves sudden death; metformin halves the deathrate in type 2 diabetics - and halves new diabetes in the overweight; appropriate estrogen replacement lowers allcause premature mortality by a third; deficiency of testosterone, estradiol, minerals, vitamins, CoQ10 , arginine, carnitine and ribose play a crucial role in the development and reversibility of arrhythmia, cardio/vascular and all-cause degenerative disease; and testosterone is antiarrhythmic but estrogen arrhythmogenic.

By contrast, unlike the above proven life-extenders, no modern designer drugs for chronic use have been shown to significantly reduce all major chronic degenerative diseases and premature all-cause mortality.

Thus all should take natural supplements early and permanently - appropriate vigorous supplements of minerals, vitamins and biologicals (including fish oil, insulin sensitizers and sex hormone replacement), to minimize early vascular disease and arrhythmia potential.

ndb

Heart. 2007 ;93:601-5. Sudden arrhythmic death syndrome SADS : a national survey of sudden unexplained cardiac death.Behr ER, Casey A, Sheppard M, University of London, UK. The estimated mortality from SADS was 0.16/100 000 per annum (95% CI 0.12 to 0.21), compared with an official mortality of 0.10/100 000 per annum for International Classification of Diseases 798.1 (sudden death, cause unknown-instantaneous death) or 1.34/100 000 per annum for unascertained causes of death. CONCLUSIONS: Deaths from SADS occur predominantly in young males. When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated: more than 500 potential SADS cases per annum in England. Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths. SADS should therefore be a certifiable cause of death prompting specialised cardiological evaluation of families.

European Heart Journal 2006 27:406-412 Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management Jill P. Pell ea University of Glasgow,
The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991–01 following pre-hospital arrest due to cardiac aetiology. Over the period studied, the proportion of people suffering pre-hospital arrest who survived to discharge from hospital changed from 11.6% (552/4766) in 1991–93, to 7.0% (558/8006) in 1997–01.

Resuscitation. 2005 65:49-55. Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Pfeifer R, ea University of Jena, Germany.
BACKGROUND AND PURPOSE: Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002. RESULTS: 72.% of the patients died or remained in a persistent vegetative state; and 28.8% survived with severe, moderate or without neurological disorders. .

N Engl J Med. 1999 341(8):569-75. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group.Plaisance P, ea .Lariboisière University Hospital, Paris, France. BACKGROUND: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS: Patients who had cardiac arrest in France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS: Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR.

Chest. 1994 ;106:872-9. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study. Berger R, Kelley M. Veterans Affairs Medical Center, Lexington, KY 40511.
BACKGROUND: The rising healthcare costs and the ethical and economic implications of cardiopulmonary resuscitation (CPR) have generated interest in defining criteria to predict the appropriateness of CPR in specific patients. Age has been proposed as one such a criterion. METHODS: As part of a quality assurance program, all instances of CPR (code-500) at our VA Medical Center were prospectively studied over a period of 45 months. Only events in noncritical care hospital areas were included in this analysis. The CPR data were prospectively collected, and follow-up of initial survivors was continued until the end of the study period or until a patient died. RESULTS: Of a total of 422 code-500 events, 387 (92 percent) met our study definition of cardiorespiratory arrest, and 255 of these occurred in a noncritical care area and were included in the study. Our immediate survival was 52 percent (n = 132), survival after intensive care unit (ICU) stay was 22 percent (n = 55), survival to hospital discharge was 11 percent (n = 28), and 4 percent of the patients (n = 10) were alive at the end of follow-up (mean, 22 months). None of the patients discharged alive had a significant new neurologic deficit, and all but one returned to their preadmission environment. The post-CPR hospital charges for each of the surviving patients was estimated at $63,000. Whether in-hospital CPR in noncritical care areas is cost-effective is an issue that society at large must eventually decide.

Drugs Exp Clin Res. 1992;18:355-65. Controlled study on L-carnitine therapeutic efficacy in post-infarction. Davini P, ea Santa Chiara Hospital,Pisa, Italy. A controlled study was carried out on 160 patients of both sexes (age between 39 and 86 years) discharged from the Cardiology Department of the Santa Chiara Hospital, Pisa, with a diagnosis of recent myocardial infarction. L-carnitine was randomly administered to 81 patients at an oral dose of g 4/die for 12 months, in addition to the pharmacological treatment generally used. For the whole period of 12 months, these patients showed, in comparison with the controls, an improvement in heart rate (p < 0.005), systolic arterial pressure (p < 0.005) and diastolic arterial pressure (NS); a decrease of anginal attacks (p < 0.005), of rhythm disorders (NS) and of clinical signs of impaired myocardial contractility (NS), and a clear improvement in the lipid pattern (p < 0.005). The above changes were accompanied by 90% lower mortality in the treated group (1.2%, p < 0.005), - in the control group mortality was 12.5%. Furthermore, in the control group there was a definite prevalence of deaths caused by reinfarction and sudden death. On the basis of these results, it is concluded that L-carnitine represents an effective treatment in post-infarction ischaemic cardiopathy, since it can improve the clinical evolution of this pathological condition as well as the patient’s quality of life and life expectancy.

Mol Aspects Med. 1994;15 Suppl:s165-75.
Usefulness of coenzyme Q10 in clinical cardiology: a long-term study.Langsjoen H, University of Texas Galveston .
Over an eight year period (1985-1993), we treated 424 patients with various forms of cardiovascular disease by adding coenzyme Q10 (CoQ10) to their medical regimens. Doses of CoQ10 ranged from 75 to 600 mg/day by mouth (average 242 mg). Patients were followed for an average of 17.8 months, with a total accumulation of 632 patient years. Eleven patients were omitted from this study: 10 due to non-compliance and one who experienced nausea. Eighteen deaths occurred during the study period with 10 attributable to cardiac causes.. Of 424 patients, 58 per cent improved by one NYHA class, 28% by two classes and 1.2% by three classes. A statistically significant improvement in myocardial function was documented . Before treatment with CoQ10, most patients were taking from one to five cardiac medications. During this study, overall medication requirements dropped considerably: 43% stopped between one and three drugs. Only 6% of the patients required the addition of one drug. No apparent side effects from CoQ10 treatment were noted other than a single case of transient nausea. In conclusion, CoQ10 is a safe and effective adjunctive treatment for a broad range of cardiovascular diseases, producing gratifying clinical responses while easing the medical and financial burden of multidrug therapy.

Mol Aspects Med. 1994;15 Suppl:s143-7. Coenzyme Q10 and antioxidants in acute myocardial infarction.
Kuklinski B, ea Klinikum Südstadt, Rostock, Germany.
Sixty-one patients admitted with acute myocardial infarction, and a symptom’s duration of less than 6 hr were randomized into two groups. Immediately after hospitalisation, members of the verum group (n = 32) received 500 mcg of selenium (as sodium selenite). Thereafter they received a daily dosage of 100 mg coenzyme Q10 (Bio-Quinone) and 100 mcg selenium (seleno-methionine) for a period of one year. The control group (n = 29) were given matching placebo preparations.. Biochemical parameters showed a reduced concentration of CPK- and ASAT-level in the verum group during the acute phase (although not statistically significant). None of the patients in the verum group (i.e. on antioxidative treatment) showed prolongation of the frequency corrected QT-interval. In the control group, 40% revealed a prolongation of the QT-interval by more than 440 msec (p < 0.001). There were no significant differences, with respect to early complications. During the one-year follow-up period after myocardial infarction, six patients (20%) from the control group died from re-infarction whereas one patient from the verum group suffered a non-cardiac death.

Int J Tissue React. 1990;12(3):163-8. Pronounced increase of survival of patients with cardiomyopathy when treated with coenzyme Q10 and conventional therapy. Langsjoen PH, ea Scott and White Clinic, Temple, TX USA.
During 1982-86, 43/137 patients with cardiomyopathy, Classes II, III and IV, had ejection fractions (EF) below 40%, and a mean EF of 25.1 +/- 10.3%. During treatment of these 43 patients with coenzyme Q10 (CoQ10), EF increased to 41.6 +/- 14.3% (p less than 0.001) over a mean period of 3 months (range, 2-4 months). The mean CoQ10 control blood level was 0.85 +/- 0.26 micrograms/ml which increased on treatment to 1.7 to 2.3 micrograms/ml for five periods up to 36 months (each period, p less than 0.001). The survival rates for all 137 patients treated with CoQ10 and for the 43 patients with EF below 40% were both about 75%/46 months. These two survival rates were comparable between 24 and 46 months, which is of extraordinary significance and importance when compared to survival of about 25%/36 months for 182 patients with EF below 46% on conventional therapy without CoQ10. The improved cardiac function and trippled survival show that therapy with CoQ10 is remarkably beneficial due to correction of CoQ10 deficiency in mechanisms of bioenergetics

This column (see below) has repeatedly pointed out that metformin (aet 1922), a plant derivative, is the only designer drug ever that has both been tested in a real longterm RCT - 20yrs (the UKPDS 1998)- and shown to halve both all-cause mortality in type 2 diabetics, and the incidence of new diabetics when used preventatively in those at risk at all ages with increasing body fat.

This has now been confirmed by a new analysis by Sally Salpeter’s prolific group - whose 2006 metanalysis showed almost as good results for appropriate HRT. Metformin is simply a variant of appropriate HRT, since metformin, like fish oil, and appropriate testosterone and estradiol replacement, is effectively a prohormone that reduces insulin resistance and thus allows insulin to work and glucose to be metabolised as energy by muscle (including the heart) and brain, instead of being accumulated as fat (triglyceride) everywhere.

But while metformin is the only ’synthetic’ panacea ever invented that remotely matches fish oil, appropriate HRT and all the other natural therapeutic food micronutrients in combination, it should not be forgotten that there are over a thousand natural insulin sensitizers listed on the internet; of which the freely available two dozen are easily combined into a potent lowcost combination that, with simple avoidance of sugar and cooked fats - at least halves all disease.

This makes the prescription metformin largely unnecessary- the combination just has to be used with discretion, and sensible regular meals , exercise and the routine supplements, to avoid causing hypoglcemia.

ndb

Am J Med. 2008 Feb;121(2):149-157.e2.
Meta-analysis: Metformin treatment in persons at risk for diabetes mellitus.
Sally Salpeter ea Santa Clara Valley Medical Center, CA USA.
PURPOSE: We performed a meta-analysis of randomized controlled trials to assess the effect of metformin on metabolic parameters and the incidence of new-onset diabetes in persons at risk for diabetes. METHODS: We performed comprehensive English- and non-English-language searches of EMBASE, MEDLINE, and CINAHL databases from 1966 to November of 2006 and scanned selected references. We included randomized trials of at least 8 weeks duration that compared metformin with placebo or no treatment in persons without diabetes and evaluated body mass index, fasting glucose, fasting insulin, calculated insulin resistance, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and the incidence of new-onset diabetes. RESULTS: Pooled results of 31 trials with 4570 participants followed for 8267 patient-years showed that metformin reduced body mass index (-5.3%, 95% confidence interval [CI], -6.7–4.0), fasting glucose (-4.5%, CI, -6.0–3.0), fasting insulin (-14.4%, CI, -19.9–8.9), calculated insulin resistance (-22.6%, CI, -27.3–18.0), triglycerides (-5.3%, CI, -10.5–0.03), and low-density lipoprotein cholesterol (-5.6%, CI, -8.3–3.0%), and increased high-density lipoprotein cholesterol (5.0%, CI, 1.6-8.3) compared with placebo or no treatment. The incidence of new-onset diabetes was reduced by 40% (odds ratio 0.6; CI, 0.5-0.8), with an absolute risk reduction of 6% (CI, 4- during a mean trial duration of 1.8 years. CONCLUSION: Metformin treatment in persons at risk for diabetes improves weight, lipid profiles, and insulin resistance, and reduces new-onset diabetes by 40%. The long-term effect on morbidity and mortality should be assessed in future trials.

Association of pioglitazone treatment with decreased bone mineral density

In this Danish trial in just 16 weeks, pioglitazone associated with 1 to 1.4% loss of bone density compared to placebo. http://jcem.endojournals.org/cgi/content/abstract/jc.2007-2249v1

Is this surprising considering that this group of drugs has never been shown to have the safe anabolic benefits of metformin?- which reduces fat mass and increases lean mass, and growth in teenagers with polycystic ovary syndrome.

Metformin reduces lipidemia, new diabetes by half and in diabetics almost halves mortality and all major chronic degenerative diseases. By contrast, like sulphonylureas, gliptins, appetite suppressants and other wannabe metformin substitutes the glitazones and statins have never been shown to have global benefit long term on all-cause mortality and all common aging degenerative diseases - let alone the incredible safety of metformin when used sensibly. Nor has insulin when added as last-ditch therapy in resistant type 2 diabetes.

So it is increasingly medical negligence to prescribe anything but metformin to tolerance early on and permanently in the overweight, including in common maturity-onset diabetics and those with common lipidemia and hypertension, if lifestyle, diet and a blend of natural supplements (including appropriate parenteral sex hormone replacement in men and women with such imbalance) that reduce insulin resistance are inadequate.
There are no long term contraindications to metformin adjusted to tolerance with sensible monitoring.

In the “simple” love story Away From Her (2006), Julie Christie, as an avid cross-country snow skier, portrays well the relentless progression from mild to moderate Alzheimer’s Disease, and perhaps more subtly, the perils of lost recent memory but retained old tapes - the spectre of paranoia against the caring loved ones, fertile ground for novelists, and unscrupulous financial and legal advisors.

It is a pity the film made no reference to the uselessness of modern ie commercial anti-dementia drugs, and the major preventative benefit - 50% to >80% reduction in new cases - of numerous natural supplements.

Like vascular disease and osteoporotic fractures, dementia including from injury, stroke, toxins and Alzheimer’s disease (AD) is major public health concern in all countries- dementia about 1% a year after age 75yrs in Framingham (80% were from AD)- but 100% disabling for the remained of life. Wikipedia gives the stats of these “diseases strongly associated with age as : dementia 1% of those aged 60-65, 6% of those aged 75-79, and 45% of those aged 95 or older suffer from the syndrome. Osteoporosis increases the risk of hip fracture fivefold to about 50% in the elderly (>64yrs), and mortality following a hip fracture is between 20% and 35% within one year in patients aged ~82 years, of which 80% were women-“ – with up to 80% of survivors remaining disabled to some degree. Like dementia and osteoporosis, “By the time that heart problems are detected, the underlying atherosclerosis is usually quite advanced, having progressed for decades” Each year, heart disease kills more Americans than cancer.[1] Vascular diseases alone cause half of all “natural” premature deaths; up to the year 2005, it was the number one cause of death and disability in the United States and most European countries” . ..

Not unexpectedly in people who realize they are losing their minds, depression and anxiety are major components – as the film so poignantly shows, in both the patients and their loved ones.
Unlike hip fracture, stroke or heart attack which without prevention is fatal in 1/5 to 1/3 - and crippling in up to 80% - waiting till dementia starts is uniformly disabling and fatal in about 7 years- whereas healthy people have a mean life expectation of close to 90years. No prescription drugs slow AD by more than a few weeks even in mild cases. But in very mild AD fish oil slows the disease over 6 months.

Overweight and thus diabetes, vascular disease and cancer, is becoming the norm. The pandemic of saccharine diseases- (including overweight- hypertension - insulin resistance- diabetes - vascular disease) and Alzheimers are strongly linked.

PREVENTION:
Hypogonadism hormones: in the Cache County Study (Zandi ea), only those who started young ie continued menopause hormone therapy HT for decades had 95% less AD than non-users or recent users. This was mirrored in the Women’s Health Initiative and the Oulu trial, in which HT started soon after menopause for a mean of 5-10 years reduced all major disease including memory problems (and deaths) by about 1/3 or more.

Smoking , alcoholism, infections, toxins and violence aside, it is self-evident that micronutrient deficiencies including hypogonadism plays a dominant role in the intimately intertwined vascular disease, dementia (and fractures) , since compared to men, women suffer these far more and younger- they have disturbance of natural sex hormone balance increasingly younger (from juvenile obesity, synthetic hormone contraception, lower parity, sterilization, hysterectomy, cancer therapy, and then menopause and with fattening grossly un-physiological postmenopausal commercial oral sexhormone xenotherapy).
Such unnatural oral mega/xenohormone) therapy is not advocated in androgen-deficient men- who are restored systemically to physiological sexhormone blood levels - or in any other branch of endocrinology. Why women are thus maltreated is a symptom of sick society, of their inferior and subjugate status throughout history, but especially their passive exploitation by the neocapitalist $trillion Drug and Disease Industry cartel that controls the FDA, lobbyist- legislators- and and the public the past 50 years (Elaine Feuer: Innocent Casualties : The FDA’s War Against Humanity: USA 1997).
At least the gender playing field is now level, with balanced physiological HRT (testosterone and estradiol) also freely available to women as lowcost fortnightly subcutaneous self-injection of testosterone-estradiol esters;
or designer monthly subcutaneous testosterone undecanoate plus estradiol valerate, or 6monthly combined implants, or daily combined creams.
If the FDA tries to deny this to women, it is for the people to exercise their constitutional rights to equal, long (evolution) -proven and natural replacement, beyond the control of the patent drug industry.

So dementia, vascular and fracturing disease - and risky, mostly futile chronic patent prescription drugs- are not inevitable, even with the risky genes:
Regular omega3 fish oil reduces the adverse abeta and tau deposits; a fatty fish meal about 3 times a week – a mean fish omega3 intake about 200mg/day- halves dementia and sudden death. Regular plant oil (omega6) blocks benefit; but without fish oil, omega6 doubles the dementia risk. Daily fruit and veg reduced it by 30%. Enough fish oil is by far the most important human micronutrient – it roughly halves all chronic major aging diseases and premature deaths.

Metformin (C4H11N5 derived in 1922 from the [galega officinalis) plant guanide base formula C6H10N3]), is the only enduring chronic preventative patent drug ever designed: in the only long-term randomized controlled trial RCT ever, the 20 year UKPDS prospective diabetes study (1998), insulin and the designer sulphonylureas had no overall benefit on survival, but metformin reduced all-cause major disease and mortality (ie vascular, cancer, infectious) by a third; and in the Canadian Healthcare study, mortality was halved in type 2 ie older diabetics who used metformin. In the 3.5year diabetes prevention trials, in USA and China, it roughly halved the incidence of new diabetes. Both overweight, insulin resistance and type 2 diabetes are strongly related to risk of memory impairment.

Ginkgo biloba has no effect on insulin resistance/sensitivity; but
ginkgo has important benefits on rheology, lipids, circulation and memory - which are critical in (pre)diabetics;;
ginkgo prolongs the half-life of metformin in vivo ie enhances the ant-idiabetic effect p<0.05, thus reduces the needed effective dose of metformin or enhances metformin’s benefit in resistant cases.

The issue is indeed that most non-starving adults are prone to both overweight diseases, diabetes, glycation and vascular memory deficits- ie metformin/galega and ginkgo are equally important natural drugs, with some relevant synergy.

Many other natural drugs - food supplements- give significant protection against insulin resistance and thus fattening, diabetes, hypertension, lipidemia, blindness, vascular disease, and memory loss, from all the vitamins , magnesium zinc and chromium, to our endogenous biologicals carnitine, carnosine, DMAE, lipoic acid, cysteine, 5HTP, GABA, MSM, proline, phosphatidylserine/choline, arginine, ribose and CoQ10; to >1000 plants like cinnamon, curcumin, huperzine A, Melissa, fenugreek, garlic, ginseng, gymnema, Salvia, stevia, lo han guo, rosemary, Yi-Gan San and BDW (Ba Wei Di Huang Wan).

In a 2005 report (Bragin ea) , such combination in mild dementia-depression cases actually improved cognition by up to 50%.

Combining fish oil, appropriate HRT, and a mix of 50 other freely available supplements offers at least 50% reduction in all major common chronic degenerative diseases and premature deaths- no modern chronic patent drug does so. Health care providers who fail to recommend such evidence-based comprehensive natural prevention should be prosecuted.

References available on request from doctor@healthspanlife.com; from whom personal consultation and supplements may also be obtained..

Health headlines from BBC the past week are ironically contradictory, but not inevitable profits of gloom.

Sugar- including cane sugar and excess fruit sugar- and cooked/processed fat – are perhaps the greatest slow “foodstuff” poisons commercialised and concentrated by “civilization”.
The industrial society and it’s omnipresent (TV- cellphone) media deliberately ruin children’s health by introducing them early to profitable sweeteners, cooked fats, fast food, TV and computer addictions, instead of natural fresh foods, exercise, playing and books. The inevitable tidal wave of obesity and chronic degenerative disease then becomes further wealth- The Disease Industry for whom Only Disease Pays. .

Obesity may thus be partly genetic, but is not inevitable with sensible habits:
A new twin study from UK found that “Becoming overweight as a child is more likely to be the result of genes than lifestyle”. http://news.bbc.co.uk/2/hi/health/7230065.stm.

But as the Child Growth Foundation says: “Even if someone has a gene which predisposes them to obesity, it doesn’t mean they will become obese if they work hard to eat healthily” . The National Centre for Eating Disorders carefully analyses how much can be done by the individual to reduce genetic risk http://www.eating-disorders.org.uk/docs/obesity.doc .

The only safe intense sweeteners are those which are both plant-sourced and which reduce insulin resistance – eg stevia. The artificial sweeteners that have been proven 100% safe are cyclamate-saccharine - but they do not reduce insulin resistance.

The only OBESITY “drug” that has been proven in major trials and long term follow up to reduce all major chronic diseases and premature deaths – by 1/3- and HALVE new diabetes (and thus cholesterol-lipid- problems) when started well before overweight and hypertension are established, is the 80year old plant extract METFORMIN. This is THE ONLY widely available low cost prescription drug that safely produces an average of 8% weight loss sustained for as long as it is taken consistently at tolerated dose.
In Canadian experience, metformin halves all deaths in type 2 diabetics followed up for a decade; and in preventative trials, it approximately halves the incidence of new type 2 diabetes. Metformin is 100% safe provided it is started at low dose eg ~125mg/day- and increased gradually over 2 weeks to the maximum dose that is well tolerated without excessive diarrhoea, nausea, abdominal bloating or pain. This dose averages about 2.5gms a day in westerners, but (due to genetic variation) may be as low as 250mg/day. It should always be stopped briefly with any acute symptoms or acute illness, and resumed at a tolerated lower dose. It must thus always be taken in consultation with a health professional.
It is understandably rarely promoted by the Disease Industry because it is out of patent, too cheap- and it work too well. For this profitable Industry, Only Disease Pays! So only expensive new drugs are heavily promoted.

Due to the destructive combination of stressful indolence- hours spent every day watching TV instead of playing outside/ sport- and stress (cortisol) and fast food stuffed with sugar and fat, even preteen children (never mind adults at all ages) suffer increasingly from overweight and teenage type 2 diabetes, and girls from polycystic ovary- infertility-hairiness problems.

Synthetic patent weight-reducing and anti-diabetic drugs eg sbutramine, orlistat, the glitazones, have major adverse effects, and have none of the global long term advantages of metformin. The only reason for their prescription is the intensive drug industry marketing imperative.

Apart from correcting the causes outlined above, preventing and treating overweight and diabetes can be easily achieved with a permanent safe low cost natural multicombination of supplements like appetite- and insulin-resistance reducing agents eg vitamins, minerals and biologicals eg metformin/galega, 5HTP, and fish oil tailored to individual tolerance. http://www.ajcn.org/cgi/content/full/83/6/S1499?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&title=n-3+fatty+acids+and+the+metabolic+syndrome.&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Health advisors who argue against this are rarely un-informed, they have usually chosen ( for profit) to promote drug industry new drugs rather than healthy truth. The Disease Industry will never invest in trials to prove the obvious, since the supplements are not patentable ie not profitable. So they pay cynical lobbyists to argue loudly that such evidence-based natural safe supplements must first be proven in vast longterm trials - although such trial proof is not required for new designer drugs by the Regulators eg the FDA, Medicines Control Councils who are funded by the drug industry! And politicians, governments don’t argue because the drug industry is a huge creator of jobs and revenue.

Modern drugs for chronic disease allowed by the FDA to be freely prescribed are withdrawn only when enough people die: The Americans have just had to stop the glitazone arm of the massive ACCORD trial in diabetics after 25% more deaths occurred on Avandia than in controls. http://www.msnbc.msn.com/id/23029191/. But- lo and behold- there is still no announcement yet about the withdrawal of the unnecessary glitazones that have no overall longterm health benefit except for the investors!.

http://news.bbc.co.uk/1/hi/health/7219315.stmLast
Thursday, 31 January 2008, 10:27 GMT
Obesity drug use rises eight-fold
Obesity levels are increasing
More than 1m prescriptions are made for obesity drugs a year - eight times the number dispensed seven years ago. The majority of these were for two treatments - sibutramine and orlistat.

http://news.bbc.co.uk/1/hi/health/7219473.stm
Friday, 1 February 2008, 00:14 GMT
Gout surge blamed on sweet drinks