Monthly Archives: November 2008









ABOUT FATS & CHOLESTEROL: Most nutrients – sugars, proteins and micronutrients-  are water-soluble:
Water abounds -we are ~30% to 75% water depending on how fat we are;
and water-soluble vitamins, minerals,  sugars, proteins and other nutrients abound  in our food chain.
It is common cause that the water-soluble vitamins – (the nine  vitamins B plus vitamin  C)- give enormous  extra multisystem protection in safe megadose supplement. These are ubiquitous if often inadequate for modern pollution, stress and epidemics  in the average  urban (or rural poor) raw and even in the lightly cooked produce/  food-chain we eat.

FATs include both the solid and the liquid form; but “fat”  – ie (semi)solid at body  temperature- is ubiquitous in human diet; once cooked, animal or vegetable or dairy , its all the same saturated sludge. Except in milk, fat is solid in animals and produce, as anyone who has had a deep cut knows- it doesn’t run out!

Expressed uncooked plant oils ie liquid at room temperature, or as the natural vegetables,  are much better  for health than cooked or animal fats,    But  they are largely omega 6 / 9 (like the omega 6 arachidonic acid in meat); and if indeed plant oils provide  omega 3, it is    ALA- alpha-linolenic acid  , not the crucial essential marine omega 3  eicosapentanoic EPA/ docahexanoic acid DHA – to which ALA is poorly converted by humans..
As opposed to oil,  FATS in humans appear to serve only a few purposes: energy storage for times of starvation; insulation against cold and falls; and synthesis of eg estrone and leptin. But the higher the fat stores, the greater the risk – eg vascular sludging (ie grime), cancer, inflammation, and trauma to weightbearing joints eg the spine, hips, knees etc.
In temperate climates, human adults carry  ideally at most 13 – 15% fat (except for women wanting to fall pregnant, when about 20-25% fat is optimal – Beth Frisch’s  hypothesis).
OIL on the other hand  is essential for lubrication in both engines and animals- and with the oil-soluble micronutrients  especially the EPA-DHA and the sex hormones – for  supple skin, mucosa (eyes, mouth, vagina), joints muscles ligaments and tendons, brain and heart . But many choose to ignore this crucial deficiency  in aging people, and instead prescribe toxic designer  “anti-inflammatory” drugs, or omega 6.
List of essential nutrients :- Wikipedia gives a useful list of the traditional dozens of essential nutrients : but this list includes many which are adequate in a prudent diet.
But the growing “news”  is on the rediscovery of the crucial protective role of appropriate  fat-soluble supplements for prevalent diseases – stress, pollution and aging eg the marine omega3 EPA and DHA;  fish oil; coQ10,  vitamin K,  and the steroids vitamin D, testosterone, progesterone and estrogens;    as opposed to the water-soluble crucial micronutrients eg arginine, carnitine, coQ10, ribose, N acetyl cysteine; glucosamine-chondroitin; lutein-zeaxanthine, essential minerals etc.
FAT SOLUBLE MICRONUTRIENTS however, are far fewer than water-soluble micronutrients, and thus have even more important diversity and potential deficiencies since our primary physical anatomy is the fatty cell membranes, and our fatty mammalian nervous systems (about 8% fat, 80% water, 10% protein):
CHOLESTEROL is obviously the crucial basic building block for cell membranes, and steroids – which we lower too far (with eg starvation or  statins) at our grave peril.  Cholesterol–  the principal sterol synthesized by animals-  is an essential component of mammalian cell membranes to establish proper membrane permeability and fluidity.  Minimum levels of cholesterol are essential for life.  Cholesterol may act as an antioxidant, in the manufacture of bile and helps digest fat, important for the metabolism of the fat soluble vitamins A, D, E and K., and is the major precursor of the various steroid hormones (which include cortisol and aldosterone, and the sex hormones progesterone,  estrogens, testosterone). It also covers nerves in the form of myelin, to conduct nerve impulses.    Recently, cholesterol has also been implicated in cell signaling processes. But since the liver makes about 1gm cholesterol a day, it is not essential in the diet.

1. FISH OIL– perhaps the most important supplement there is-  as the till-now unique and only source of the essential fatty acids EPA and DHA, is discussed at length.
Along with nuclear fallout), we  WW2 & baby boomer generations got plenty of fish oil as kids  – in breast milk; as cod liver oil in malt; or  provided fish was lightly cooked, or raw- sushi or eg pickled (not cooked) herring (not fried). And of course there were plenty of oily fish around- sardines, anchovies, pilchards, mackerel, tuna, salmon, cod. But these are now increasingly scarce, or polluted whether wild or farmed. We now rarely find even canned pilchards or salmon with the fish oil left in the cans- it is usually run off and replaced by harmful saline or plant oil. And northern hemisphere fish is increasingly contaminated by heavy metals let alone synthetic xenoestrogenics  like dioxin, PCBs, insecticides etc which are rapidly sterilizing the planet (look at the 90% fall in the bee population in N America- no bees, no cross-pollination, no flowers, no plant produce). .
So we now all need to take fish oil to get our essential minimum 800mg EPA+DHA a day.
A popular myth is heavy metal contamination of fish oil. But  toxic heavy metals are water-soluble and bind heavily to proteins, so there are none in clean commercial fish oils. see 1, 2 – which are indeed  rigorously controlled for deadly industrial  solutes like PCBs, DDT, dioxin.

In Alzheimer’s disease, the latest research affirms the likely protective role  especially for  the elderly of early and permanent fish oil supplement ie DHA; and the harm of supplementing plant oil ie excessive arachidonic acid.


2.1 VITAMINS A- CAROTENOIDS– the provitamin A beta-carotene β,β-carotene  – is crucial in supporting skin, vision,  memory, and immunity against infections eg viral. Patients with acne have been shown to have low blood levels of vtamin E and especially vitamin A. Beta-carotene is composed of two retinyl groups, and is broken down in the mucosa of the small intestine  to retinal, a form of vitamin A.. so supplementing b-carotene provides us with vitamin A as we require it.
There is apparently no toxic dose of bcarotene C40H56, but prudence- if only to avoid yellow skin- is not to much exceed 15000iu/day;   whereas excessive vitamin A –retinol  C20H30O-  dose increases incidence of some cancers eg in smokers.
No trial has been published comparing head-on the patented (vitamin A- modified)  oral designer drug isotretinoin Roaccutane C20H28O2  with combination of the skin nutrients: beta carotene C40H56  plus vitamins B C D E plus fish oil and zinc. Since most of the latter have proven major anticancer, antiviral, cardiovascular and antidiabetic as well as (like betacarotene) antiinfective, skin and memory benefits, there is no comparative evidence to justify except as last resort  the use of toxic isotretinoin for cystic acne, especially not in children.

The careteinoids C40H56O2 lutein and it’s isomer  zeaxanthine are crucial in protection against visual loss- macular degeneration- and Alzheimer’s disease.

2.2 VITAMIN D There is a flood of new research  papers recently  on the importance of vigorous (not traditional 400iu/d) vitamin D supplement   against  all major acute and chronic diseases including infections.
It becomes clear that we optimally need vit D  bloodlevels of ~80-120nmol/L, ie  5000iu to 10 000 iu/d rather than 400-800 iu/d,  just as men and women  need testosterone .
There are now well over fifty conditions associated with suboptimal vitamin D levels. (adapted from Dr Joe Mercola) :

dermatoses: eczema; acne,  Psoriasis ,lupus. Multiple Sclerosis
Alzheimer’s disease Diabetes 1 and 2 Muscle pain

IgA nephritis

Asthma Hearing loss Obesity
athleticism impaired Heart disease osteoporosis
Autism Hypertension Parkinson’s
cancer* hyperactivty learning disorder, ADHD Periodontal disease, cavities
chronic fatigue infertility  miscarriage prematurity pre-eclampsia prostatism, BOO
infections; Septicemia Insomnia Rheumatoid- & osteo-arthritis,SLE
Crohn’s disease learning disorder schizophrenia
Cystic fibrosis; COPD Macular degeneration; myopia seizures
Depression Migraines thrombosis

*cancers of  breast, colon ovary kidney and endometrium occur much less in sunny places in the world.

One cannot  find a major acute, or  chronic, youthful  or degenerative  aging, disease not on this list;     and only fish oil may have wider benefits.   Even age-related lung function decline has strong inverse relationship with baseline vitamin D level; which is not surprising considering how osteoporotic shortening and bowing restricts the lungs, and lack of vtamin D weakens muscles.
So perhaps only  regular outdoor workers – hikers/bikers/swimmers –  with strong muscles and bones need not worry about their vitamin D level.

But the cost of a vitamin D3 measurement is awesome  in RSA (R660) or about US$66. Ultrasound BMD sceening is a  more affordable indirect screen, with checking of calcium bloodlevel occasionally so as not to overdose vitamin D.

Vit D production  from sunshine apparently self-limits vitamin D production for safety to about 400 to 2000iu internal synthesis/day. Vit D in cod liver oil is regulated by treaty to  about 100iu/gm oil.
The manufacturing industry has reportedly, without announcing it, redefined and sells “pure” vitamin D powder as 100iu/mg instead of the scientific standard  40 000iu/mg; thus what they sell  as pure  “vitamin D3” is actually 0.25% . So we have to pay freight for 99.75% inert filler to be shipped around the world. This too is the standard commercial fraud.

So for  the benefits of safe vigorous vitamin D 6000iu/day or 50 000iu /week, we need a vit D supplement.

2.3 VITAMIN E the mixed tocopherols are most important fat-soluble antioxidant   vasodilators; but dose should not exceed about 1600mg 800iu/day since, like betacarotene, this vitamin in excess is  associated with increased lung cancer when combined with the 4000 carcinogens that smokers choose to ingest . Supplement of vitamin E may benefit circulation, Parkinsons, Alzheimer’s or visual loss.

2.4 VITAMIN K supplement has recently  appeared to  be almost as important as vitamins  D and C supplements in preventing not just warfarin dose instability,  but also osteoporosis fractures, cancer and cardio/ vascular disease. The only major difference is that vitamin K supplements do not appear to reduce infection- but vit K supplement may be safe & worthwhile during/ after antibiotics to avoid vitamin-K deficiency (and thus bleeding and increased vascular, bone and cancer risk ). In the recent ECKO trial from Univ Toronto (Cheung 2008) , vit K just 1mg/d halved fractures in postmenopausal women over 2 -4yrs despite no clear increase in bone density.


3.1 THYROXINE T4 AND TERTROXIN T3 are  the  crucial fat-soluble thyroid hormones (combined in Diotroxin) which especially after mid life often require replacement for either poor thyroid production or for resistance due to antibodies.


3.2.1 CARDIAC GLYCOSIDES eg digoxin are hydrophilic ie fat-soluble natural steroids from plants and animals (apparently from our adrenals and brain)  that strengthen heart contraction and slow the heart in preventing/ treating rapid atrial fibrillation. Obviously we have evolved them too over a million years, and plant glycocides have been used medicinally for centuries if not millenia.

3.2.2 ADRENAL: CORTISONE (and ALDOSTERONE)  are also  crucial fat-soluble adrenal  steroid  hormones which may with aging or stress burnout (type C personality) justify  replacement orally for relative if not absolute cortisol deficiency.

3.2.3 SEX HORMONES: the  all-systems ie anti-aging benefits of lifelong parenteral primary  human sex hormones  testosterone, estrogens, progesterone  (from the gonads and adrenals)  have  been documented for millennia, and confirmed for sixty years with their appropriate supplementation- reducing all-cause mortality and morbidity by at least 1/3- especially testosterone and it’s daughter estrogens for men and women; and increasingly in new studies that parenteral estrogen halves the risk of heart attack post menopause.    eg .

The American National Osteoporosis NOF website for patients  has legion bewildered queries from  patients being told dogmatically by their  doctors that they must take new  (risky and long-term unproven) designer patent  single-target  ie fraudulent drugs eg bisphosphonates, strontium ranelate  for osteoporosis – not the old and proven  safe dozen appropriate  natural multisystem supplements that combat all chronic major degenerative diseases as well as optimizing childhood development, learning-memory, and defence against  infections –  ie the freely available  vits B 6,9,12, C, K, calmag, zinc, boron, manganese, proline, fish oil, and for sexhormone imbalance/ inadequate levels, appropriate testosterone for both sexes plus appropriate parenteral estrogen for women (or occasionally DHEA where appropriate). .

4. CoQ10 ubiquinols :    these vital antioxidant insulin sensitizers appear beneficial in doses of up to 300mg/d against heart failure ; cancer; migraine; Parkinson’s; oral-gingival disease; Alzheimer’s; hypertension; COPD; and cardiac arrest.
Compared to niacin, fish oil, CoQ10 and other insulin sensitizers, there is no justification for the use of statins for mild-to-moderate  lipidemia, when these synthetic designer drugs are a cause of coQ10 depletion (reported repeatedly since 1990)    and  do nothing for non-cardiovascular disease and mortality including insulin resistance;
and when (because drug companies will not risk head-to-head trials of statins against alternatives)  there is no evidence  that statins are as good  (against mild-moderate  hypercholesterolemia-associated CVD) as eg niacin and other vitamins-minerals, fish oil, metformin, coQ10, arginine, carnitine, ribose,  and other insulin-sensitizing antioxidants;
and when supplementing CoQ10 also does nothing for the myopathy let alone impotence caused by statins.

FAT-SOLUBLE POISONS STORED IN BODY FAT such as DDT or PCBs, are also stored in the fatty tissues, but the body has no use for these substances and they are NEVER withdrawn from these fatty tissues for any valid use within the body.
These harmful chemicals (DDT, PCBs) do leak out of fatty tissues (during times of sweating, for instance), but when that happens there is no beneficial use for them in the body — and they cause far more harm  than good after they have leaked out.
Worse, these poison are stored in the body fat of all flesh we eat (just as heavy metals are stored in protein ie muscle); hence vegetarians run lower risk.
Worse, aluminium (which is not usually water-soluble) accumulates in  the brain (let alone bone), and is one of the few minerals that has no known biological benefit, but contributes greatly to dementia and fractures.
Worse, there has been massive pollution of reserves by recycled water effluent from sewage works and industry, leading to global fauna sterilization /destruction by the masses of contraceptive and anabolic steroid hormones prescribed for humans and  animals (Deborah Cadbury: The Feminization of Nature 1997 )  that threatens to sterilize and thus wipe out most of humankind this century.
And worst of all, deliberate adulteration of commercially grown meat/fish for accelerated growth by anabolics – especially the high-risk synthetics like ethinylestradiol and progestins- is especially poorly regulated since the industrialized countries  notoriously dump these (as well as stocks of eg dangerous insecticides, and genetically modified seeds)  via ruthless politicians/middlemen on poor countries like South Africa  where there is minimal monitoring of transgressions.

NON-ESSENTIAL “ESSENTIAL” (PLANT) OILS eg from cloves, tea tree, garlic,  mrenthol, eucalyptus, citrus, rose, may indeed have medicinal benefits used topically/ in aromatherapy; but are outside the scope of this review since they are not human biologicals like the vitamins, steroids and essential fatty acids..
IN CONCLUSION: whether by design or random evolution, we developed dependent on if not from  sea life, and especially marine oil, fat-soluble micronutrients; but with longevity, and as we become eaters of largely cooked flesh and produce, with depleting marine fish reserves, we need marine oil and fat-soluble micronutrients ever more- not processed plant oils and cornstarch.
It’s like all other natural supplements and valued old products:
Nothing has yet contradicted  that metfomin (a plant extract) is the last “synthetic” ie drug industry  designer preventative  for chronic prescription use that actually reduces all-cause mortality and morbidity ie is the panacea; without enough insulin sensitizers, excess calorie are simply diverted to more cholesterol and body fat;

while  the natural supplements: FAT-SOLUBLE  fish oil; vit D3; and testosterone, +-  extra estrogen  for women  – look like they may prove equal  to if not better than metformin solo as panaceas.

You can’t beat nature/creation  for providing healthy options;                                                                      nor  endless human greed in trying to do better for profit by promoting designer substitutes?

If we continue to destroy species -especially marine life- at the rate mankind is doing, there will soon be no marine life- EPA/DHA – left- and  the science industry  (unlike nature) has yet to work out how to make them.


The USA Litigation Industry Lie about Appropriate Hormone Replacement.


    This  litigation  Nevada sues manufacturers of hormone therapy drugs  was guaranteed to happen given that the medical malpractice industry (legal terrorism- the shock doctrine, disaster capitalism)  is one of the most profitable and pernicious moneyspinners in the world.   

     So now Governments, regulators  and  industry must be sued for damages by civil society, alcoholics, cirrhotics, type 2 diabetics, emphysema- lung cancer sufferers, the overweight and  the victims of drunken driving, for allowing  homicidally  damaging  tobacco, alcohols and sucrose (sugar)  for social (not medicinal) consumption to be sold without  prescription and medical supervision (as if there were any justification whatsoever for smoking, for oral sucrose or aspartame..)


           It’s far worse than the HRT scenario since unlike the prime human biologicals eg testosterone, estradiol and progesterone  -essential for  growth and  health in all systems – tobacco, alcohol, aspartame and sugar (including in soft drinks and candies) are anything but beneficial .


          If tobacco, sucrose and oral alcohol were available only via a medical practitioner, obesity, sickness and mortality rates would be decimated – but that would not suite governments or the “food” and Disease Industry- nor the Medical Insurance/Schemes industry, since the more claims there are, the more they can charge, the bigger the profits. So they don’t ban the overweight, tobacco or alcohol (ab)users).


         The fact that appropriate sex  hormone therapy reduces by a third  the major aging degenerative diseases, and overall mortality, and mortality from breast cancer,  is conveniently ignored. But the Media rarely cares- Only Bad News Sells.

  INFORMED CONSENT:        So its like Viagra (which can rarely precipitate death or blindness):  every time they collect a prescription or supply of any sex or hormone therapy- including corticosteroids; progesterone and other HT tablets/patches/injections/ creams,  plant estrogenics like black cohosh, red clover, soya etc –  all patients will have to sign a consent form that they know the myths and facts  that abound about HT , that they have read the poster on display.

     Since the same concerns about shortterm and longterm (eg cancer) risk apply to phytohormones (black cohosh, red clover, soya etc), these may also not be sold without due warning that they should not be taken without medical supervision.


on a sombre note,

be aware that today is World Toilet Day,

to highlight the plight of not just half of humankind but even well over a million Americans who do not have flush toilets.

Is clean running water (rivers, taps)  and  waterborne sewerage , even the clean well and  freestanding pit toilet and septic tank, a human right, or a privilege only of the haves?




          The attending internist – anaesthetist drug expert for those needing anaesthetia/ analgesia,  is  a crucial lifeline for the patient who might otherwise see just the surgeon and GP.


         And how many anaesthetists or surgeons first trained as specialist physicians in preventative medicine?




     Apart from the primary role of the anaesthetist – safe  life support, pain relief, and muscle relaxation through surgery- there are obviously at least seven other overlapping domains that the anaesthetist  can improve if necessary, and bring to the attention of the patient & GP (as opposed to the surgeon & ICU specialist who would inevitably otherwise just focus on current problems):


1. Steroids- corticosteroids CS as the anaesthetist well knows,  at the appropriate replacement (rather than rare pharmacological) dose, since relative CS deficiency or resistance is increasingly common in the older & sicker;


2. The Superhormones- Sex steroids & thyroid in replacement dose– deficient in at least half by midlife.

    Various Swiss/German studies  in ICU/ the ER have shown that men (and postmenopausal women) do worse than menstruating young women because the active well-housed gonads of the lattter are least perturbed by acute illness/acute injury. Thus  men (who  anyway clearly have androgen resistance compared to women – Bancroft’s hypothesis – involving apparent desensitization of the central nervous system to testosterone TT during early development in the male) suffer catastrophic fall in their main balancing anabolic immunomodulating hormone – testosterone – during major illness/injury. This cardinal hormone can  easily  be measured, and if suboptimal safely replaced if only temporarily with a single shot of Sustanon or Depotrone. The proportionate dose applies equally to the common androgen-deficient older woman. Similarly, thyroid deficiency can easily be measured immediately, and replaced with Diotroxin or even better Tertroxin initially.

      The older patient needing major surgery may already as a consequence long have lost/ given up sex due to both illness and the causal or consequent fall in sex hormones – but sexual activity  may well  have become the only healthy exercise  and antidepressant that many older  people get  if not need.


3. Secosteroid: relative vitamin D deficiency  is increasingly recognized in all populations and agegroups, with the evidence suggesting that the optimal blood level is the upper quintile of the average adult ie around 100nmol/L to drastically reduce fractures, CVD, cancer, depression, autism and infections.  Deficiency has probably increased as fish has become unobtainable, with rising dairy product intolerance, with increasing avoidance of sunburn, and with the forced hypocholesterolemia (from low cholesterol diet and statins)  driven by the lunatic fringe who for profit insist that even normal levels of cholesterol are causal in vascular disease, not simply an effect of  stress- and obesity-induced insulin resistance.

      So, while vitamin D intoxication occurs only with intake  in excess of 50 000  to 100 000iu daily, vitamin D is easily and cheaply boosted to near the optimal level with eg 50 000iu a week or about  6000 iu a day. Unfortunately it takes weeks to get a vitamin D level measurement back from up country (at a  local cost of R660 ie US$66); but provided blood calcium , ALP & ESR etc do not suggest the very rare malignant hypercalcemia, it is harmless to give 50 000iu vit D pre-op, whether orally or sc..


4. the populist Synthetic designer but  adverse  drugs- Statins, sulphonylureas/ glitazones,oral HRT pills,   bisphosphonates,  antacids,  NSAIDs non-steroidal anti-inflammatories, psychotropes, and most antihypertensives,  –  should be at least temporarily suspended preop and in ICU; since there is rarely justification for any of them, and they all cause significant morbidity.

    statins are better replaced by fish oil, CoQ10 and other natural insulin-sensitizing antioxidants;

    the fattening  hypoglycemic- risky antidiabetic tabs by appropriate dose metformin +- insulin; only metformin halves mortality in diabetics, halves the incidence of new diabetics when used to promote weight loss & lower IGR in the overweight- and metformin plus androgen is antithrombotic, mildly thrombolytic and antilipidemic;

    the gastrotoxic thrombogenic (and sudden-death eg Voltaren injection ) NSAIDs replaced by  fish oil; paracetamol- opioid; and safe beneficial natural analgesic NSAIDs by  a combo of curcumin-MSM -vit B5-cat’s claw-bromelain-boswelia,  and for osteoarthritis and CVD protection, chondroglucosamine; 

     We have all had experience of anaesthesia, either as the patient, the relative  or as one of the team. It may not always be good shortterm or longterm. Readers have been lucky- we were in good hands, and survived to be reading this.
     so everyone can contribute some comment


with  calmag-zinc, carnosine – glutamine-glycine-milk thistle  to prevent gastric erosion/reflux and leaky gut, largely        

    replacing the  H2 Antagonists and PPIs with their dizzifying effects.

    HRT pills replaced eg natural physiological  estradiol -progesterone- testosterone  patch or cream;

    no populist antihypertensives   act for 24 hrs; the betablockers are now reserved only for ischaemic heart disease and arrhythmia because of increased risk; and the ACEI/ ARBs cause symptomatic let alone asymptomatic bronchial/angioedema risk in at least a quarter if not half  of users;

 whereas the best antihypertensive regime remains what has been proven in numerous trials for almost 50 years- lowdose reserpine 0.0625 (initially 0.125)mg/d plus lowdose coamilozide eg amiloretic 1/4 to 1/2  day. we seldom see patients who need amlodipine added as the best 4th drug choice for  suboptimal control, provided they simply stop sugar, cooked fats and excess salt, and take routine fish oil, the other multisupplement discussed here, and appropriate metformin, and parenteral HRT (for men & women respectively);


     prescription psychotropes:  as substitutes, apart from the major benefits of natural parenteral  HRT also as antidepressant and neuroprotection, there are the primary brain neurotransmitters melatonin and GABA gama-amino butyric acid let alone 5HTP 5hydroxytryptamine; all of these are usually appropriate, freely available, safe and relatively low cost;


    and bisphosphonates replaced  by all that is needed – appropriate combo of testo-estradiol;  proline;  the key minerals     CalMagZincBoronMn;

               and the key anabolic vits  B6-B9-B12, C, D & K – especially to combat the rapid bone and muscle loss  & delayed/ failed healing  of major surgery,  let alone prolonged immobility with complications.


5. safe oils – fish oil should always be added pre-op, replacing (as capsules or liquid) both aspirin and   the plant oil supplements (which are inflammatory) with the essential EPA + DHA at least a gram a day ie as  4  gm fish oil a day,  which further help reduce constipation, thrombosis, inflammation- pain, depression, infection, memory loss and arrhythmia.


6. safe other supplements: added to the above in eg one drink twice a day: daily bcarotene 6000iu, the other vits B, E 400iu/d; and vit C to tolerance ie short of diarrhoea- eg 2-3 gm/d; orally / by n/g tube, but  eg 1-5 gm in every vacolitre while on a drip;

    the other minerals eg Cr, Mo, Se; and  if appropriate iron.

    N acetyl cysteine + guaifenesin as crucial lung protection;

and the magic quintet to reverse cardiovascular disease- CoQ10, arginine, carnitine, ribose and carnosine. (arginine is the key Nitric oxide substrate). 


7. Screening: Fortunately very little needs to be added to what is already often routine before major surgery and in ICU: apart from  baseline FBC creat elecs, LFT, calcium & redcell magnesium, there is appropriate testing for CK; iron;  T4, TSH;  glucose-insulin; and the steroid profile- cortisol; vit D, DHEA, testost, estradiol, progesterone & SHBG; and (rarely informative) FSH-LH.


8. Whose priorities and interests are served by perioperative / intensive care ICU prevention?   Patients and acute response doctors, like gynes and other surgeons,  traditionally focus only  reactively on the acute presenting problem-  not on long term prevention.

Obviously longterm prevention is against the shortterm interests of both patients (it takes too much discipline); and  of private hospitals, the new drug industry, and private practice specialist internists & gynes-  for whom only profitable disease pays; and against the interests of politicians- since the Disease  Industry generate vast jobs and taxes (and opportunities for graft).


    But the evidence from the literature and experience the past 50 years is that such prevention from admission can halve mortality, morbidity and complications including post-op confusion ie halve hospital stay and shortterm/ longterm incapacity.

          Waiting for the major fracture before implementing lowcost safe effective preventatives may be worthwhile for the surgeon and hospital- but 20% die from the hip fracture, only 20% recover full health thereafter.


And only longterm androgen replacement  may reverse the chief cause of osteoporotic fractures- frailty and falls. Nothing can reverse a fatal thrombosis, or chronic dementia, only early and permanent prevention can avoid these.





News bulletins by the media   are a  hazard to health when  they are dangerously  misleading because they do not review and give  the evidence-based facts. .. this morning’s radio news broadcast wrongly that  “vitamins E and C supplements no use in prevention of cardiovascular disease”.

The journalist authors  cannot have been bothered  to read the freely available full paper  of last week on the latest vitamins E and C trial , and the detailed reports on vit C on Wiki.  and on the Oregon State University website; nor  last week’s abstract  on calcium + vitamin D supplement and risk of breast cancer.


The Media  really need to have health reports vetted by specialist doctors who are not dependent on either the NIH/FDA, or funding by Drug Corporates;  there is so much disinformation out there – often fostered by corporate vested interests in promoting drugs instead of what actually works – for the $trillion Disease Industry, Only Disease Pays..


Remember that most trial are funded only by corporates with an axe to grind- in this case the US Govt, which is funded to the tune of billions by the Drug Industry (in taxes, jobs, new drug registrations,  and unmentionable other funds), and which lies continuously  (like especially the Bush Administration  team  of eg Cheney, Rumsfeld, Wolfowitz and the Bushes  have done for the past 30 years ) to protect their industry interests;  including  US drug companies,  by suppressing proven natural supplements that make most new chronic drugs largely  unnecessary.  


         We do not eat just one or two foodstuffs- we would soon fade and die.


so any trial that tries to supplement just one or two essentials eg vits C & E , or calcium plus vitamin D,  is unlikely to show benefit –

especially when our food chain is rapidly depleting, especially as we age, and especially with mushrooming stress and pollution;

and especially  when the supplements are not accompanied by all the other microsupplements that  balance the diet and metabolism up to about early mid life, then run out, 

and when the supplements used may be commercially donated and promoted ie they may not be the best form of the supplements. This applies especially to eg mixed tocopherols (vitamins E).



The cancer study from  the Womens’ Health Initiative used a trivial dose of vitamin D (400iu/d) compared to the 10 – 20 times higher effective dose  (5000 to 10 000iu/d) that is now recommended against fractures, cancer, vascular disease and infections. The abstract   fails to note either

* that the trial was secondary (not primary ) prevention ie the mean age of the participants at outset was 63years, (not early midlife as primary prevention would require)- these women on average were already overweight, with a high proportion already having eg hypertension and vascular disease, and many had already been (not physiological non-oral human hormones) on oral horsehormone therapy – which has been known since 1980 to promote breast cancer when taken for well over 10 years;


* the abstract  fails to point out that the results apply only to the women of the age spread and ethnicity specified, and to the low dose of vitamin D used in that trial for that relatively short timespan – a mean of 7 years-which is too short to have much influence on a cancer which has a gestation of about 20years before it presents clinically.


 eg the CDC paper from SEER data  compared women at different ages: the number of women who will develop breast cancer in the next 20 years rises from 5.6% ie 0.28 % a year from age 50yrs  to 6.55%  ie 0.33% a year  from age 60yrs. But by 70yrs the incidence of new cancer falls to 5.94% ie 0.0.287%pa. But at the mean age of 63yrs in the WHI, the risk of breast cancer  from the CDC figures  was only about 2.4% over 7years. In the WHI, the actual incidence figures were  higher   – 2.9% on supplements, 3.01% on placebo- ie 4% lower on supplements. So the numbers, and the timespan, were simply not big enough to show the growing benefit of supplements in more appropriate safe higher doses started earlier and for longer.  


This is spelt out  by a major university report ; and  the massive Nurses Study   showed that higher dose vitamin D is associated with a third less  breast cancer risk .



The full Physicians’ Health Study  trial paper on Vitamins E and C IN PREVENTION OF CARDIOVASCULAR DISEASE  (JAMA 12 November 2008)   states specifically that the trial provides no supports for THESE SUPPLEMENTS ie 500mg vitamin C and 200iu vitamin E a day  for a mean 8years on vascular disease, started in overweight men at an average age of 64yrs, half of whom had smoked, half with hypertension; and 60 %  exercising and 3/4 on aspirin- which would have masked a lot of the benefit of the vitamins since aspirin and exercise are each known to reduce disease and death by at least 20% . This trial was thus very late secondary prevention- NOT primary prevention ie started in the healthy young.

 and even so, although there was slight increase in the rare hemorrhagic stroke on the vit E (bearing out the 2005 study , there was 26% reduction in total strokes, 9% decrease in all mortality & 12% decrease in heart attacks! 

and the vitamin C was associated with 43% fewer heart attacks.

But this group (of elderly doctors) was so well in general that their total mortality was only 1.5% a year, and cardiovascular mortality only 0.5% a year.  


There is good evidence that vitamin E up to 800iu/day is valuable medicine (and a sex/ fertility promoter), although the jury is out on much higher doses.

The trial report  said nothing about  supplements started far more sensibly   by the latest in young midlife if not in youth (which is when chronic disease starts);

and nothing about other doses eg the long-recommended human need for at least 3gms vitamin C a day- on which there are scores of good studies (and up to 30-60 times that dose in times of illness)-  with the only limiting effect being diarrhoea in some people who are less tolerant than others. Major analyses of vitamin C have shown that vitamin C supplement well above 700mg/day is strongly beneficial against all diseases  .


 This topic has regularly been reviewed in this column.

This update reviews relevant peer-reviewed papers on Pubmed the past two year.



The Turkish trial (Cayan  Aug-2008) confirms in rats  that “bladder functions may deteriorate post menopause ” and “in addition to estrogen replacement therapy ERT, testosterone TRT  has a significant role to increase bladder smooth muscle, leading to improvement in bladder functions”  “In castrated rats  on HT for 60 days, smooth muscle/collagen ratio of the bladders was significantly higher on  testosterone and testosterone + estradiol treatment groups.” .

The Turkish rat trial confirms the rat trial in Brazil (Madeiro 2002) where “the group receiving  androgen/estrogen retained a higher number of vessels, epithelial thickness and quantity of muscular fibers (p < 0.05) than those on  isolated conjugated estrogen” .

Laura Owens  claims recently  that testosterone has been shown to reduce SUI  in women, but there are no peer-reviewed studies on Pubmed that claim this, only in rats so far.

 This is in stark contrast  to estrogen therapy ET  alone in women- which (like the SERMS) double the already majority incidence of leaky bladder by the midsixties, with rapid loss of bladder collagen; which worse SUI on estrogen  is only partly mitigated by addition of progestin, which may also worsent SUI.

             Since  low  testosterone  (as opposed to vigorous youthful level) also associates with worse prostate cancer, and prostatism in men, restoring youthful testosterone levels may also be relevant to men for the above urinary reasons.



2.1The Lund (Sweden- Gotmar,  Aug 2008) study of 6900 women aged 60-70yrs confirmed the obvious, that   “women on HT(oral estrogen ± progestin)  had lower testosterone and FTI and were less satisfied with mood and energy (p < 0.05)”;

YET “sexual well-being was not correlated to testosterone or FTI (p > 0.05)”

In  perimenopausal women  Lower testosterone concentrations were associated with lower quality of life.   but counter-intuitively found     Lower testosterone concentrations were  not related to sexual well-being”.


2.2 Finally, the report this week by Sue Davis, John Studd ea NEJM 2008: Nov 6  from Australia, UK, Sweden, France, USA and Canada on Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen:   a 52-week strict  RCT  in 814 women with hypoactive sexual desire disorder  randomly assigned to receive a patch delivering 150 or 300 µg of testosterone TRT per day or placebo; with a subgroup of participants followed for an additional year. As compared with placebo, the higher dose  of TRT was associated with more significant increases in desire and decrease in distress p<0.001. They dont say how many continued their usual vaginal estrogen or phytoestrogen..   The vigorous physiological TT level that the TRT achieved  produced plausible symptom relief, and some androgen overdose symptoms easily controlled by dose titration.

 But  the women in this RCT  were already mostly overweight if not obese; and thus surely with  implausibly low basal E2 levels – 17.5pmol/L  both off and on TRT  at +- 54.4 years?  despite more than half not having had hysterectomy;  and no data were given about previous HT use (which omission  was massively  criticised in WHI reports) – and no mention of how many of the women trialists did continue   vaginal estrogen or phytoestrogens, or how ths was factored into mulltifactorial analysis of outcomes. 


And unlike healthy young women who have testosterone:estradiol ratios of about 4:1 eg 1000pmol:250pmol/L , these women had mean T:E2 ratios of 150:5pg/m/L ie  30:1 at baseline, which rose to 660:5 pg/ml or  130:1 on the higher dose of TRT.  In addition, their DHT levels doubled  from about 70 to 170 pg/mlL.  So their effective androgen (TT+DHT) :E2 ratio rose from about 220:5 ie 44:1 to 830:5 ie the ratio almost quadrupled to 166:1 – ie 40 times the ratio in healthy young women.

       So apart from  the one woman who (perhaps deliberately out of fear both of refusal, and fear of breast surgery) failed to report her bleeding breast cancer before starting on TRT, there were 2 women who developed BRCA out of well over 500 women-years on TRT,  after 4 and 12mo respectively. But breast cancer takes decades to grow to become clinically detectable. – ie they must obviously already  have had longstanding   small BRCA which (in these buxom women) was obviously missed on the baseline mammogram.  And since  the women of widely different ethnic (albeit mostly “European”)  origins were recruited to 65 centres accross 3 continents, there could have been low chance of uniform rigorous screening mammography standardization.

          2.3 ROUTE OF TESTOSTERONE REPLACEMENT: as discussed in previous comments, the important issue is appropriate parenteral HRT. Whether HRT including  testosterone is better delivered by patch, vaginally or by subcut injection is a separate issue not addressed by Davis and Studd  – since so much metabolism occurs during transcutaneous passage (eg to DHT) , but surely less during faster transmucosal absortion, and less still during subcutaneous absorption.

          But all of endocrinology depends on correcting hormone imbalance  to physiological levels and balance. However, unlike hypogonadal men who have always been prescribed physiological levels of testosterone replacement by the physiological parenteral route, the HT industry treats postmenopusal women like they do livestock, expecting commercial industrial doses of nonhuman hormones (eg premarin, progestins) by the known higher-risk oral route –OHT. It is incomprehensible that qualified medical doctors still comply with this heresy despite the hazards of industrial OHT being well known and publicised the past 30years. Is it just to let women take even “appropriate” OHT up to the age of 60 years (which did well in the young WHI and Oulu cohorts for up to 8 to 10years) for the sake of William Masters’ “convenience” (1957) , given the risks long term of such high doses, including longterm increase in breast cancer (Henderson ea 1980)      

       The same argument applies to any prescribed hormone imbalance- why induce even worse androgen excess in such sexually dysfunctionl postmenopausal women than these trialists already showed at baseline? When all they required was measurement also of their progesterone levels, and appropriate supplement  with appropriate estrogen-progesterone cream eg on the face (to counteract testosterone virilism) – as is routine in good practice    which has been long known to do nothing but good?





3.1  Margo  & Winnin a comprehensive 2006  review Testosterone Treatments: Why, When, and How?  detailed  well all the benefits of parenteral TRT including augmenting and balancing estrogen replacement ERT against hot flashes; fractures depression, and loss of memory, drive/energy and sexual responsiveness; with no evidence of harm provided  TRT dose is titrated to maintain bloodlevels within the range and overall sexhormone balance of healthy young women

 But they made one crucially  misleading assertion – that  “traditional hormone therapy using estrogen and progesterone can increase the dose of CVD and uterine/ breast cancer”   for which they quote the WHI (2002 Rossouw) paper.   But Rossouw’s paper did not say that.   And “traditional” HT has never used oral progesterone HT,  in USA largely  the far more potent and adverse synthetic medroxyprogesterone – which is hardly used in Europe.

 As the Nurses’ Study suggested, and the International Menopause Society, and the WHI itself,  and numerous other expert papers have pointed out since, appropriate hormone therapy using ±1mg/d  oral estrogen equivalent (± appropriate progestin) ie in otherwise well women from menopause produces about 1/3 reduction in all major common aging diseases and mortality- with only slight increase in the rare complications- deep vein thrombosis and gallstones.   

       To any clinician who bothered to read the original  1998 WHI  design paper  and the key 2002 and 2004 WHI papers, it was and has always been  obvious that only the WHI women allocated oral HT soon after menopause ie well below 60yrs were appropriately allocated oral HT as is always done in clinical practice – and these women (as in both WHI 2002 and  the Oulu trial) have always done very well up to about 10 years.

       But no sensible clinician ever put on “conventional” oral estrogen- progestin  elderly overweight  women, as in the majority in WHI -well over 60yrs, smoking, hypertensive and predictably with latent vascular disease and preclinical breast cancer- which has been well known since the 1970s to increase risk when started or long continued is such at-risk women. Rossouw ea carefully specified in 2002 that the global results of the first report should not be extrapolated to other agegroups, other forms or routes or ethnicities of women.

But Margo & Winn’s paper  made it clear that they were respectively academics in family practice and community medicine, not in specialist menopause medicine, gynaecology or endocrinology. Their review was and is (like eg the anecdotal  Million-Women Study , and the hysterical analogy in 2002-2003  of HT with  “thalidomide disaster” from European  and German medicines Regulators ) thus understandably superficial,  of limited relevance, and not to be quoted. It was the Million Women Study report which infamously confused the natural prime human  hormone estradiol  with the vastly potent synthetic  ethinyestradiol –  which has never been recommended for HT (except by bureaucrats- not menopause specialists- also infamously on the  EU  core drug list for HT at  the time).   


3.2 As about so many misguided  condemnatory pronouncements on appropriate HRT for men and women from “authorities” in USA UK and Europe the past 6 years since the first WHI report, one  can only echo  international experts like Traish A, Guay AT  ea from Boston University  a year ago:  Are the Endocrine Society’s Clinical Practice Guidelines on Androgen Therapy in Women misguided? the Guidelines _  do not necessarily represent the opinion held by the many health-care professionals and clinicians who are specialized in the evaluation, diagnosis, and treatment of women’s health in androgen insufficiency states… The recommendations provided in the published Guidelines are neither accurate nor complete… In their own disclaimer, they stated that the Guidelines do not establish a standard of care… It is our goal to elevate this debate in order to provide women who are afflicted with androgen insufficiency and sexual disorders with the highest quality health care and to relieve their distress and suffering, as well as to improve their quality of life.”


Albeit observational,  This  new  study  from one of the world’s leading University hospitals (Copenhagen Denmark) has  massive power – 3 million women years over a 6year span; it confirms  that  it is folly  to  double  the risk of heart attack   in postmenopausal women by prescribing them oral HT (estrogen +- synthetic progestin) (or no HRT),  when harmless dermal/ vaginal HRT halves their risk. This in an age-group where avoidable cardio/vascular disease kill (or cripple) well over half. 


        This contrasts with the statins (HMGA inhibitors) for mild-moderate hypercholesterolemia, where in the absense of cardiovascular disease- ie in primary prevention-  statins lower CVD by less than a third and have if anything adverse influence on non-CVD morbidity and mortality.


      The statistics on parenteral estrogen were  based on some  100 000 women years- about the same size as  the billion-dollar Women’s Health Initiative  trial of oral HT  over about the same period in about the same agegroup. By contrast, oral HT (solo premarin) reduced deaths (by 27%) only in the 50-59year cohort of the WHI(2002) – whereas in the combined oral premarin-Provera leg of the WHI(2004), there was (as in the Danish study) no overall benefit. The authors of the Danish study reason against healthy-user bias.


     Denial of this long-obvious evidence- that natural (ie balanced human parenteral) HRT is best- cannot be stupidity, so perhaps it comes down to the Disease Industry’s  ruthless profiteering:  explaining parenteral HRT takes longer, and more effective and safer cheap prevention decreases the needs of  aging women for monitoring and interventions.


Illich’s Medical Nemesis, the medicalization of society (1974), described how western medicine  promotes sickness by discouraging self-determination (with eg sensible disciplined diet lifestyle and vigorous supplements), labelling many conditions as diseases requiring doctor care (eg overweight, stress, mild hypertension/ mild-moderate lipidemia, or self-induced insomnia ) and prescription perseverance with profitable but adverse prescription patent drugs like oral HT and nonsteroidal antiinflammatories  that in the long term cause as much harm as good .


    The latest tricks of the consumer (food- entertainment-disease)  global industry conglomerate and it’s   regulators and lobbyists are failure  to stop the sale  of  the greatest killers – cigarette smoking, raw sugar and commercial fast foods loaded with sugar, aspartamate, corn omega 6  and saturated fats; 

discourage people from taking the best prevention there is- appropriate vigorous safe supplements like  parenteral human HRT, and vitamins minerals and the other natural biologicals;

      and creating  imaginary pandemics eg anxiety-panic disorder, mild depression/ hypercholesterrolemia, impotence that need  costly new designer drugs. Pfizer and the FDA have for years colluded to  deny  access – despite the Freedom of Information Act – to their public trials of sildenafil- Viagra in thousands of men , but subsequent other studies and trials confirmed the massive fraud of  Viagra marketing-  that Viagra works poorly  in men with relative androgen deficiency;  that all that most men with impotence and suboptimal testosterone levels need is lowcost fortnightly  selfinjection sc of human depot testosterone, with only perhaps 20% actually requiring some Viagra equivalent as well longterm.



     The Disease Industry  thus wants to  force people to deteriorate with aging  without natural prevention till they become sick, then have to enroll as patients.


Over the generation since Illich, not one patent drug for chronic prevention has reduced all-cause mortality and morbidity in the chronic major degenerative diseases of aging, unlike the natural supplements:

*metformin the plant extract (1922);

*fish oil;

*appropriate HRT; and

*the basket of some 50 vitamins, minerals and the other biologicals.


        The  much safer  effect of vaginal  estrogen is understandable  considering that  absorption of low dose  vaginally  ie transmucosally must be much higher than transdermally,  subject to less biotransformation than it is in slower transit through dermis. .


Parenteral human HRT has always been known to be safer than oral HT (at 10-20 times the dose)- since the much higher oral dose required for symptom relief has been known for over 30 years to increase the risk of thrombosis, fluid retention, biliary disease, and, cumulatively, breast cancer.


 But despite Masters and Grody showing in the first HRT controlled trial in 1953 how well old women do on parenteral testosterone-estradiol 20:1, most doctors (but not most women) obtusely prefer to follow Masters’ classic Industry-led  hypocrisy  at the AMCOG meeting in 1957, that the “convenience of the HT pill” (ie Wyeth’s Premarin) takes priority over what was already proven as generally  best for postmenopausal women-  parenteral testosterone: estradiol, without endometrial need for any progestin since testosterone protects both the breast and endometrium. This has since been amply confirmed in  Sweden (von Schoultz ea; Hirschberg ea ), Australia (Zhou Dimitrikakis ea) and  North America (the Wake Forest Primate HRT research  group- personal communications). 


        So unless  women specifically want cosmetic ie facial cream benefit, one should always advise them to use the cream vaginally – with appropriate co-mix with testosterone / progesterone. .


The ideal may be to let them use the estrogen +- testosterone vaginally, with progesterone facially   -especially  when ERT is started in the agegroup 60-69yrs, and especially  when the ERT is vaginal; since starting conventional oral mega-HT (as in the Womens’ Health Initiative) after the age of 60years has been universally discouraged for the past 5 years. 


        Or more simply, many women in the pre/perimenopause require initially just testosterone for relative androgen deficiency (aka FADS)  – which can most adjustably be taken as cream daily; or most conveniently be taken  by tiny selfinjection subcutaneously sc as about 20-50mg depotestosterone every 2 to 4 weeks, or testosterone undecanoate 50-100mg sc every 3 months. Then appropriate  parenteral  estrogen/ progesterone can be added from menopause.