Category Archives: diabetes

THE STATIN- FOR- ALL -SENIORS HOAX: FOR WHOM TOLLS THE BELL? FOR WHOM ARE STATINS EXCEPT RARE HIGH-RISK PATIENTS’ SEVERE HYPERCHOLESTEROLEMIA, AND PROFITEERING? FURTHER DISCREDITED FOR PRIMARY PREVENTION:

neil.burman@gmail.com

19 Sept 2014 update:     ABSTRACT:  readers  of this column recently commend its statin commentary, last updated in June, about the controversy of statins  in primary prevention of cardiovascular disease CVD. This update now  reviews crucial major recent evidence that the marketing hype  of “statin deficiency” in the average aging population is a  dangerous fabrication (eg Vytorin) of the $billion Disease and Drug corporate industry  – especially when statins inhibit omega3  and CoQ10 which like other human micronutrient protectors- magnesium, iodine, arginine, carnitine, ribose, vitamins , B, D3, C & K2,   and human  sex hormones – are increasingly deficient  or imbalanced in an aging western population and urban convenience food  diet.

     The prizewinning immunologist   Dr Duncan Adams from Univ Otago   in the elite QJM 2011 pithily demolishes The Great Cholesterol ie Statin Myth, commends the statin trials metanalysis of  Ray ea from Cambridge 2010 that showed no benefits of statins in mild to moderate cholesterolemia. .     More evidence says  dont use  natural supplements along  with statins to reduce statin risks and enhance statin benefits, but better to avoid the risks  from statins, smoking and excessive alcohol eg ROS reactive oxygen species , in an aging slothful  fattening population:  with improved exercise, more water, a Banting-type low-carbs high-fat and -greens – fermented (ie high in vit K2)  diet, a multivite-multimineral plus vigorous well-tolerated supplements of CoQ10,vits D3 and C, fish oil,  magnesium, sulphur, coconut oil, and appropriate metformin and human sex hormone replacement.
     Rather than  Big Pharma’s promotion of  Statinopause, statin deficiency ,  we need to address the multiple age-and diet-related deficiencies (and some excesses)  that lead to the preventible degenerative diseases of aging- and which are worsened by the Food Factory chain  promotion that has dictated the (Gary Taubes’  Diet Delusion  and Nina Teicholtz’ The Big Fat Surprise) expose  of processed grain-fed nutrient-depleted (but fructose-loaded) foods, high carbs low animal fat/cholesterol diet for forty years. This has   compounded the deficiency of -fat-soluble micronutrients   like vitamins D3, CoQ10, A,  E & K2,  lecithin and marine omga3 – EPA and DHA; and naturally compounded pollution  by environmental-  radioactivity, electromagnetic and radiofields-,   and air, foodchain and drug pollution the past 50 years years by plastics, CO2 and volatile emissions, mercury, aluminium, fluoride, lead, bromide;   micromineral depleted salt, fatally potent endocrine disruptors, antibiotics, xenohormones, pesticides  and numerous other synthetic drugs launched on the public until they are recognized to kill humans.        
                                                                                    

  Margaret McCartney  general practitioner, Glasgow writes : We lack the tools to help patients decide about statins BMJ 2014; 349 doi:     The National Institute for Health and Care Excellence (NICE) recently approved atorvastatin for people in England and Wales who have a 10% risk of a cardiovascular event within 10 years; it had previously been a 20% risk.1 GPs are advised to treat such people—which includes everyone older than 85—and to continually review everyone else in case they pass the 10% threshold.

          This decision on funding statins is based primarily on cost effectiveness to the NHS.2 The press release from NICE mentioned the potential benefit to the population (namely, it “could help prevent up to 28 000 heart attacks and 16 000 strokes each year”3) but not the absolute benefit to the individual.

But life is more complicated than that: people make choices for multiple reasons. Many patients stop taking statins after starting them4; others, faced with the choice of taking a drug with a small chance of benefit, would rather not do so; and some people will want to take them no matter how low their risk may already be.

We lack the tools to accurately predict individual risk at such low thresholds—leading to overtreatment and, to a lesser extent, non-identification of risk.5 The general practice cake is finite; cutting a bigger slice for healthy people at lower risk means a smaller slice for people who have symptoms and are unwell. The chance of a longer life is offered to people who are willing to take tablets consistently, but we know that these compliant patients are already more likely to live longer, even when taking a placebo.6 7 This policy, which benefits people who are already the healthiest, has the potential to widen health inequalities.

       Who is keeping an overview of where NICE is taking us? The conflicts of interest among the members on its drafting panels are buried in minutes rather than in the guidance itself, and we still lack public access to most of the trial data that NICE uses.8 But we are told to press ahead regardless when, most bewildering of all, we don’t have a decent shared decision aid—designed and tested for the five million more people advised to take statins—about the benefits and harms of statinisation and the management of cardiovascular risk.

      “Should I take statins?” is a question asked of GPs every day. We urgently need better tools to allow guidance to guide, rather than dictate new targets. Our lack of resources to deal with such a common question simply isn’t acceptable.

Background:
2013 Italian  Statin HMGA   study Pasin ea shows that statins- cholesterol-busters- do not help patients with sepsis.
A 2010   review Yue ea of all published studies in  3,022 postmenopausal women (mean age, >62.7 y), showed  that statin use doesnt prevent fractures or increases bone density.

why should synthetic designer metabolic poisons – statins-  be expected to help peripheral  conditions like fracture risk and menopause?  when statins promote diabetes – insulin resistance, and  block healthy  metabolism throughout the body, in brains, muscles, kidneys, skin- but especially  lowering liver manufacture of cholesterol that is one of our top lifegivers  for our needed reproductive and adrenal steroids- including our two prime anabolic steroids( vitamin D3 and androgen). And statins increase the risk of highly malignant Merkel Cell skin carcinoma by 25%, as well as dermatitis eg Ma .  ..

We have known for  ~forty  years that while anticholesterol drugs  are  valuable for  rare people with severe hypercholesterolemia HCH risk of  vascular disease, statins’  longterm adverse effects are numerous, and there has never been evidence to justify their routine mass  use  for mild to moderate HCH- ie CVS risk below ~15 to 20% in 10 years-   despite the Cholesterol-statin industry investing multimillions in their promotional trials and in their lobbyists.

The Sheffield Cholesterol  and Multiple Risk Table by Jackson ea 25 years ago in the Lancet  was impressive  as a guide to  life extension by taking a statin permanently. When used for secondary prevention of coronary heart disease CHD , treatment with an inhibitor of hydroxymethylglutaryl-coenzyme-A reductase HMGA results in worthwhile benefit that clearly exceeds any risk in patients whose risk of coronary death is 1.5% or more per year ie >15% per 10 years. This evidence can be extrapolated logically to primary prevention of coronary disease provided that treatment is targeted at those with similar or higher risk. The table highlights the predominant effect of age on coronary risk; a person who is free of vascular disease and younger than 52 years is unlikely to have the specified degree of risk. Even in older people (60-70 years) several risk factors are generally required to attain this degree of risk. Some people are candidates for lipid- lowering drug treatment with serum cholesterol as low as 5.5 mmol/L, whereas others with cholesterol as high as 9.0 mmol/L are not. Although cholesterol lowering is a powerful method for preventing coronary events in people at high risk, cholesterol measurement by itself is not a good way to identify those with high risk. At that stage I had already been advised for 20 years , and declined on the evidence,  to take an anticholesterol drug , since in my early 50s despite my cholesterol of 6-7, my normal weight, HDLC, Hcy, Lpa,  bloodpressure, blood glucose, lifestyle and diet  put me at low risk
.Now the updated Sheffield 2011 Table  is  by  Jackson et al  in the prestigious QJM. At my age and low risk factors (no FH of CHD despite familial risks  (diabetes, atrial fib and mild lipidemia), my  Sheffield score of about 10 barely  puts me into the statin benefit range of 5 months gained. My coronaries and carotids are clear of plaque at last imaging, on all the natural supplements mentioned in this review, but not statin or any other designer hypolipidemic drug. If my patients have already been started elsewhere on a statin, I suggest they try just 5mg/day to minimize risks. . .
ADVERSE EFFECTS:  by design, they are antimetabolic;  oxidant ie increase ROS reactive oxidant species;  reduce CoQ10 by 39%.  Although these adverse effects are dose dependent and may be rare, they are cumulatively serious against muscle, liver, kidneys, memory, mood,  pancreas,  skin, sexual function; they cause diabetes, neuropathy and perhaps worsen cancer.  Thus they are like cancer chemotherapy, only for severely ill patients ie those with severe familial hypercholesterolemia..
     As  Beyond Health summarizes last year,      “Cholesterol does not cause heart disease. The French  Paradox- they have the highest average cholesterol in Europe, around 250mg(6mmol/L), but the lowest incidence of heart disease and half the heart attacks we have here in the U.S. In Crete, the home of the healthy Mediterranean diet, a 10-year study failed to find a single heart attack despite average cholesterol levels well over 200 (5 mmol). There are as many heart attacks in people with cholesterol levels over 300 (7.5mmol) as those whose levels are under 200 . Half of all heart attacks occur in people with normal cholesterol levels.   Cognitive problems affect about 15 percent of statin users, including episodes of temporary amnesia called transient global amnesia (TGA). Statins have an adverse effect on tau, a protein made by brain cells that helps maintain their structure. Abnormal tau proteins are linked with neurodegenerative diseases like Alzheimer’s, Parkinson’s and ALS.  Statins  cause progressive cognitive decline, ranging from mild to severe, and anxiety, depression, inability to deal with stress, and violent behavior. Statin-takers are more likely to develop peripheral neuropathy, and to experience tremors and vertigo.  Other health issues linked with statins include cancer, suppressed immunity, cataracts and optic nerve problems, liver damage, impotence and loss of libido, hypersensitivity reactions that can lead to the autoimmune disease lupus, birth defects if taken by pregnant women, skin rashes and dryness, hair loss, gastrointestinal problems, insomnia, and pancreatitis. “
LESSONS FROM FAMILIAL HYPERCHOLESTEROLEMIA:
Wiki says In FH, Initial studies showed increased activity of HMGA but more showed that this did not explain the very abnormal cholesterol levels in FH patients. The binding of LDL to its receptor, and effects of impaired binding on metabolism  proved to be the underlying mechanism for FH.  Heterozygous FH is a common genetic disorder inherited   in 1:500 people in many “European”   populations – the Afrikaner, French Canadians, Lebanese Christians, and Finns have high rates of specific mutations that make FH particularly common in these groups. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with lipid lowering agentsstatins, bile acid sequestrants.. . Homozygous FH often does not respond to medical therapy and may requires radical  other treatments.
 
       But search of Pubmed and Google  for STATIN mortality reduction IN FAMILIAL HYPERCHOLESTEROLEMIA gives few reports showing  that statins meaningfully reduce mortality  and add  QALYs quality life years.
                        A current comprehensive  Medscape review August 2014 Familial Hypercholesterolemia Medication  does not specify any  % reduction in mortality on statins or any other drugs, despite lowering LDLc levels 50-60%.
and  Familial Hypercholesterolemia.  Youngblom E, Knowles JW. Editors.  GeneReviews® Univ. Washington 2014 Jan  says Familial hypercholesterolemia (FH) is characterized by severely elevated LDL cholesterol (LDL-C) levels that cause atherosclerotic plaque deposition in arteries and a markedly increased risk of coronary artery disease at an early age. In FH, the more common CVD is coronary heart disease (CHD), which may manifest as angina and myocardial infarction; stroke occurs more rarely. Heterozygous FH is relatively common (prevalence 1:200-500). Persons with untreated FH are at an approximately 20-fold increased risk for CHD. Untreated men are at a 50% risk for a fatal or non-fatal coronary event by age 50 years; untreated women are at a 30% risk by age 60 years. In contrast, homozygous FH (HoFH)  is much rarer (prevalence 1:160,000 to 1:1,000,000). Most individuals with HoFH experience severe CHD by their mid-20s. The rate of either death or coronary bypass surgery by the teenage years is high.
Indeed,  Fred Raal, Dave Marais ea from their clinics’  long term results at   Wits and UCT showed Reduction in Mortality in Subjects With Homozygous Familial Hypercholesterolemia Associated With Advances in Lipid-Lowering TherapyCirculation 2011 but the ~60% reduction in mortality in the statin era in this rare group (187 such subjects, mostly Afrikaners, very few smokers) was even so statistically barely significant. When the patients lost to follow-up in the statin-naive group were included in the analysis and censored on the date that statin therapy became available, the hazard ratio for the end point of death remained barely significant at 0.38 (95% CI 0.15–0.94; P 0.04), and the hazard ratio for the end point of MACE was not significant 0.54 (95% CI 0.25–1.18; P=0.12)
However, a  new JAMA study   from the Netherlands paints a gloomy picture- following almost 277  kids from age ~14 years for  Ten-Year Follow-up After Initiation of Statin Therapy in Children With Familial Hypercholesterolemia, after 10 years twice as many of those on statins were smoking  compared to their “normal” sibs, but worse, the FH sibs on statins, despite 20% lower cholesterol,  had the same increase in carotid artery thickening as their sibs without FH.
 
Nordestgaard, Tybjærg-Hansen ea for the European Atherosclerosis Society Eur Heart J. 2013 say . Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population:  to prevent coronary heart disease: consensus. .  Of the theoretical estimated prevalence of 1/500 for heterozygous FH, <1% are diagnosed in most countries. Recently, direct screening in a Northern European general population diagnosed approximately 1/200 with heterozygous FH. All reported studies document failure to achieve recommended LDL cholesterol targets in a large proportion of individuals with FH, and up to 13-fold increased risk of CHD. Based on prevalences between 1/500 and 1/200, between 14 and 34 million individuals worldwide have FH. We recommend that children, adults, and families should be screened for FH if a person or family member presents with FH, a plasma cholesterol level in an adult ≥8 mmol/L(≥310 mg/dL) or a child ≥6 mmol/L(≥230 mg/dL), premature CHD, tendon xanthomas, or sudden premature cardiac death. In FH, LDLC targets are <3.5 mmol/L(<135 mg/dL) for children, <2.5 mmol/L(<100 mg/dL) for adults, and <1.8 mmol/L(<70 mg/dL) for adults with known CHD or diabetes. In addition to lifestyle and dietary counseling, treatment priorities are (i) in children, statins, ezetimibe, and bile acid binding resins, and (ii) in adults, maximal potent statin dose, ezetimibe, and bile acid binding resins. Lipoprotein apheresis can be offered in homozygotes and in treatment-resistant heterozygotes with CHD.                                                                                                                                                            
THE FAILURE OF EZETIMIBE, VYTORIN:
But ezetimibe as an addon to statin eg in  Vytorin has been thoroughly discredited.  As Forbes.com said last year,   Pharma & Healthcare 2013   The Fate Of New Cholesterol Drugs Depends On IMPROVE-IT   “.But  Improve-It was not completed as planned in 2013. The new American  guidelines delivered a strong statement questioning the increasingly controversial theory that LDL lowering by itself is beneficial. “We found that non-statin therapies really didn’t provide an acceptable risk reduction benefit compared to their potential for adverse effects in the routine prevention of heart attack and stroke,”  IMPROVE-IT is the large, seemingly endless outcomes trial studying Vytorin, which has been a blockbuster drug for Merck. But the drug’s reputation, and its sales, have diminished in recent years because of a raging controversy over the lack of any evidence for clinical benefit. Vytorin lowers LDL cholesterol but no one knows if it improves outcomes. The IMPROVE-IT trial is supposed to resolve this controversy next year, but it will do so only as the patent on the drug nears expiration.     There’s a really good analogy to help understand the way IMPROVE-IT could impact the fate of the PCSK9 inhibitors. Just recently supporters of Amarin’s fish oil pill Vascepa thought the drug would coast to approval for a broad new indication. Their optimism was based largely on an agreement with the FDA that did not require a large outcome study before approval. But over the past few years several large outcome trials– not entirely dissimilar to IMPROVE-IT– failed to demonstrate clinical benefit for drugs that, like Vascepa, lowered triglycerides. The FDA tore up its earlier agreement with Amarin. In all likelihood Vascepa will not gain the new indication it seeks until an ongoing outcome study is successfully completed. The other Merck CVS drug trial of Tredaptive, a combination of simvastatin and niacin B3 vitamin, failed to show the new drug was better than a statin alone.

However, the Improve-It trial already failed when it showed no significant target benefits of more intensive LDLC lowering by it’s planned   2.5  years finish ie  2010 ; so numbers  (10 000 to 18000)  and time were increased to 18000 subjects, to finish now.. The latest is that results will be released  17 November…

what do other  STATIN  trials show? A Canticle for Statins?

COMPARISON OF THE 2011 CAMBRIDGE METANALYSIS AND  2013 COCHRANE STATIN METANALYSES:

 Ray et al from Cambridge Univ UK in Arch Intern Med. 2010:  a   meta-analysis of 11 randomized controlled trials (Jupiter, Allhat, Ascot, Mega, AfCaps, WOSCOPS, ASPEN, CARDS, Prevend-it, PROSPER, HYRIM) involving 65,229 participants  ie ~244,000 person-years , mean age 62yrs,  systolic BP 141, LDLC 3.45, mean duration 3.7yrs (Jupiter only 2.2yrs), 19% diabetics,   found no  benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
and 3  years later Taylor ea (London Univ Cochrane Database Syst Rev. 2013)  concluded  in   their abstract: Statins for the primary prevention of cardiovascular disease THAT  Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life. In Eighteen randomised control trials   in  56,934 participants , mean age 57yrs, cholesterol baseline 6.17mol/l, LDLC 4.1;  duration 1 to 5.3years ie mean about 3.15 years ( they did not report mean bloodpressure). . Fourteen trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All-cause mortality was reduced 14%  by statins (OR 0.86, 95% CI 0.79 to 0.94).  as was combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81) There was no evidence of any serious harm caused by statin prescription .                         

BUT
t
heir full published paper tables   showed that statin use – in a mean time of only 3 years-   ” increased Diabetes 18% from 2.4% on placebo to 2.9% on statin; with  more fatal strokes,  liver, renal, arthritis adversity. and all-cause mortality from 5-1 to 4.4%; NUMBER NEEDED TO TREAT NNT 96. THE ABSTRACT DOES NOT GIVE THESE GLUM NUMBERS, that statins benefit  only 1 in a hundred.  BUT the dull paper states  Only the JUPITER trial showed strong  evidence of a reduction in total mortality.
As this column has previously pointed out, the Jupiter Trial was clearly flawed when we first reviewed it, and further debunked by diverse major groups by 2011/2 .
so while  the Cochrane study patients were 5 years younger but had baseline LDLC 19% higher,  than in the Cambridge analysis,   ie by age and LDLC, the Cochrane analysis could still not show meaningful reduction in mortality other than in the disputed Jupiter study.. But the Cochrane trials had only 1/8th of the diabetics in the Cambridge analysis.
 
     The 2013 Cochrane statin review’s   evidence for using statins for primary prevention in higher-risk persons without CVD  admits it’s antimortality benefit   is based solely on the weight of the seriously flawed Jupiter trial. But while the Taylor Cochrane analysis used only 8 of the trials (skipping PROSPER, ASCOT and ALLHAT)  analysed in the Ray Cambridge analysis, the Cochrane analysis added another 10 trials. Despite covering 7 more trials than the Cambridge 2010 analysis, the Cochrane analysis included 25% fewer patients than the Cambridge analysis,

     So  what the innocuous abstract of the London  UK  Cochrane review   failed to say is that, in their full paper (available on application)  weighted by the biased Jupiter trial,   to lower mortality by 14% in about 3.5years, to avoid one death,   96 well people need to take fairly vigorous dose statin for 1 to 5.4 years – or 1 patient for a few hundred years–   with serious risks of diabetes (up 18%), liver, kidney, myopathies, peripheral neuropathy, intracerebral hemorrhage (ICH), and other diseases of the central nervous system (eg  cognitive impairment, depression, sleep disorders, nightmare, and headache- . mood (suicide risk increased 2.5 fold – Davison & Kaplan 2014 Canada );

and (unlike the anticancer benefits of metformin and vitamin D3) no benefits in reducing cancers rates. Such bad risk: benefit ratio confirms what  has always been known, that there is no place for mass long-term consumption of statin whether in a mythical Polypill (Wald and Law 2003–   with adverse Bblocker, ACEI and aspirin,) or even more farfetched added to our diet staples- water, bread etc..

It is common cause that diabetes increases major  risks 4 fold; so advocating  96 well people to take a statin to lower  mortality  by 1 case in 3.5 years ie 330 patient-years while >3% develop diabetes, stroke, depression, myositis, hepatorenal  and other major complications,  is  negligence,  when patients do so much better on metformin plus other natural proven life-extending  supplements like fish oil, coconut oil, vitamins esp vit D3 & K2,  minerals etc. 

As Pubpeer said on 27  July 2014, its a crisis of  trust in what top journals (in this case the Cochrane Review) publish. For TRUST read distrust…

This is in contrast to metformin prevention in similar overweight well people,  which lowers all risks by at least a third, with no adverse effects  provided dose is started low and titrated to tolerance ie ~250 to 2500mg a day. THE BMJ STATIN FUROR JUNE 2014:
Just last month, the long-awaited independent review of the BMJ June 2014 STATIN publication (of articles denouncing the value of statins for mass primary prevention ) confirmed  that the BMJ editors under  Dr Fiona Godlee were correct in  standing by the June papers  that there is no mortality benefit from statin treatment in people at less than a 20% 10-year risk of cardiovascular disease, as Canada implements.,
The panel, chaired by Dr Heath with  six internationally renowned experts, concluded the journal had handled the two articles appropriately and that its processes were timely and reasonable. 

Now  three new 2014  studies put more wolves  among the Big Pharma profiteering disease-mongering sheep:
one from India describing many promising new competitors to displace statins;  one from Oxford University warning yet again of the adverse effects of anticholesterols, this time by CETP inhibitors; and one from New York University mocking the wannabe Statinopause, statin deficiency:

      George,  Elangovan  ea in India  J Cardiovasc Pharmacol Ther. 2014 Jul  Look  into the Crystal Ball -Upcoming Drugs for Dyslipidemia: say: . Although statins are effective anti-dyslipidemic drugs, their use is fraught with issues such as failure of adequate lipid control in 30% of cases and intolerance in select patients. The limited potential of alternatives such as fibrates, bile acid sequestrants and niacin has spurred search for novel drug molecules with better efficacy and safety, eg  promising cholesteryl ester transfer protein CETP inhibitors such as evacetrapib and anacetrapib; (MTP) inhibitors eg lomitapide; Apo CIII inhibitors eg  mipomersen;  PCSK9 inhibitors eg evolocumab, alirocumab; farnesoid X receptor modulation; and Lp-PLA2 inhibition. While it may not be an easy proposition to dismantle statins from their current position as a cholesterol reducing agent and as a drug to reduce coronary and cerebro-vascular atherosclerosis, our improved understanding of the disease and appropriate harnessing of resources using sound and robust technology could make rapid in-roads in our pursuit of the ideal anti-dyslipidemic drug.

BUT
Miller NE. University of Oxford, UK   in F1000Res.2014 Jun   warns  Time to think again about .  CETP inhibitors and cardiovascular disease:   Inhibition of cholesteryl ester transfer protein (CETP) lowers plasma LDLC concentration and raises HDLC, suggesting it might prevent CVD. From the outset, however, the concept has been controversial owing to uncertainty about its effects on HDL function and reverse cholesterol transport (RCT). Although there has long been good evidence in rabbits  that CETP inhibition reduces atherosclerosis , the first information on CETP as a CVD risk factor in a prospectively followed cohort was not published until after the first Phase 3 trial of a CETP inhibitor had begun. The worrying finding that in humans CVD incidence was related inversely to plasma CETP has since been reproduced in each of five further prospective cohort studies. Similar results were obtained in subjects on or off statin therapy, for first and second CVD events, and for mortality as well as CVD morbidity. Additionally, two recent studies have found alleles of the CETP gene to be associated with an increased risk of myocardial infarction. Meanwhile, CETP gene transfer in mice was found to increase RCT from peripheral macrophages in vivo, and human plasma with high CETP activity was shown to have a greater capacity to remove cholesterol from cultured cells than plasma with low activity. This mounting evidence  in humans and mice for a protective function of CETP has been given remarkably little attention, and indeed was not mentioned in several recent reviews.  It appears to show that CETP inhibition does not test the HDL hypothesis as originally hoped, and raises a pressing ethical issue regarding two Phase 3 trials of inhibitors, involving more than forty thousand subjects, which are currently in progress. As the weight of evidence now clearly supports an adverse effect of CETP inhibition on CVD, an urgent review is needed to determine if these trials should be discontinued.
and
Han, Weinberger, SutinNew York University. J Gen Intern Med. 2014 Aug. warn:  Statinopause.        Statins are the cornerstone of lipid-lowering therapy for CVD prevention. The  American College of Cardiology (ACC) and American Heart Association (AHA) 2013 guidelines represent a fundamental shift in how statins will be prescribed; recommending  statins for nearly all older patients up to age 75 years, including healthy adults with low normal lipid levels and no atherosclerotic cardiovascular disease (ASCVD) risk factors other than age. Under the 2013 guidelines, age becomes a main determinant for initiating statin therapy for primary prevention among older adults. Specifically, according to the new guidelines, white males aged 63-75, white females aged 71-75, African American males aged 66-75, and African American females aged 70-75 with optimal risk factors would be recommended for statin treatment for primary prevention. Based on the new guidelines, one could term these older adults as having “statin deficiency,” a condition warranting statin treatment. We call this putative condition of age-related statin deficiency “statinopause.” After careful examination of the trial evidence, we find very little support for the new recommendations for primary prevention. The lack of evidence underscores the need for clinical trials to determine the risks and benefits of statin therapy for primary prevention among older adults.                                                                                                                                                           
HALF OF PATIENTS DISCONTINUE STATINS WITHIN A YEAR IN REAL LIFE:     Already in 2009    Goldenberg N1, Glueck C: wrote  in real life practice, about half of patients who are prescribed statins discontinue the medication by the end of the year. from the  Cholesterol and Metabolism Center,  Jewish Hospital, Cincinnati, Ohio, USAin  Vasc Health Risk Manag. .    Efficacy, effectiveness and real life goal attainment of statins in managing  CVS  risk. Statins became available in 1987 for the treatment of hypercholesterolemia .   Multiple, well-designed, placebo-controlled, double-blind studies revealed that each 1% reduction in serum cholesterol level was associated with about 1% reduction in risk of CVS events. Low-density lipoprotein (LDLC) cholesterol reduction to less than 78 mg/dL may be associated with reduction of atheroma burden. Patients with high levels of high specificity C-reactive protein and having LDLC less than 3.4 mmol/L (130 mg/dL) in primary prevention settings benefited from aggressive LDLC reduction with rosuvastatin over a 2-year period.  Medication adherence is lower in younger patients, women, and absence of known CHD. Personal features of the prescribing physician and dispensing pharmacies also affect patients’ compliance. More studies are needed to evaluate if “compliance packets” would benefit patients in a real life situation.
STATINS DEPLETE  Co10, OMEGA3 AND OTHER ESSENTIALS:.
     Coenzyme q10 therapy 2014  .Garrido-Maraver J1,  Sánchez-Alcázar ea . at Seville Universities say coenzyme Q10 (CoQ10) have  key role in mitochondrial bioenergetics; antioxidant; obligatory cofactor for uncoupling proteins and a modulator of the mitochondrial transition pore; expression of genes ; human cell signaling, metabolism and transport. CoQ10 deficiencies are due to autosomal recessive mutations, mitochondrial diseases, aging-related oxidative stress and carcinogenesis processes, and statin treatment. Many neurodegenerative disorders, diabetes, cancer, and muscular and cardiovascular diseases have been associated with low CoQ10 levels as well as different ataxias and encephalomyopathies. CoQ10 causes no serious adverse effects in humans.  Oral a CoQ10 is a frequent  antioxidant used in many diseases that may provide a significant symptomatic benefit.

        Statin treatment and new-onset diabetes: a review of proposed mechanisms. Brault ,  Daskalopoulou ea .2014  at McGill and Harvard say   New-onset diabetes has been observed  involving statin therapy. To explain this association, three major mechanisms have been proposed . First, certain statins affect insulin secretion through direct, indirect or combined effects on calcium channels in pancreatic β-cells. Second, reduced translocation of glucose transporter 4 in response to treatment results in hyperglycemia and hyperinsulinemia. Third, statin therapy decreases other important downstream products, such as coenzyme Q10, farnesyl pyrophosphate, geranylgeranyl pyrophosphate, and dolichol; their depletion leads to reduced intracellular signaling.

     Michel de Lorgeril ea .Universite Joseph Fourier, Grenoble France  BMC Med.2013 ask: do statins inhibit omega-3?. Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions. .Early randomized controlled trials (RCTs) demonstrated the health benefits of omega-3 fatty acids (n-3), whereas recent RCTs were negative. We now address the issue, focusing on the temporal changes having occurred: most patients in recent RCTs are no longer n-3 deficient and the vast majority are now treated with statins. Recent RCTs testing n-3 against arrhythmias suggest that n-3 reduce the risk only in patients not taking a statin. Other recent RCTs in secondary prevention were negative although, in a post-hoc analysis separating statin users and non-users, non-significant protection of n-3 was observed among statin non-users whereas statin users had no effect. Recent RCTs testing statins – after the implementation of the New Clinical Trial Regulation in 2007 – are negative (or flawed) suggesting that the lack of effect of n-3 cannot be attributed to a parallel protection by statins. Finally, statins favor the metabolism of omega-6 fatty acids (n-6), which in turn inhibits n-3; and contrary to n-3, they increase insulin resistance and the risk of diabetes. Thus, n-3 and statins are counteractive at several levels and statins  inhibit n-3.

ie statins undo the proven benefits of omega3 and CoQ10. .

VITAMIN D AND CHD:

 Charles Glueck ea at the same Cincinnati Jewish Hospital. in  Med Hypotheses. 2011 describe HOW Vit D repletion reverses statin intolerance in 91% of statin-intolerant patients. Symptomatic myositis-myalgia in hypercholesterolemic statin-treated patients with concurrent vitamin D deficiency leading to statin intolerance may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle.   Myositis-myalgia is the most common cause of statin intolerance, leading to cessation of statin use, with consequent failure to lower LDL cholesterol to target levels for primary and secondary prevention of cardiovascular disease (CVD). Despite published and new empirical evidence, the medical establishment has refused to accept it, requiring placebo-controlled, double-blind studies, none having been reported to date.

Glueck’s promotion of vitamin D as antidote or alternative to statin is borne out by at least 5 papers on Pubmed since 2003 (Kajinami), Yavuz 2009 ea ) –  some of which show that vit D level may rise significantly on statin.
       Now a  major review from Universities of Newcastle UK and Harvard by Kunadian, Manson ea   Am Heart J. 2014 of  Vitamin D deficiency and coronary artery disease: concludes: Coronary artery disease being the leading cause of death in developed countries, older patients are at particularly high risk of poor outcomes following acute coronary syndrome,  and impaired nutrition, including low vitamin D levels, may play a role.  Longitudinal studies have demonstrated increased cardiovascular mortality and morbidity associated with vitamin D deficiency. Low vitamin D levels have been linked to inflammation, higher coronary artery calcium scores, impaired endothelial function and increased vascular stiffness. Most available trials have tested only low doses of supplementation in relatively low-risk populations.


Specific Critiques of the Jupiter study and Contrasting results from other studies: :
 Wiki quotes Dr. Michel de Lorgeril, et al  In 2010,  published “a critical reappraisal” of the JUPITER Trial in the Archives of Internal Medicine,  what they saw as flaws in the trial, pointing out that the cardiovascular mortality rate and the case-fatality rate for myocardial infarction were much lower than they expected; they also questioned whether the study had been biased and perhaps manipulated because it was sponsored by a pharmaceutical company with a strong commercial interest in the outcome. They concluded that, “The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.  In addition, some prior and some subsequent studies have contrasted with the JUPITER trial results.       Five  other major university papers in prestige journals  also criticized the Jupiter study in 2011/12: Samson ea Florida State, Serebruany Johns Hoplins; Ridker Harvard, and  Morrissey ea Cedars-Mt Sinai;  while Lopez and Wright from Spain and Canada published an exhaustive debunking of the Jupiter claims of significantly reduced mortality.
            as we have long questioned about mass use of statins, Jay Cohen MD 2014 Aug 4th asks in  the MedicationSense E-Newsletter again: what is The Truth About Crestor: Is Crestor Dangerous And, if so, Why?  Crestor is the newest statin and the strongest statin yet. Statins are highly touted drugs for reducing cholesterol. Studies clearly show that statins improve cholesterol numbers (by lowering LDL and raising HDL) and may reduce C-reactive protein. Statins impede atherosclerosis, reduce heart attacks and strokes, and cardiac death. Thus, the statins Lipitor and Zocor are not only the #1 and #2 top-selling drugs in America, but also household names.  Other statins include Pravachol, Mevacor, and Lescol–and now ultra-potent Crestor. Until 2001, there was another statin: Baycol. It was then the newest statin and a potent statin–until it was withdrawn because of dozens of deaths. Is Crestor another Lipitor or another Baycol? Although Crestor has been on the market only a year, it has already been linked to numerous cases of severe muscle breakdown, kidney toxicity, and deaths. Public Citizen recently petitioned the FDA to ban Crestor...
 

       Conclusion: these references reviewed confirm that  is no justification for the myth of routine use of statins for primary prevention in the average population, especially in view of their risks, especially  increase in diabetes, and the availability of safe and far more globally healthgiving natural antiaging antioxidant energizing  insulin-sensitizing supplements that do a far better job of reversing both CVD and all other major diseases. .

update  16 June 2014 as this column has argued since 2008 (and this author for 40 years in refusing to take them for lack of proof)-  given their numerous serious and nuisance harms-  there never has been good enough evidence to justify synthetic designer cholesterol-busters for primary prevention with mild-to-moderate cholesterolemia ie without the presence of cardiovascular disease;

in contrast to   harmless multipurpose (antiatheroma antidiabetic antithrombotic antihypertensive anticancer all-disease prevention) micronutrient supplements like fish oil, coconut oil, DMSO, metformin,  vitamins esp C D & K2, minerals esp magnesium, chromium, zinc, iodine; , human nonoral HRT, CoQ10, arginine, carnitine, carnosine ; numerous mixed medicinal herbs; etc.

In the Statin-use debate creates furor at BMJ    CMAJ  on June 16, 2014,   Carolyn Brown argues  “Statins are beneficial for people with proven coronary artery disease, but a recent BMJ article questioned their use as a prophylactic measure.            “Are statins going to have a big impact on coronary artery disease or are they going to be one of the big mistakes that the medical profession has made?” That’s the question asked by Dr. James Wright, a Canadian who co-authored an analysis of the evidence on statins that appeared in the British Medical Journal (BMJ) in October 2013. 

      ” It seems like a straightforward question, but that article has led to a furor in the United Kingdom, with a well-known researcher calling for its retraction and the BMJ editor-in-chief Fiona Godlee defending the journal’s publishing process on radio and television. At issue is the clinical uncertainty about the preventive use of statins. “We’re fairly certain that benefits outweigh the harms in people with proven coronary artery disease (CAD). That’s based on a highly statistically significant but modest reduction in total mortality,” says Wright, who is managing director and chair of the Therapeutics Initiative (TI) at the University of British Columbia. But he says most prescriptions for statins are aimed at preventing CAD.

               “The evidence for this is not as rigorous and serious adverse effects have been documented. The UK’s National Institute for Health and Care Excellence (NICE) recently proposed extending preventive use of statins from patients who have a 20% chance of developing CAD in the next 10 years (its current guideline) to those with a 10% risk. This has led to a debate over the accuracy of risk calculators, unnecessary prescribing in seniors (since age is a major risk factor) and adverse effects. Canada’s guidelines recommend statin therapy in patients with risk below 20% only if their levels of cholesterol or other indicators exceed certain thresholds. Wright believes the statin issue has become heated because “so many people are taking them. They have been in the news so much and there [is] so much money being spent on them.” “Publication of our article has reignited the debate,” says Dr. Kamran Abbasi, international editor of the BMJ, who spoke on behalf of Godlee. “There are people who disagree vehemently on this issue. They can’t reach any sort of consensus on it at the moment.” The BMJ article re-analyzed data from the Cholesterol Treatment Trialists (CTT) Collaboration meta-analysis and cited adverse effects rates from various studies.

             ” Sir Rory Collins, a researcher at Oxford University and head of the CTT group, corresponded directly and met with Godlee in December 2013 about the article, calling for a retraction. He has also stated his view in media interviews. As a result of Collins’ complaint, the article was corrected, as the authors agreed that they had erred in reporting rates of side effects from the observational study. Wright says, “The issue around side effects is just that there is some harm.” The analysis had cited a rate of statin-related adverse effects of 18%; in fact, the original study found 17.4% of patients had a “statin-related event” but only approximately 9% discontinued statin therapy as a result. The correction affirmed that the CTT study failed to show that statins reduced the overall mortality risk in patients with a less than 20% risk of CAD over 10 years. Godlee also published an editorial explaining the journal’s decisions on how to handle the controversy and appointed an independent panel to rule on whether a retraction is warranted. Collins says he has submitted detailed material to this panel and maintains that there remain “extensive problems” with the analysis paper, beyond what the correction addressed. Charlotte Haug, vice-chair of the Committee on Publication Ethics (COPE).

update 2010   A new review, this time from a top team in France, further demolishes the deceptive  Jupiter trial promoting rosuvastatin Crestor, confirming that it was fatally flawed:

Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER Crestor controversy: a critical reappraisal.

Michael de Lorgeril ea conclude: ” The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.”

This concurs with the fraud of modern medicine increasingly pursued by combined Drug Industry and Government Regulator conspiracy, including www.lef.org/…/Media-Attempts-to-Misrepresent-Scientific-Findings.htm

and

Justice Dept declares war on doctors.

and why use a drug that can cause cancer , and tendinopathy, and  thrombocytopenia? Pubmed  shows at least 7 causally linked case reports since 1992 and 2008 , including one  now for rosuvastatin.

and Univ California San Diego alone reports 300 cases of statin-related myopathy.

contrast this with the trial report last week from a hypertension unit in Israel where a simple combination of vits C & E, coQ10 and selenium for 6 months – with no risks- lowered arterial stiffening, hypertension, lipidemia and glucose.

so why use statins except in severe familial lipidemia?

Feb 4th 2010 

 Early last year this column pointed out that the JUPITER trial was another nail in the coffin of primary use of statins.

Now a University California    Davis team concur further   in “Another look at the results of the JUPITER trial…  that many of the participants did not receive care consistent with current standards. Thus, the benefit of statin therapy would have been more difficult to demonstrate if standard therapeutic recommendations had been followed. In conclusion, these considerations cast doubt on the contention that statin therapy should be initiated in apparently healthy individuals on the basisof elevated high-sensitivity C-reactive protein levels.

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UPDATE: LEGISLATING REDUCED ADVERSE FOOD ADDITIVES, MANDATING ADDED MICRONUTRIENTS

  The  Mail and Guardian Health supplement (11 April 2013)  featured the dynamic South African Health Minister   Dr Aron Matsoaledi legislating lower salt -sodium chloride-  in staple processed foods  eg in cereals, butter, potato crisps,     by about half  over the next 6 years.
         This is long overdue since salt-related hypertension and often associated.  obesity are  historically  major killers not just in Afro-Americans  but in any longer-living people and especially stressed poverty-stricken  peoples as in Africa.

The linked bad nutritional -and lifestyle – choices – Salt-Stroke  – smoking- – hypertension- obesity – diabetes – heart – kidney disease – are  quoted by S.A. Stats  2010 from death certifications as rising  to 24%  of deaths after age 50 years, leading even infections at  20%  as the commonest causes  of  seniors’ death in South Africa. Nonnatural causes ie violence account for only 5%, and cancers only about 4%.

           This in a population that ( both by self- choice and by State- and supply-chain corporates)   heavily self-poisons with industry-promoted salt,  concentrated   fructose-   sucrose, ethanol , unsafe sex, and smoking –  the deadly self-abuse quintet  causing the great majority of premature deaths and  disability – diabesity- brain-heart-vascular-renal-cancer -arthritis, infections, Alzheimers(type 3 diabetes) and violence. – ie the team of  high-profit horsemen (alcohol, smoking, sugar, fructose, salt and other addictive drugs; television, sex, guns, knives, fast motoring, and ruthless medical practices)  of the global marketting corporates .
          But not a word was  said in those two salty  pages  about simultaneously legislating for  processed consumables  the other greatly needed adjustments:
REMOVING from the environment, from  consumables (water and processed food , toothpaste, sweetened  drinks and sweeteners, baby milk formulae, hygiene products, vaccines, etc,)  or at least steadily reducing, other notorious and unnecessary  toxic  marketed hazards- aluminium, aspartame + sucralose, mercury, fluoride, bromine, refined sugars, cooked fats, and pesticides, hormones, antibiotics, and estrogenics eg soya ( unless fermented) used in food, medicine,  and vaccines ; and REPLACING in processed foods commonly and increasingly deficient  micronutrients in the regional diet especially for the poor masses and children – eg minerals (magnesium, calmag phosphate, zinc, iodine, lithium,  selenium,  sulphur, boron); vitamins (especially A, B, C, D3, K2, coQ10; and other crucial  essential  antiinflammatory  antioxidant  anti-obesity insulin sensitizers eg virgin coldpressed  coconut oil and uncooked marine omega3.
      From scientific studies there is little doubt that hypertension is proportionate to sodium chloride overload, as it  is especially to deficiency of magnesium, potassium, iodine, water, and vits  B, C, D3 and K2.  But scientific evidence is still unclear as to whether it is just the excess  essential halogen mineral CHLORINE.  in NaCl that  is the dietary cause of  hypertension,  not SODIUM in NaCl- but not in other essential forms eg with carbonate.
HALOGENS  in nature are the four major  elements – fluorine, chlorine, bromine and iodine from the lightest, ie lowest atomic number,  upwards.  Fluorine as  the lightest  is one of the most reactive ie corrosive of all materials. Halogens with metals eg sodium form sea- salts. As their weight/atomic number rises, they become less reactive,   Apart from  bromine they are disinfectants.
 IODINE is certainly  the heaviest and thus least reactive halogen iodine is the  essential  mineral that in adequate intake is  major anti infection- (among the strongest antimicrobials we have)-  anticancer, healer, thyroid metabolism and thus heart regulator, and major chelator – detoxifier- against the lighter  halogens – the toxic bromine and fluorine, and excess chlorine.
 The food and drug industry needs cudgeling to stop polluting water, medicines and food with unhealthy fluorine, chlorine and bromine.
FLUORINE is still misguidedly used , promoted in drinking water , toothpaste and antibiotics ; while  for obscure reasons BROMINE.  has replaced iodine in eg bread. FLUOROSIS and BROMaiSM  are notorious poisonings – and unlike iodine and chlorine,  the fluorine and bromine have no human essential  biological benefit as even trace elements. Fluorine – like aluminium, bromine, cadmium, mercury, iron, – may be invaluable in industry, but Fluorine is not essential for mammals or humans. Its use in dentistry has with mercury amalgams long been scientifically debunked as harmful and unnecessary, and is being phased out by preventative dentists everywhere. .
         Tricyclics and other pre-1980s antidepressants had several side effects due to their nonselective interference with neurotransmitters other than the serotonin target; the fluorinated fluoxetine was selective and one of the first avoiding this problem. but the serotonin deficiency hypothesis has never been proven to be a major factor in depression.  Many current antidepressants receive this same treatment, including the selective serotonin reuptake inhibitors citalopram But antidepressants have major adverse effects, are rarely as good as talk therapy, and often do  worse than natural mood-improving nutrients eg vitamins and fish oil.
Quinolones are artificial antibiotics often fluorinated to enhance their effects,eg ciprofloxacin. But these antibiotics are notorious for terrible advese effects including crippling weakening  – rupture of tendons, and are never essential. 
 BROMINE. Africa.   is still listed as a food supplier to the baking industry in South Africa!    But Wiki writes: bromine has no proven essential function or need in humans. an unwanted side effect is ozone depletion. As a result, many organobromide compounds that were formerly in common use—such as the pesticide, methyl bromide—have been abandoned. It reacts vigorously with metals, especially in the presence of water, to give bromide salts. It bonds easily with many elements and has a strong bleaching action. Like chlorine, bromine was used as a wartime poison gas, and disinfectant / pesticide- ie a poison! so bromines were removed from medical/vet use in the 1970s. Long-term use of potassium bromide (or any bromide salt) can lead to bromism. Yet it is used in: production of brominated vegetable oil, which is used as an emulsifier in many citrus-flavored soft drinks (for example, Mountain Dew). After the introduction in the 1940s the compound was extensively used until the UK and the US limited its use in the mid 1970s and alternative emulsifiers were developed. But .Soft drinks containing brominated vegetable oil are still sold in the US (2013).  Bromine, like chlorine, is used in maintenance of swimming pools, Water purification compounds, disinfectantsinsecticides, and photographic processes. .
        Dr Joe Mercola wrote in the Huffington Post 2010: “Bromines are common endocrine disruptors. What makes it so dangerous is that it competes for the same receptors that are used to capture iodine. If you are exposed to a lot of bromine, your body will not hold on to the iodine that it needs. And iodine affects every tissue in your body — not just your thyroid.  You are already exposed to far too much chlorine and bromine. Bromine can be found in a number of places in your everyday world, including: plastics, Bakery goods and some flours often contain a “dough conditioner” called potassium bromate; •Soft drinks (including Mountain Dew, Gatorade, Sun Drop, Squirt, Fresca and other citrus-flavored sodas), in the form of brominated vegetable oils (BVOs); Medications such as Atrovent Inhaler, Atrovent Nasal Spray, Pro-Banthine (for ulcers), and anesthesia agents; Fire retardants (common one is polybromo diphenyl ethers or PBDEs) used in fabrics, carpets, upholstery, and mattresses       According to van Leeuwen, who has extensively studied the effects of sodium bromide on thyroid function:   “Although the bromide ion is widely distributed in nature, the main route of exposure in humans stems from bromide residues in food commodities as a result of the abundant use of bromide-containing pesticides, like methylbromide and ethylene dibromide, for soil fumigation in intensive horticulture and for postharvest treatment.”      One clinical consequence of overexposure to bromine is suppression of your thyroid, leading to hypothyroidism, .
         
   Another is bromide toxicity: .Bromine — The Bully of the Halide Group:  When you ingest or absorb bromine, it displaces iodine, and this iodine deficiency leads to an increased risk for cancer of the breast, thyroid gland, ovary and prostate — cancers that we see at alarmingly high rates today. This phenomenon is significant enough to have been given its own name — the Bromide Dominance Theory.   Aside from its effects on your endocrine glands, bromine is toxic in and of itself. Bromide builds up in your central nervous system and results in many problems. It is a central nervous system depressant and can trigger a number of psychological symptoms such as acute paranoia and other psychotic symptoms.  In fact, in an audio interview, physician Jorge Flechas reported that, between 1920 and 1960, at least 20 percent of all hospital admissions for “acute paranoid schizophrenia” were a result of ingesting bromine-containing products. In addition to psychiatric problems, bromine toxicity  eg from the old BromoSelzer can manifest as the following: Skin rashes and severe acne; Loss of appetite and abdominal pain; Fatigue; Metallic taste; Cardiac arrhythmias. . These effervescent granules, developed by the Emerson Drug Company of Baltimore, were used to treat heartburn, upset stomach, indigestion, headaches and hangovers. Bromides were withdrawn from the American market in 1975 due to their toxicity.  Bromo-Selzer still  on the market  no longer contains bromide.                                                                                                                   
       
          Bromines in Your Bread Box: Potassium Bromate:  The ban on bromines have not prevented them from sneaking into your foods and personal care products.  You probably are not aware of this, but nearly every time you eat bread in a restaurant or consume a hamburger or hotdog bun you are consuming bromide, as it is commonly used in flours.  The use of potassium bromate as an additive to commercial breads and baked goods has been a huge contributor to bromide overload in Western cultures.  Bromated flour is “enriched” with potassium bromate. Commercial baking companies claim it makes the dough more elastic and better able to stand up to bread hooks. However , successful companies manage to use only unbromated flour without any of these so-called “structural problems.”  Potassium bromate is also found in some toothpastes and mouthwashes, where it’s added as an antiseptic and astringent. It has been found to cause bleeding and inflammation of gums in people using these products. Mountain Dew, one of the worst beverages you can drink, uses brominated vegetable oil as an emulsifier. Not only that, it contains high fructose corn syrup, sodium benzoate, more than 55 mg of caffeine per 12 ounce can, and Yellow Dye #5 (tartrazine, which has been banned in Norway, Austria and Germany.)  A weapon of mass destruction — in a can.   .Even drinking water can be a source of bromide. When drinking water containing bromide is exposed to ozone, bromate ions are formed, which are powerful oxidans.
   Sodium bromate can also be found in personal care products such as permanent waves, hair dyes, and textile dyes. Benzalkonium is used as a preservative in some cosmetics.    Finally, bromine and chlorine were the most common toxic elements reportedly found in automobiles, according to  David Brownstein, MD (March 2007). They showed up in the seats, armrests, door trim, shift knobs and other areas of the car.  The United States is quite behind in putting an end to the egregious practice of allowing bromine chemicals in your foods. In 1990, the United Kingdom banned bromate in bread. In 1994, Canada did the same. Brazil recently outlawed bromide in flour products.    Iodine Levels and Cancer Risk:  Iodine levels have significantly dropped due to bromine exposure; declining consumption of iodized salt, eggs, fish, and sea vegetables; and soil depletion. In the U.S. population, there was a 50 percent reduction in urinary iodine excretion between 1970 and 1990. What’s this doing to our country’s health?   The Japanese consume 89 times more iodine than Americans due to their daily consumption of sea vegetables, and they have reduced rates of many chronic diseases, including the lowest rates of cancer in the world.
            The RDA for iodine in the U.S. is a meager  0.15 mg/day, which pales in comparison with the average daily intake of 13.8 mg/day for the Japanese.  There is a large body of evidence suggesting that low cancer rates in Japan are a result of their substantially higher iodine levels. Iodine has documented antioxidant and anti-proliferative properties.   A strong case can be made that your iodine RDA should be closer to what the Japanese consume daily, if breast cancer rates are any indication. Low iodine can lead to fibrocystic breast disease in women (density, lumps and bumps), hyperplasia, and atypical mammary tissue. Such fibrocystic changes in breast tissue have been shown to reverse in the presence of iodine supplementation after 3-4 months.   If youwant to be tested  for iodine deficiency, the urine iodine challenge test is the best way to assess your iodine level.
              Bromine and Your Thyroid   Adding to the negative health effects of bromine, the damage to your thyroid health deserves special mention. bromine exposure depletes your body’s iodine by competing with iodine receptors. Iodine is crucial for thyroid function. Without iodine, your thyroid gland would be completely unable to produce thyroid hormone. Even the names of the different forms of thyroid hormone reflect the number of iodine molecules attached — T4 has four attached iodine molecules, and T3 (the most biologically active form of the hormone) has three–showing what an important part iodine plays in thyroid biochemistry.   Hypothyroidism is far more prevalent than once thought in the U.S. The latest estimates are that 13 million Americans have hypothyroidism, but the actual numbers are probably higher. Some experts claim that 10 to 40 %  of Americans have suboptimal thyroid function.   Many of these folks may actually have nothing wrong with their thyroid gland at all — they may just be suffering from iodine deficiency.
        Seven Tips for Avoiding Bromine and Optimizing Iodine   Trying to avoid bromine is like trying to avoid air pollution — all you can do is minimize your exposure. That said, here are a few things you can do to minimize your risk:
       1. Eat organic as often as possible. Wash all produce thoroughly. This will minimize your pesticide exposure. 2. Avoid eating or drinking from (or storing food and water in) plastic containers. Use glass and safe ceramic vessels.
        3. Look for organic whole-grain breads and flour. Grind you own grain, if possible. Look for the “no bromine” or “bromine-free” label on commercial baked goods. 4. Avoid sodas. Drink natural, filtered water instead.          .
         5. If you own a hot tub, look into an ozone purification system. Such systems make it possible to keep the water clean with minimal chemical treatments. 6. Look for personal care products that are as chemical-free as possible. Remember — anything going on you, goes in you,                                                                                          
        . 7. When in a car or a building, open windows as often as possible, preferably on opposing sides of the space for cross ventilation. Utilize fans to circulate the air. Chemical pollutants are much higher inside buildings (and cars) than outside.
           Avoid Unfermented Soy Another major contributor to thyroid dysfunction that I did not discuss above is unfermented soy. Soy isoflavones – estrogenics- can wreak havoc on your thyroid. Kaayla Daniel’s groundbreaking book, The Whole Soy Story: The Dark Side of America’s Favorite Health Food is a powerful exposé that reveals the truth about the soy myths that have infiltrated our culture. So if you want to keep your thyroid healthy, you’ll definitely want to avoid bromines, and unfermented soy products of all kinds, including soy milk.”
               These changes  – removing fluoride, bromine, aluminum, mercury, lead, unfermented soy-  from consumables, and cutting added iron and chlorine – may possibly add fractional cost to production?  but will hugely improve educability and health, productivity and employability, and reduce premature disability and death  far more than just  hypertension- vascular risks;  and greatly reduce acute and chronic illness and infections, hospitalization and need for risky modern  chronic prescription medication..  And since iodine deficiency is widely endemic ,  increasing population iodine intake up to 12mg a day  like Japanese get,  – not 0.15 mg/ d – will  hugely reduce premature aging,  common goiter and hypothyroidism, infections, vascular disease  and cancer
But of course Corporates, Governments and the Disease , Drug and Hospital Industries  dont want disease ,  jobs and profits to be decimated by natural supplements avoiding most common diseases- the Fraud of Modern Medicine since Only Disease Pays.

THE 2014 VIRUS SEASON DAWNS: URGENT UPDATE: AVOIDING THE SEMMELWEIS REFLEX; natural antibiotics- Vitamins C & D3 – avoiding vitamin denialism.

update 22/3/2014the March equinox:Vaccines and antivirals for preventing   and  treating  influenza in healthy adults have  very modest benefit.  as  the seasonal flu epidemic wanes in the northern hemisphere and approaches in the south, Authorities eg the US CDC  continue relentlessly to promote mass flu vaccination. The South African Authority NICD recommends vaccination for anyone at high risk ie the elderly, infants or the sick, and carers. It also recommends antivirals eg Tamiflu for infection- but the BMJ recently publishes  Study claiming Tamiflu saved lives was based on “flawed” analysis. a 2012 BMJ  report by the samemedical journalist   Zosia Kmietowicz   notes Cochrane group rejects Roche’s offer of “advisory board” to discuss analysis of oseltamivir data. The 2011 Cochrane question remains unresolved:  Does Oseltamivir Tamiflu  Really Reduce Complications of Influenza?

But current Cochrane review of controlled trial publications to 2013 confirms  Vaccination of pregnant women is recommended internationally, while healthy adults are targeted in North America. The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 (95% CI 64 to 80). . Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 (95% CI 29 to 115). Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms CONCLUSIONS: Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women.  This review includes 90 studies, 24 of which (26.7%) were funded totally or partially by industry. Out of the 48 RCTs, 17 were industry-funded (35.4%).

A current German review  Methodological quality of systematic reviews on influenza vaccination.   Fourty-six systematic reviews fulfilled the inclusion criteria. Average methodological quality was high  but variability was large (AMSTAR range: 0-11). Quality did not differ significantly according to vaccination target group. Cochrane reviews had higher methodological quality than non-Cochrane reviews (p=0.001).  this was due to better study selection and data extraction, inclusion of unpublished studies, and better reporting of study characteristics (all p<0.05).

20/1/2014   Protecting us from the new year northern hemisphere viruses:   natural antibiotics- Vitamins C & D: avoiding vitamin denialism as cause of more deaths.

Abstract: The Semmelweis  Reflex is about rejecting, deriding important new scientific discoveries or any serious sincere statement/action.    I didnt  fully appreciate the importance of that  age-old human  (mostly male) evil – mocking, martyrdom  and murder by denialism-  until I started this review of the current flu season threat and the role of supplements, and researched  pioneer medical martyrs Drs Ignaz Semmelweis, Jack Drummond  and Linus Pauling  as  paradigms of the scourge of modern vested-interest denialism and falsehoods, in medicine as much as politics, religion etc..

In fact,  just as it is negligence to deny (as Semmelweis’s persecutors did) gloving up or  properly washing  hands between examining patients , or ensure that every adult has bloodpressure checked occasionally, it is clearly bad practice  not to ensure that everyone – especially the young and old,  takes a multinutrient plus extra vigorous dose vitamins D3 and C, plus some protective herbs- garlic, cinnamon, ginger, origanum; and fish oil and/or coconut oil if not both; and drastically cut down sweetness intake- especially fructose, sucrose  and aspartame that now pervade all mass- produced food and drinks..

update 21 January 2014 : URGENT: THE 2014 FLU EPIDEMIC:     “High H1N1 prevalence and mortality rates a concern:    Type A (H1N1) influenza, the  commonest flu virus in Canada this year, has a higher  than anticipated mortality rate  causing some to wonder if it’s virulence has increased.             The worrisome factor  “is the reported mortality rate,” says  McGill University. As of Jan. 13, there were twenty confirmed deaths in Canada   attributed to H1N1. “There are more deaths than what we expect for the regular H1N1 influenza, The strain this year could be more virulent . 96% of this year’s lab -confirmed influenza is H1N1. The virus is unusual in that it appears to affect younger people more than other strains of seasonal influenza. People  20 to 65 are being hit harder than usual, comprising 52% of flu cases.                                  However, if you look at Europe,  it’s still H3N2. Its an example of how   you never know what the flu is going to do.”           Alberta confirmed a death  on Jan. 8, due to the virus H5N1, an avian virus. The  deceased woman had recently returned from China. The mortality rate is higher with H5N1 than H1N1, “but fortunately, it’s not an easy virus to transmit”. So far, it seems that there are no cases of H5N1 transmission from human-to-human. It seems   like the cases of H5N1 are few and far between and related to contact with birds in  China.     Patrick Janukavicius, Montréal, Quebec.  In the same period, at least 20 children have reportedly died of the same strain in USA.

update 12 Jan 2014  THE ANTIFLU VACCINE DECEPTION: this review by Doc Joe Mercola     stresses the disease-mongering myths,  futility and risks in real life of flu vaccination  and antiflu drugs eg Tamiflu ; and the overwhelming importance of natural immune boosters like Vit D3 & C, zinc, selenium,  herbs, and hygienic prevention.

1 Jan 2014  CURRENT INFLUENZA STATUSThe  22 December  solstice is the sun at its southern nadir seen from planet Earth, the onset respectively of real winter in the Northern hemisphere, and real summer in South Africa. Last year   the Gregorian New Year heralded a fierce flu season in the northern hemisphere, and as usual feathered- and jet-propelled  air travel brought the corresponding surge at the bottom of Africa.

And ominously, the Plagues & Pandemics   (Howard Phillips 2012) of temperate climates  that did so much historically  to mould global demography not least  the past 360 years in South Africa ( –STDS- pox, bubonic, polio, cholera, influenza, and now  tuberculosis, Mad Cow disease, and   HIV-AIDS). and especially antibiotic-resistant germs – are all on the increase despite (or because of) the increasingly futile $trillion armamentarium of 20th century designer vaccines and other antimicrobials.. 

Pneumonia is a welcome   friend of the old, often rapidly relieving prolonged degenerative incapacity;  such ending mostly by virus respiratory infection  the gateway for the  final bacterial infection.  

Unlike the  selflimited coronavirus common cold, breath-and hand-borne type A  influenza, although usually mild in the well,  is the commonest trigger in the frail.  Many  of us in our (grand)parents’ time lost relatives in the 1918/1919 “Spanish”  H1N1  flu pandemic. But that was a unique  global catastrophe because it killed mostly  armies  of healthy men, and then  young working adults, apparently from cytokine storm, with 30 % of the workforce out for up to3 weeks if not  20% mortality.  This is harrowingly described in the recently published   Letters ( to his Mother) of Dr Arthur Conan Doyle, who lost – apart from his first wife to TB- more young relatives to the  flu  than to warfare.

The recent spring  months here – apart from seasonal allergies -have seen declining viral respiratory illness in Cape Town, with the  upper respiratory accent often shifted down to more gastritis-enteritis .

But New Year 2014   UK and northern North America forecast  and are having a  wet if not white New Year.  ‘Flu rates are reported already high  and rising  in USA and Canadamostly influenza A H1N1(swine-avian flu-the main 1918/19 killer); including already 6 deaths in USA and 3 in Canada.

but not in Europe, where  the influenza (A > B) prevalence is still low and slightly more H3N2 than H1N1;  in UK there has rather been been increase in RSV respiratory syncytial virus bronchitis in infants. .  .

In fact by 28 December the exploding H1N1 deathtoll had hit 13 in Texas alone; especially in youths; with increasing Tamiflu resistance reported eg in Missisippi.. On 24 Dec the USA CDC mailed an emergency Advisory Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season: From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A pH1N1 pdm09 virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported.  While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur. 

Our  regional  South African Communicable Diseases Institute says H1N1 was documented here from April to September. But of 2566 pts with severe respiratory illness for January to October 2013 enrolled and tested at the five sentinel sites, only 6% were positive for influenza – mostly virus -H1N1. A pneumonia case in Cape Town was found to be due to Leigionnaire’s.

Now from China 147 human cases of avian influenza H7N9 have been confirmed including 48 deaths. – especially from poultry contact. No vaccine is currently available for avian influenza (H7N9) virus.

SAPA–AFP, 10 December 2013:  Resistant flu virus keeps contagiousness.  A mutant form of the H7N9 flu virus that is resistant to frontline drugs is just as contagious as its non-resistant counterpart, according to a study, published inthe journal Nature Communications.  The virus has claimed dozens of  lives since its outbreak in February. H7N9 is believed to have spread to humans from poultry, where it circulates naturally. The World Health Organisation (WHO) said on its website that “so far”, no evidence has emerged of  “sustained” transmission of H7N9 among people.

And H7N1 and H7N7 has broken out in ostriches in South Africa,

So never mind the  common cold  coronaviruses and many other prevalent infections, increased caution is due against all common diseases at this season- both the USA H1N1 swine flu circulating the past few years,  and now the Chinese H7N9 flu. . And the MERS-Co Virus Middle-East SARS-type outbreak has not gone away… 9 new cases reported the past week or two  from the KSA alone .the-deadly-middle-east-coronavirus-outbreak/

A  current NEJM  has a new report of a trial of quadrivalent Vaccine for Prevention of Mild and Moderate-to-Severe Influenza in Children by vaccine manufacturers GSK. The vaccine reduced severity by perhaps 70%- but at a cost of 1.5% serious adverse events, 50% more than the control group (hepatitis A vaccine only).                                                                                    The question remains- why risk  flu vaccine’s ~1.5% serious adverse events when a single high dose of vitamin D3  300 000iu  even just annually, and regular vitamin C with a multivite  including zinc and selenium (at trivial cost ) largely cover one  against a multitude of infections including AIDS and TB, and all degenerative health   problems?

PRECAUTIONS:

Is it coincidence, or divine evolution, that we have had available at low cost  for about 60 year (never mind zinc,  selenium, iron, iodine, vitamins A and vitamin E) two safe natural major antimicrobials in vigorous safe dose   –  vitamins  C and D3?  Medico-Pharma Big Business and governments have been heavily discrediting and ruthlessly suppressing these  for their own profiteering vested interest  even as plagues of HIV, TB,  influenza rage, and Big Business determinedly profits hugely from killer  smoking and alcohol sales despite increasing  marketing restriction?   South Africa- a major producer of alcohol and tobacco-smoke, and fossil-fuel-burning power stations, factories and motorvehicles – continues to lead the world with  the highest road and respiratory death rates  despite zealous attempts to reduce their lethal  use.

Apart from optimal hygiene including  avoiding livestock  and poultry contact, smoking, alcoholism and pollution including  swimming and sick buildings- air-conditioning-           what can we take  to minimize avoidable influenza  ie immune depletion risk? apart from enough  sunshine, exercise, rest, sleep, walking barefoot, not carrying a cellphone,   and good mixed fresh organic diet? The clinical benefit of influenza vaccines is anything but proven, and the adverse risks appreciable.

Big Business and thus governments  and the media  profit from illness, so they keep publishing articles promoting Big Business: new antibiotics, vaccines  and other synthetic drugs that do not prevent or cure but if anything perpetuate chronic degenerative obesity-diabetes-vascular-respiratory,- digestive-arthritic-cancer diseases; – and  GMO-genetically modified preserved  food  and bottled drinks stuffed with slow poisons like refined cornstarch – fructose; salt; sucrose and cereals, soya,  Roundup, antibiotics, preservatives, estrogenics,  aspartame,  and especially boiled and baked omega6 and sugars;  instead of marine omega3 and MCT- medium chain triglyceride virgin coconut oil, and unrefined cereals eg oats, wholewheat bread etc..  

Big Business and it’s cash-cow  Disease Industry decries  the natural healthgiving lowsugar Asian/ Mediterranean  diet-organically pastured and grown livestock meat and dairy products, lightly cooked if not raw (oily)  fish,  fruit and nuts, coloured veggies,  and plenty of  oils in their natural plant form. These were  the norm till food processing became Big Business in our lifetime post WW2, and the developed world was bluffed by Organized Medicine, the Food Barons and Big Pharma  with the masterly fiction of Ancel Keyes, into jettisoning the natural longevity “sea and farm” diet of the east eg Japan, and West eg Mediterranean (fresh produce & cholesterol-rich dairyproducts, meat and fish)  for the Diet Deception (Gary Taubes, Tim Noakes) and Bad Pharma ( James le Fanu, Ben Goldacre) of Ancel Keyes‘  low-fat high-refined cereals, margarine; and  the cholesterol -busting and psychotropes/ painkillers /antidementia/antivascular/ antidiabetic disease Designer Drugs-for-all  myths.

It spends multimillions promoting alcohol,  smoking and ever-newer designer prescription drugs and vaccine, and  disinformation on old well-proven cheap drugs like  reserpine, amilozide, metformin,  natural physiological  human hormone replacement,  natural antioxidants and anti-inflammatories ,  and decrying  ineffective but deliberately lowdose and isolated or imbalanced  vitamins and minerals .

The ATBC vits A+E trial  (isolated highdose vits A and E) was  one such  farce in very high risk smokers in an icy climate. . Others have been the recent Norwegian trial using only up to 1000iu vit D supplement a day,

and the current Annals Int Medicine editorial  review of three new articles condemning multisupplements: , on which Mike Howard publishes a scathing critique

*a commercial multisupplement in the TACT  post-heart attack trial – but the composition of the multisupplement  included only deficiency-disease prevention microdoses of micronutrients including 100iu vitamin D3/d and equally negligible vitamin K-  not pharmacological doses of key vitamins eg vits B, C, D & K2 that are well proven to greatly reduce infections and chronic degenerative diseases ;

* the  Physicians’ Health Study  randomized elderly professional men  to placebo or combinations of vitamin C (500 mg synthetic ascorbic acid), vitamin E (400 IU of synthetic alpha-tocopherol), beta-carotene (50 mg Lurotin), and a multivitamin (Centrum Silver – this included  anti-deficiency disease low dose of all common vits and minerals BUT   only 400iu Vit D3),   .

* The third study- on lowdose (traditional anti-deficiency disease) Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer was simply a literature review of 26 best-quality  published trials of microdoses – not pharmacological safe macrodoses.

ie these  three trials published in this  Annals Internal Medicine issue to please Big Pharma advertisors to discredit supplements shared the usual problem of now well-known futile lowdose supplement doses  at least of vitamins D3 and K, if not also vitamin C in the multigram dose scientifically promoted by the Drs  Stone- Klenner-Pauling followers.

Sir Jack Cecil  Drummond (1891-1952) was one of the world’s pioneer 20th century  biochemists and nutritionists in UK,  from  1916- 1952 discovering or defining  and promoting  under his world-famous biochemist professors Rosenheim, Halliburton and Funk the role especially  of vits A, B, C  and E. Thanks to his and Churchill’s forceful vision and foresight, he oversaw  food supply and diet  and thus keeping Britons healthy through and after WW2. He was  so successful in promoting healthy cheap and unpatentable micronutrients and natural fresh food  (in the face of the mushrooming megaprofit  processed food  and designer drug industry) that it  speculatively led to his and his family’s  1952 assassination by competing interests  in France The Vitamin Murders, Fergusson 2007. .

        MURDER BY DENIALISM: It is incontrovertible   common cause that irrational and often jealous medical denialism costs endless lives:
* Scurvy prevention:  Dr James Lind (who did the first ever recorded clinical trial) showed by 1750 that sailors’ scurvy on long sea voyages  was preventable; but  despite his pioneer discovery, the British navy cost the lives of thousands more seamen from scurvy when the Admirals  neglected for 50years until the Napoleonic Wars to supply the fresh produce-  eg limes – that rapidly cured and prevented the lethal scourge.

This despite the fact that another UK navy surgeon Dr John Woodall had already over 130 years earlier- by 1617 – published in UK  The Surgeon’s Mate stating We have in our owne country here many excellent remedies generally knowne,- Scurvy-grasse, Horse-Reddish roots, Nasturtia Aquatica, Wormwood, Sorrell, and many other good meanes… to the cure of those at home…and Sea-men returned from farre who by the only natural disposition of the fresh aire and amendment of diet, nature herselfe in effect doth the Cure (of scurvy- for which antiscorbutic citrus had been known since antiquity) without other helps. the Lemmons, Limes, Tamarinds, Oranges, and other choice of good helps in the Indies… do farre exceed any that can be carried tither from England.

* Childbed fever prevention:  in 1865  Dr Ignaz Semmelweis (1818 -’65) an AustroHungarian Roman Catholic ob-gyne in Vienna, was locked up, and beaten to death  within weeks, because he showed – to the outrage of his peers- that handwashing with chlorinated lime eradicated the epidmic puerperal fever (three times that in the midwives’ ward)  in  the  doctors’ labour wards; 70years before Thir Reich terrorists took charge, his senior colleagues reacted violently to his progressive promotion of (what was already more advanced British and  French) hygiene and science, and his urging them to wash their hands after examining corpses before examining women in labour..  .  Tragically for Semmelweis and new mothers in the Hapsburg empire then,  Pasteur (b 1822) and Lister (b 1827) ‘s germ antiseptic discoveries  were already being implemented further west, but  had not yet been publicized.

    *metformin after centuries of use as an antidiabetic herb galega officinalis,  and its extraction as an antidiabetic in 1922, came into increasing use globally from the 1950s as the best treatment for type 2 diabetes, but the USA- to protect their own new patent antidiabetic  drugs – ruthlessly suppressed  its use there (like that of the natural salt lithium for manic depression)  for 40years till the mid-1990s.

     *AIDS and ART denialism: until  5 years  ago in South Africa   the  overwhelming-majority “people’s”  government  (with the country’s vast resources),  and its successive  “health”  ministers,   cost the lives of an estimated 300 000  AIDS victims through sufferers  – indigent state dependents-  being denied  antiretroviral ART  drugs, (never mind still till now denied quality education and civil  security,  and thus    adequate basic nutrition, and meaningful housing,  jobs and thus hope.)  Genocidal AIDS denialism about which the still-ruling (since 1994) leadership cadre did nothing until under  intense  international pressure and repeated Constitutional Court orders, combined with political rival factioneering in the ruling party,   they  ousted the denialist president and his denialist Disease Minister in 2008.

DENIALISM TARGETS IN NUTRITION: 

VIGOROUS VITAMIN C ASCORBIC ACID  PHARMACOTHERAPY : Much effort and Big Pharma money  has been  spent to denigrate the irrefutable science-based work   (between their advocacy years shown) of Drs Irvine Stone (1934-1984), Fred Klenner(1948-74) and Linus Pauling (1970-1991) of  antibiotic dose >50 to 1000 mg/kg/d pure vitamin C (not the antiscurvy  10mg/d)  – as a universally needed essential in primates. We primats,  like guineapigs and a few birds and fish species,  are among the few  that do not make their own since we  lost the needed gene and thus enzyme in our evolution..

It took about 150 years after Lind’s publication for the antiscorbutic factor to be named as vitamin C by Dr Jack Drummond, another 10 years for it to be assayed and its structure proven- but despite the pioneering clinical work of Dr Fred Klenner in the 1950s proving the lifesaving benefit of tens of grams a day intravenously, it took another 20 years before Dr Linus Pauling  took up Dr Irvine Stone’s conviction and put highdose vitamin C  on the world Nobel prize map; just on Pubmed,  vitamin C has >51 000 citations  since 1921, and intravenously in 763 entries  since 1946, with  Dr Fred  Klenner reporting  it intravenously  asmajor antibiotic in the Southern Medical journal from 1948..

The 2009 book  Injectable Vitamin C and the Treatment of Viral and Other Diseases collection  of  medical journal papers from the 1930s to 2006 details the exhaustive scientific evidence proving the uniform benefit of even 1gm a day vit C both as an antimicrobial antiinflammatory antioxidant  and immunomodulator against major crippling / lethal diseases from polio to tuberculosis, pneumonia, hepatitis, rabies, encephalitis, neuritis, poisoning, cancer, and pancreatitis;                                                                                   

          and the persistent resistance of the FDA and other multinational Regulators to recognize (so as to protect their domestic patent drug manufacturers- Big Pharma and their politician and civil service lobbyists )- such uniquely safe and effective natural drug therapy.         The final chapters of that 2009 book pose the crucial questions of overwhelming vested interest by the organized medical – hospital –pharmaceutical mega-industry and governments in not eradicating preventable disease, the Big Pharma banning of natural effective remedies-  The Origin of the 42-Year Stonewall of Vitamin C, and Medical Resistance to Innovation,

The  University of Oregon,  the  Riordan-Gonzalez group and more recently Hemila and Chaker‘ and Ullah et al’ s 2012 reviews have  published much  validating what Drs Goodall, Lind, Drummond, Stone, Klenner, Pauling and Cameron started.

VIGOROUS   VITAMIN D3 CHOLECALCIFEROLPHARMACOTHERAPY  costing wholesale ~ <US$0.5/month for ~200 000iu /month  in South Africa)  reduces serious infection by perhaps 90% ie 9fold: . eg 80iu/kg/d – 500iu/d (15000u/month) for an infant, 50 000iu/wk or 200 000iu/mo for an adult; who if obese, may need two  to three times the average dose, to achieve the (?) optimal 25OH vit D level of around 70ng/ml for health, higher for any acute or chronic chronic illness.

The modern prophets of vitamin D3 have been the three pre-WW2 doyens :

Prof Chris E Nordin (MB ChB 1950) working in bone physiology for 60 years now; 84 papers on vitamin D on Pubmed 

Prof Walter Stumpf (1927-2012; MD 1952) the recently deceased  professor at North Carolina University, neuropsychiatrist and radiobiologist  in his 60year medical career with over 500 publications (76 on Vit D on Pubmed) including early discovering that vitamin D targets all systems and diseases; professor-walter-e-stumpf-ahead-of-his-time/ and https://healthspanlife.wordpress.com/tag/stumpf-dr-walter/

paralled by Prof Robert Heaney (MD 1951) at Creighton University, osteoporosis and nutrition authority with 119 vitamin D papers on Pubmed since 1982, over 400 publications to date;

succeeded by Prof Mike Holick (PhD 1971, MD 1976) with 391 publications on vitamin D since 1970 on Pubmed, who has done more than most to show that the maximum daily body production of vitamin D3 with plenty of sunlight is enough to prevent rickets and reduce all disease, but nowhere near the pharmacologically therapeutic 80iu/kg/d needed to maintain a vigorous all-disease protective bloodlevel of 60-100ng/ml.

and Dr John Cannell (MD 1976, registered psychiatrist from 1993, nutritionalist), a  legendary whistleblower .   who successively campaigned against  #cigarette smoking; and  uncovered:   # the cigarette-smoking  (Black Lung) compensationitis fraud of miners’ pneumoconiosis;          #the fictitious inflated “above national average” school results (Lake Woebegone)  that all states were inventing and  reporting (as is still happening – mass government deception- in South Africa) ;  then the  
# recovered memory therapy (RMT) scandal – a form of psychotherapy in which patients recovered memories of abuse that they had no previous memory of. Such therapy resulted in false memory syndrome (FMS) of events that never occurred as well as an epidemic of multiple personality disorder (MPD), a rare disorder historically conceived of as being a hysterical disorder.  Unfortunately, many MPD patients believed the psychiatrist conducting the RMT and went home to falsely accuse their parents and others of horrendous acts that never occurred. Cannell teamed up with two Harvard professors to write a peer reviewed paper on RMT, debunking the witch-hunt;                                                                               then since the 1990s researching and promoting  # vitamin D deficiency as major cause of much psychopathology including autism, and vigorous vitamin D therapy to correct multiple diseases, through the Vitamin D Council. He has (co)authored some 13 papers, and published a book. .

Now a major longterm German Cancer Research screening program has just publishd   the 2002-2013 ESTHER study (Perna ea) of 10 000 citizens followed with serial 25OH vit D  levels; to assess the association of apparently unsupplemented vit D levels with fatal and nonfatal CVD in the same study population.  Follow-up data, including survival status, up to over 9  years. Comparing subjects with 25(OH)D levels below 12ng/ml and above 20ng/ml resulted in the lower vitamin D level cohort showing a higher hazard ratio of 1.27 (95% confidence interval = 1.05-1.54) for total CVD and 1.62 (1.07-2.48) for fatal CVD in a model adjusted for important potential confounders. No significant association for nonfatal CVD was observed. In dose-response analysis, we observed an increased cardiovascular risk at 25(OH)D levels below 30ng/ml. Results for CHD and stroke were comparable to the results obtained for the composite outcome CVD. Our results support evidence that low 25(OH)D levels are associated with moderately increased risk of CVD, BUT  the observed association is much stronger for fatal than for nonfatal events.

But the benefit of sunlight in healing tuberculosis has been used for well over a century; while the Google antibiotic benefit of calciferol on Pubmed goes back at least to 1950.

In a prospective 16 mo trial in press from Australia, vit D3 even just 60 000iu/month (ie 2000iu/day) halved antibiotic use in seniors.  (Tran, Neale  ea 2014) Effect of vitamin D supplementation on antibiotic use: a randomized controlled trial.

Since the toxic dose of vitamin D long term  reportedly may be as high as 600 000iu/day or a blood level well >150ng/l , imagine how much better the antimicrobial benefit of vitamin D3 at 80 to 100iu/kg/day or pro rata – even higher eg 10 000+iu/day for obese people who sequester more vit D in fat. .

Dr Robert F  Cathcart wrote 30 to 20 years ago in  Med Hypotheses. 1981 Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy   The amount of oral ascorbic acid tolerated by a patient without producing diarrhea increase somewhat proportionately to the stress or toxicity of his disease. Bowel tolerance doses of ascorbic acid ameliorate the acute symptoms of many diseases. Lesser doses often have little effect on acute symptoms but assist the body in handling the stress of disease and may reduce the morbidity of the disease. However, if doses of ascorbate are not provided to satisfy this potential draw on the nutrient, first local tissues involved in the disease, then the blood, and then the body in general becomes deplete of ascorbate (Anascorbinemia and Acute Induced Scurvy). The patient is thereby put at risk for complications of metabolic processes known to be dependent upon ascorbate.                     1984 Vitamin C in the treatment of acquired immune deficiency syndrome (AIDS). evidence is that massive doses of ascorbate (50-200 grams per 24 hours) suppress the symptoms of the disease and can markedly reduce secondary infections. In combination with usual treatments for the secondary infections, large doses of ascorbate will often produce a clinical remission which shows every evidence of being prolonged if treatment is continued. .. despite continuing laboratory evidence of helper T-cell suppression. There may be a complete or partial destruction of the helper T-cells during an initial infection that does not necessitate a continuing toxicity from some source to maintain a permanent or prolonged helper T-cell suppression. However, it is possible ascorbate may prevent that destruction if used adequately during that prodrome period. Emphasis is put on the recognition and treatment of the frequent intestinal parasites. Food and chemical sensitivities occur frequently in the AID syndrome and may aggravate symptoms considered to be part of the AID syndrome. A topical C-paste has been found very effective in the treatment of herpes simplex and, to a lesser extent, in the treatment of some Kaposi’s lesions.  Increasingly, clinical research on other methods of treating AIDS is being “contaminated” by patients taking ascorbate.                                                     1991 A unique function for Vitamin C is as reducing substance,  electron donor. When vitamin C donates its two high-energy electrons to scavenge free radicals, much of the resulting dehydroascorbate is re-reduced to vitamin C and therefore used repeatedly. Conventional wisdom is correct in that only small amounts of vitamin C are necessary for this function because of its repeated use. The point missed is that the limiting part in nonenzymatic free radical scavenging is the rate at which extra high-energy electrons are provided through NADH to re-reduce the vitamin C and other free radical scavengers. When ill, free radicals are formed at a rate faster than the high-energy electrons are made available. Doses of vitamin C as large as 1-10 g per 24 h do only limited good. However, when ascorbate is used in massive amounts, such as 30-200+ g per 24 h, these amounts directly provide the electrons necessary to quench the free radicals of almost any inflammation, and reduces NAD(P)H and therefore  provide the high-energy electrons necessary to reduce the molecular oxygen used in the respiratory burst of phagocytes. In these functions, the ascorbate part is mostly wasted but the necessary high-energy electrons are provided in large amounts.

A recent review from Atlanta Kearns ea found 30 papers which aggregate to show that annual vitamin   D3 dose (not D2) of  optimally 300 000 to 500 000iu (wholesale cost ~R5 in South Africa)  for deficient adults is best for avoiding poor patient compliance with minimal risk and major benefit.

THE INFERIORITY OF VITAMIN D2 SUPPLEMENT: It should be noted that the long-used Lennon’s Strong Calciferol datasheet  (1974 updated 2004) does not indicate that this 50 000iu tablet labelled ‘calciferol’  is in fact vitamin D2 (ergocalciferol), not the fourfold more potent cholecalciferol D3 formed by sunlight in the skin. This is disclosed only on the Lennons website.. and in the South African Medicines Formulary.  So ‘Strong Calciferol’ in South Africa (actually  the D2 not D3 form of calciferol) is convenient but seriously deceptive mislabeling-  much weaker than the ideal vitamin D3, and therefore its effect unpredictable compared to D3- in fact Dierkes ea Norway show that  giving D2 may actually lower 25OH vit D level in the blood..   Sadly, despite this being reported to the local manufacturers and authorities, no correction of the clinically serious misperception created by the Strong Calciferol label and insert has been issued  to health practitioners by the Medicines Control Council and the manufacturer Aspen-Lennons. 

A recent 8yr study in Cape Town blacks   Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in South Africa Martineau, Nhamoyebonde ,Wilkinson ea   confirmed that vitamin D deficiency (serum 25(OH)D <20 mg/L) is associated with susceptibility to tuberculosis (TB) in HIV-uninfected people in Cape Town as it is Europe. Vitamin D deficiency was present in 62.7% of 370 participants and was associated (OR ~5.4)  with active TB in both HIV-uninfected  and HIV-infected -(P < 0.001) people. Vitamin D status varied according to season:  25(OH)D concentration was double in summer-January- March compared to winter (23 vs 12ng/l; P < 0.001). Reciprocal seasonal variation in TB notifications was observed:lowest in autumn  and highest in spring October through December (4,2 vs. 5; P < 0.001). Vitamin D deficiency is highly prevalent among black Africans in Cape Town and is associated with susceptibility to active TB both in the presence and absence of HIV infection.

Antimicrobial implications of vitamin D is detailed by Youssef,  Peiris ea (USA  Dermato-Endocrinol  2011)   against all microorganisms – viruses, fungi, bacteria, protozoa  (except perhaps leishmaniasis)  as both profound prevention and therapy; in many cases without commercially invented marketed antimicrobials to which there is growing and deadly  microbial resistance, let alone toxicity.. There is evidence that seasonal vitamin D deficiency  status contributed greatly to the 1918/19 flu-pneumonia pandemic (Grant & Giovannucci 2009).

and finally, a month ago JAMA published from Marianna  Baum,  Richard Marlink ea the universities of Miami, Harvard and Florida  Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic  Antiretroviral-Naive HIV-Infected Adults in Botswana A Randomized Clinical Trial,  that Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive.  2 year supplementation with either daily vitamins BCo,  C and E, selenium alone, or B,C,E with selenium vs placebo: study  conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART between  2005 and July 2009.  Results  participants receiving the combined supplement of vitamins plus selenium vs placebo had half the  risk of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46); and secondary events of combined outcomes for disease progression  or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56); . There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated  unlikely  related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups.Conclusions and Relevance  In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing vitamins BCo,C,E and selenium was safe and significantly reduced the risk of immune decline and morbidity. Micronutrient supplementation may be effective when started in the early stages of HIV disease.

THE PARADOX OF THE GLUCOSE- ASCORBIC ACID- CHOLESTEROL- STEROID CASCADE:              Is it coincidence, or  evolution, that the basic animal fast-energy circulating anabolic substrates are glucose, fatty acids and aminoacids?   from which basic glucose C6H12O6 ( from ingested  fructose C6H12O6 and sucrose C12H22O11, or fats or protein)  the liver manufactures the basic cardinal steroid  cholesterol C27H46O.     Then from cholesterol we metabolize by adding or splitting off carbon molecules  the crucial anabolic and regulating  human hormones-                                                                                                                    1. ouabain C29H44O12  the  adrenal hormone  made also  in the hypothalamus and heart ; adrenal),                                                                                                                                           2.  active calciferol C27H44O the strengthening and reproductive secosteroid;                                                                                                                                   3 the prime sex/ reproductive steroids  pregnenolone C21H32o2,  and thence progesterone C21H30O2,  testosterone C19H28O2, DHEA C19H24O2. and thence estradiol C18H24O2. and                                                       4 the prime adrenal mineralo/glucocorticoid steroids  cortisol C21H30O5, aldosterone C21H28O5.

But we primates and a few other species lost the ability to synthetise on demand in quantities of grams a day the crucial vitamin C ascorbic acid C6H8O6 that is key to all the above.                                                                                            And vested interests in the Disease Industry want us to believe the biological nonsense  heresy  that we must ingest minimal unprocessed foods- cholesterol, fats (especially dairy, marine oil Omega3 and medium-chain triglyceride- coconut oil)   and abundant vitamins C and D3, but eat abundant processed foods-  refined plant Omega6,  refined carbs- fructose,  sucrose, fruit juice,  cooldrinks, cereals, confections- which overload causes insulin resistance and thus lipidemia,  obesity- metabolic syndrome -diabetes, cancer and cardiovascular disease.

The Semmelweis reflexA current Wiki essay sums up the current genocidal problems of deliberate deceptions/denialism in Diet, Vitamins and causality  – for ruthless profit and possibly cynical eugenics: “The Semmelweis  effect is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms.The term originated from the saga of Dr Ignaz Semmelweis, who discovered that childbed fever mortality rates reduced ten-fold when doctors washed their hands with a chlorine solution before examining  patients. His hand-washing suggestions were rejected by his contemporaries, often for non-medical reasons. For instance, some doctors refused to believe that a gentleman’s hands could transmit disease (see Contemporary reaction to Ignaz Semmelweis).   In his book The Game of Life, Timothy Leary provided the following polemical definition of the Semmelweis reflex: “Mob behavior found among primates and larval hominids on undeveloped planets, in which a discovery of important scientific fact is punished”. The expression has found way into philosophy and religious studies as “unmitigated Humean skepticism concerning causality“.[2]”

Idealism, ethics may evolve; but the  problem of  human bigotry, self-interest and subjective ie personal bias do not diminish, they spread.  It is classic that Semmelweis  (1818-1865) the observant innovative  Catholic medical scientist of his time (before microbes and antiseptics   were known) was fatuously condemned  not just by his jealous  competing Vienna colleagues,  but even by his progressive and reformist  Copenhagen  contemporary obgyn Prof Carl Levy (1808-1865)- who outlived him by only 4 months;

ironically at the same time that their Copenhagen contemporary Dr Soren Kierkegaard (1813-1855) was increasingly  isolating himself on the lonely ethical journey  against the convenience lazzez- faire  tide, writing for ethical life and religion against the hypocrisy  of the Church and becoming the father of both reformist theology and psychology. But unlike Semmelweis who was way ahead of the bioscience  and humanity of his time, Kierkegaard stuck to and isolated himself in   promoting the incompatible ie  blind-faith-based   religion – the dilemma of Abraham’s conviction (or delusion)  to sacrifice his son-  and ethical morality;

and closely followed by    Rudolph Steiner (1861-1925) another more  profound European  thinker who bridged  science, spirituality, progressive education, architecture, agriculture, natural medicine, nutrition,    and   social  reform;

contrary to the rationalists of the 19th Century “Age of Enlightenment” and since, like   British historian-philosopher -ethicist  Winwood Reade (1838 – 1875)  who published the enduring secularist’s bible The Martyrdom of Man (1872), of which  Churchill wrote  25 years later  “he was right but wrong to say it” on the book’s critique of the wrongs of war and religion, of mankind’s selfishness, corruption  and destructiveness (by the greedy aggressive acquisitive minority)  against the  weak masses and the environment) that carries on worse in the 21st century than even the 20th century;                                                                                                                                          and    150 years later bioscientist and philosopher Stephen Jay Gould (1941-2002) rationalized sadly   the non-overlapping Magisteria of Science and Faith, objective “provable” science – which in fact is seldom immutably constant as is mathematics-  and purely faith-based  “unprovable” religious belief.

It was only a year ago that Richard Conniff published his column on   Strange Behaviours, The Medical Martyrs. And the medical  hero martyrs in this review-  Semmelweis,  Margaret Sanger, Drummond  and Pauling –  never made it onto his list.

But then nor did  the modern medical  freedom fighters  Steve Biko,  Agostinho Neto,  Che Guevera. Jonas Savimbi, Neil Aggett, and the living spouse of Steve Biko, Dr Mamphele Ramphele….

Women of the Century apart (like Margaret Sanger, Marie Curie, Eleanor Roosevelt, Golda Meir, Indira Gandhi,  Helen Keller, Benazir BhuttoMother Theresa, Aung San Suu Kyi -many of whom have been martyred),                 it is a philosophical debate whether among the men  the medical martyr  Semmelweis (1818-1865) ranks with  his  19thC contemporaries-   Lincoln (1809-1865), Kierkegaard(1813-1855), Pasteur (1822-95), Lister (1827-1912)  ;  and his successors (and 20th C  leading achievers): Koch(1843-1910), Edison(1847-1931), Steiner (1861-1925), Gandhi(1869-1948),  Weizmann(1874-1952), Churchill (1874-1965), Einstein (1875-1955), Jung (1875-1961), FD Roosevelt(1882-1945), JK Galbraith(1908-2006), Martin Luther King (1929-68), Pauling and Mandela   as arguably giant enduring male leaders -innovators-  teachers and achievers  of the past two centuries.

Unlike eg Socrates, Hippocrates  and Jesus of Nazareth, one of the  five greatest polymath medical and ethical sages of all time Rabbi Dr Moses Maimonides (RamBam)  avoided martyrdom by burying himself in practicing selfless medical service for sultan and peasants alike, and jurisprudence   for his GreekoRoman based  Islamic-Sephardic   times and philosophy, like his guru predecessor Avicenna and his contemporary savant Averroes. .

CONCLUSION:   Today it can  be argued that the denial of effective phamacotherapeutic doses of especially  vitamins C and D3, let alone supportive doses of balancing vits (A, B1,3,5,6,9 & 12, E and K2); the often-crucially  deficient minerals (eg magnesium, sulphur, phosphate, iodine, zinc and selenium), and biologicals like human transdermal balanced HRT, coenzyme Q10, alphalipoic acid, milk thistle, cinnamon, fish oil, chondroglucosamine, DMSO, coconut oil,  is a repetition of denialism of the germ theory,  and of optimal physiological human micronutrition as well as macronutrition. .

      – especially when patients are poor and thus malnourished, and plagued by diarrhoea and stress, TB, lipidemic vascular disease and cancer; and when antiretroviral ART- although life-saving- is even more diabetogenic and neurotoxic  than untreated AIDs.

Even transdermal administration is  better than nothing, perhaps  better  (for the frail and noncompliant eg oldies) than oral or injection eg of vitamins D3 & C and progesterone , metformin, (in addition to the usual magnesium chloride, vits A, BCo & E)  may be beneficial whether by patch or cream for both healing, infection, calming,  heart, circulation, infection, arthritis, osteoporosis,   and neuritis, applied under coconut oil,  codliver oil and DMSO as further analgesic, anti-inflammatory,  memory and absorption enhancers.

REFERENCES:     New reviews bear out the major benefits of micronutrient supplements selenium,  zinc, silver, vits A, B, C, D, E;  and DMSO, sutherlandia and aloe  against HIV-AIDs. and co-infection;

Micronutrient supplementation for children with HIV infection. Irlam JH,  Rollins NC ea . Cochrane Database Syst Rev. 2013 Oct 11;10:CD010666.

Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial.Baum MK,  Marlink R ea .JAMA. 2013 Nov 27;310(20):2154-63. .

Preliminary trial of aloe vera gruel on HIV infection.Olatunya OS,  Oyelami OA. ea, J Altern Complement Med. 2012 Sep;18(9):850-3. doi: 10.1089/acm.2010.0735.

In vitro effects of Sutherlandia frutescens water extracts on cell numbers, morphology, cell cycle progression and cell death in a tumorigenic and a non-tumorigenic epithelial breast cell line.Stander A,  Joubert AM. ea, J Ethnopharmacol. 2009 Jul 6;124(1):45-60

Sulfur in human nutrition and applications in medicine.Parcell S.Altern Med Rev. 2002 ;7(1):22-44.

Coconut (Cocos nucifera L.: Arecaceae): in health promotion and disease prevention.DebMandal M, Mandal S.Asian Pac J Trop Med. 2011 Mar;4(3):241-7

below  are some of the  most recent  94 studies  of vitamin D and human infectionin   published just  in 2013:

New insights on the role of vitamin D in the progression of renal damage: Kidney Blood Press Res. 2013;37:667-78. . Lucisano S, Santoro D.ea  Many studies indicate relationship between hypovitaminosis D and survival, vascular calcification, bone mineral metabolism, immune, cardiovascular and endocrine. Vitamin D analogs reduces proteinuria, in particular through suppression of the renin-angiotensin-aldosterone system (RAAS) and exerts anti-inflammatory and immunomodulatory effects. In particular vitamin D deficiency contribute to an inappropriately activated RAAS, as a mechanism for progression of chronic kidney disease (CKD) and/or cardiovascular disease. Human and experimental models of CKD showed that vitamin D may interact with B and T lymphocytes and influence the phenotype and function of the antigen presenting cells and dendritic cells, promoting properties that favor the induction of tolerogenic T regulators rather than T effectory. Interstitial fibrosis may be prevented through vitamin D supplementation. .

Should vitamin D supplementation be a regular part of asthma care? Gordon BR.Otolaryngol Clin North Am. 2014 Feb;47:97-108. .Vitamin D (vitD3) deficiency occurs frequently and has profound effects on health, especially asthma.

Vitamin D in asthma and future perspectives.Huang H,  Zarogoulidis K. ea Drug Des Devel Ther. 2013 Sep 23;7:1003-13.

 vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients?; Türkoğlu M, Aygencel G et al.; Journal of Critical Care 28 (5), 735-40 (Oct 2013)

Association between vitamin D and hepatitis C virus infection: a meta-analysis. Villar LM, Romero-Gomez M. ea World J Gastroenterol. 2013 Sep 21;19(35):5917-24.

Association between prehospital vitamin D status and hospital-acquired bloodstream infections. Quraishi SA, Christopher KB. Ea, Am J Clin Nutr. 2013 Oct;98(4):952-9.

Human parvovirus B19 associated dilated cardiomyopathy. Jain P, Jain A, Khan DN, Kumar M. BMJ Case Rep. 2013 Aug 5;2013.

The role of vitamin D supplementation in the risk of developing pneumonia: three independent case-control studies. Remmelts HH,  van de Garde EM ea  .Thorax. 2013 Nov;68(11):990-6.

Correlation between serum vitamin D level and severity of community acquired pneumonia in young children   Ren J, Sun B, Miao P, Feng X. Zhongguo Dang Dai Er Ke Za Zhi. 2013 Jul;15(7):519-21. Chinese. http://www.ncbi.nlm.nih.gov/pubmed/23866270

Role of vitamins D, E and C in immunity and inflammation. Shaik-Dasthagirisaheb YB, Pandolfi F. J ea Biol Regul [Correlation between serum vitamin D level and severity of community acquired pneumonia in young children].Homeost Agents. 2013 Apr-Jun;27(2):291-5.

Pre-hospital vitamin D concentration, mortality, and bloodstream infection in a hospitalized patient population.Lange N, Christopher KB ea. Am J Med. 2013 Jul;126(7):640.e19-27.

Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic. Pinzone MR, Nunnari G. eA Eur Rev Med Pharmacol Sci. 2013 May;17(9):1218-32.

Vitamin D deficiency and sudden unexpected death in infancy and childhood: a cohort study.Cohen MC, Offiah A, Sprigg A, Al-Adnani M. Pediatr Dev Pathol. 2013 Jul-Aug;16(4):292-300.

Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population.Aregbesola A, Tuomainen TP. ea J Epidemiol Community Health. 2013 ;67:533-6.

Treatment of pulmonary tuberculosis.Nunn A, Phillips PP, Abubakar I.Curr Opin Pulm Med. 2013 ;19(3):273-9.

Role of vitamin D in children with respiratory tract infection.Esposito S, Baggi E, Bianchini S, Marchisio P, Principi N. Int J Immunopathol Pharmacol. 2013 J26(1):1-13.

Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study.Koh GC, Dedicoat M. PLoS One. 2013;8:e57752.

Improving outcomes in patients with psoriasis.Tidman MJ. Practitioner. 2013 ;257:27-30, 3.

vitamin C refs & infection:

Authors’ perspective: What is the optimum intake of vitamin C in humansFrei B, Birlouez-Aragon I, Lykkesfeldt J.  Crit Rev Food Sci Nutr. 2012;52(9):815-29.

Micronutrients at the interface between inflammation and infectionascorbic acid and calciferol. Parts 1 & 2: .Ströhle A, Wolters M, Hahn A. Inflamm Allergy Drug Targets. 2011 ;10:54-74- FULL TEXT IS ON LINE. .

Vitamin C for preventing and treating tetanus Cochrane Database Syst Rev. 2008 Apr 16;(2):

TESTOSTERONE and ESTROGEN IMPLANTS- IMPLANT CONTRACEPTION.

update 4 March 2013:  the bad news for cheats – especially after cyclist Lance Armstrong’s confessions in January  2013, and the St Valentines Day massacre – the   Blade Runner Oscar Pistorius media frenzy  including unfounded accusations of steroid abuse ‘roid rage – is that testosterone is not recommended and prescribed for bodybuilding or performance enhancement, but solely where medically appropriate.

the good new news is that, while worldwide supplies of testosterone periodically run out,  it and estradiol are    now available once more in South Africa as appropriate 70-year old pellet implants for men and women needng HRT .  But the cost including implanting every 4-6 months remains likely much higher than fortnightly selfinjection or daily cream application.

at the beginning of 2013  authorities  were bemoaning the end of attempts to market depot hormone contraception for men.  But given increasing longevity, and falling male and female fertility, and potentially double the duration of fecundity of men compared to women, and the  real hazards of male and female sterilization and continuous female contraception with all current commercial ie patented synthetics,  for the determined couple  implants offer physiological reversible contaception without the risks of commercial patents.  For males implants of testosterone and progesterone, and for the female  triple implants of testosterone progesterone and estradio,  remain an option to be explored.

Jan 2010:  the important  report  from South African authorities on testosterone replacement for men  is wrong on one account:  such replacement with injection need not cost almost R6000pa  for the  ideal 3monthly German Schering AG ultralongacting brand.

as this column has repeatedly pointed out, physiological depot  injection has been available in South Africa for almost 70 years.  Currently it retails at perhaps R350 per gram as depotestosterone,  the equivalent dose to the 3monthly 1gm  injection (ie 160mg/fortnight)  being 160mg 1.6ml  every 2 weeks ie a cost of about R1400 per year.

This is easily and safely self-injected subcutaneously with a tiny (insulin) 25g needle, and gives physiological blood levels to most men – as with all chronic drugs, the dose and interval  simply needs to be titrated to individual metabolism and response, always under periodic medical screening. Eldrely men usually need and tolerate perhaps 20% less than younger men, who may well tolerate 200mg/fortnight.

It is blatantly wrong  to give the shortacting Sustanon monthly- this brand has been banned by authorities- and  unphysiological to give monthly the gold standard   depotestosterone cypionate / enanthate- with a life of about 3 weeks, since it is well known that the irrationally marketed higher dose for less frequent injection  eg 400mg imi monthly will give the adverse peaks and troughs that Dr Hafferjee notes. It’s like condemning  eg spirits or wine when 4% beer provides far less alcohol- but common sense tells us they are equally good (or bad!),  just the dose and interval needs to be proportionate.

Authoritative data on rational dose and interval of old depotestosterone has been freely available since at least 1991, so there is no justification whatsoever for proclaiming Nebido or other costly  forms of testosterone replacement  as the necessary gold standard- this is classic marketing hype.

We have long insisted that in this age of gender equity, men are as entitled as women to appropriate HRT- but the obtuse authorities and their stupid medical advisors refuse to recognize that both genders equally need all appropriate hormone replacement including physiological sex hormones for their vast life-extending multisystem benefits, least of which is sex.

Yet Discovery Health  has recently refused an elderly man testosterone replacement (recommended by his psychiatrist)  on the grounds that it is an aphrodisiac. Such refusal  of long-validated endocrine replacement (by their medical officers) amounts to medical negligence let alone defamation, fraud  and woeful ignorance.

Nebido and depotestosterone cypionate/enanthate are equally, superbly physiological if used rationally eg subcutaneously, to avoid the unnecessary multiple risks of intramuscular injection.  It can be questioned whether any patient who refuses to be taught his own injection warrants such costly replacement- the same natural selection applies to millions of insulin-dependent diabetics. And replacement of testosterone often relieves type 2 diabetics of the need to use costly and risky  insulin, when appropriate testosterone and metformin reduce all-cause mortality by perhaps half, whereas insulin in type 2 diabetics does not.

Just yesterday this column decried confusing causation with association in the comm0n  but far from majority universal problem of hyperandrogenism in women. There are only two major anabolic hormones that decline seriously with both aging and disease in both men and women, in whom appropriate physiological testosterone and vitamin D3  replacement (with appropriate physiological estrogen for women) is thus often required lifelong from what is potentially middle age to maintain health into vigorous- rather than frail- old age.

UPDATE: WHAT’S THE PROBLEM WITH BONE DENSOMETRY AT ALL AGES AND SEXES??

neil.burman@gmail.com

WHAT’S THE PROBLEM WITH BONE DENSOMETRY?

Answer: none provided it is safely and economically measured and safely and economically corrected at all ages from small children to dotage. It is so cheap and easy to halve  the fracture risk and rate in all, and thus save vast suffering, costs and especially deaths.

A spinal surgeon laments as we all do  the poor correlation between dual xray bone density analysis DXA and fracture risk.
The simple answer is that bone density is not the top risk factor for fractures,

The chief risk for fractures in the aging is falls and fragility ie global health balance  including agility-co-ordination, balance, and strength- muscle mass.

As this column has previously detailed, DXA is valuable for looking at risk areas in the hip or a vertebra;
but just as screening X-ray mammography overdiagnoses clinically relevant breast cancer,   trunkal DXA measurement  increasingly overreads bone density  as we age because of false densification- vascular calcification overlying hips and spine, and progressive collapse wedging of vertebrae.

That’s why,  as  this column has previously referenced,  QUS -quantified ultrasound – done mostly at the heelbone, has become the international gold standard for monitoring global fracture risk, since that bone measured in its long axis  is generally free of overlying vascular calcification and collapse wedging. It is recommended by  international bodies, many leading universities from Cape Town to Cambridge to Scotland, Japan and USA. .

There is generally  good  correlation between true DXA measurement at hip and spine, and heel QUS measurement.
And QUS lacks the cumulative radiation risks of DXA.
That’s why QUS bone density  is increasingly recommended from childhood, for monitoring and thus simple prevention of frailty   – thus avoiding  the mushrooming  fracture and frailty risk in later life

http://www.ncbi.nlm.nih.gov/pubmed/22878531 Osteoporos Int. 2012 Aug  Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria.Chan ea  Garvan Institute of Medical Research,Sydney,  Australia.

http://www.ncbi.nlm.nih.gov/pubmed/22037972 Osteoporos Int. 2012 Jan:143-53.Quantitative ultrasound of  heel and fracture risk. Moayyeri ea .University Cambridge  UK. Metanalysis: 21 studies with 55,164 women and 13,742 men were included  with a total follow-up of 279,124 person-years. All QUS parameters were associated with risk of different fracture:  1 SD decrease in BMD associated with almost doubling of  hip fracture risk.  (RR by BUA  1.69, SOS was 1.96). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Different validated devices predicted fracture risks with similar performance; with  similar performance in men and women. This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women.

Oct 30, 2010.

FRAILTY FRACTURES- OSTEOPOROSIS- ARE ALSO COMMON- AND EASILY PREVENTED-  IN AGING MEN

The just-published Champ study of osteoporosis in men over 70yrs in Australia shows the high risk for older men as well: 25% had vertebral fractures, but only 77% of the men with fractures had even osteopenia let alone osteoporosis on DXA screening. and this does not factor in the overreading by DXA at the spine and hip owing to the high prevalence of both calcinosis and vertebral collapse. And abysmally few of the men were taking realistic preventatives.

The study bears out:

that frailty,  usually from aging  – is the chief risk factor for non-violent fractures;

and  the low sensitivity of especially  DXA screening, never mind the folly of waiting for fractures or dementia or worse before doing safe lowcost (QUS bone risk) screening as one incentive to starting multipreventative supplements.

As the GIOS Project in Spain yet again confirms, simple  diagnosis and safe  treatment of those at risk of non-violent fractures is scandalously neglected.

And it does not require costly risky high technology – xray screening  bisphosphonates or strontium ranelate..

Like doctors, men are far more resistant than even women to heeding warning to start screening and supplements early enough.

The  CHAMP  study again highlights the importance of asymptomatic middleaged men never mind women having periodic no-xray ultrasound quantitative bone strength scans  routinely as the gold standard so as to prompt them to take the appropriate blend of the fewscore supplements effective against both frailty fractures as well as the associated lipid- diabetes- vascular -respiratory- dementia- cancer diseases.

CHRONIC ILLNESS- MANAGED ANTIAGING & GENERAL PRACTICE CLINIC SOUTH AFRICA

update 6 April 2015

In Claremont  Cape Town

A  Specialist Family Internist Clinic offers consultations by appointment especially for managing (and ideally preventing)  the major chronic degenerative diseases of aging  and  maintaining physical, mental (and why not sexual?) vigour to a ripe and healthy old age; as well as preventing and managing acute disease at all ages.

The clinic (a specialist physician and a nutritionalist)  offers all-system evaluation and if available, natural  (as well as essential prescription orthrodox) prevention/treatment including metabolic – weight-endocrine-diabetes; heart-lung -kidney; hypertension; neurological-pain; joint & muscle; abdominal, immune system ie infection, cancer and auto-immune  support;  genito-urinary, & sexual problems;

and appropriate screening – ECG, non-xray ( no-touch thermography- eg thermomammogram;   SureTouch tactile) mammograms, non-xray (ie  ultrasound) BMD ie  bone fracture risk measurement, body composition, and appropriate hormone profiling/replacement.

Phone during office hours for appointment: for Claremont office  ph 021-6717415  or 6831465 (or 083-6299160) – at Grove Medical Bldg 1st floor no 15 (opp ABSA Bank Parkade c/o Grove Ave Pearce Rd)  , or neil.burman@gmail.com ;  or consultation by telephone/Skype or email .

by appointment only:        OFFICE HOURSby appt: ph office:  9am-5pm weekdays, 9am-1pm Saturdays.  AFTER  HOURS up to 9pm any day generally at office: –  email doctor   neil.burman@gmail.com  or ph 6am to 9pm  0836299160. EMERGENCIES  cannot be dealt with- acute emergencies and trauma, bleeding cases  must go to any  Emergency Unit .

Billing according to means ie specialist professional rates:  eg as a preferred provider for Discovery Health-  consultation procedure  0190; for needy patients, what the medical scheme pays  Detailed medical report and advice protocol provided at R300. Even Hospital Plans have to pay for outpatient consultation for scores of PMBs ie Prescribed Medical benefit conditions like Menopause.

 Needy patients desiring brief consultation can be seen by arrangement at GP rate.    Bone density scan  (covered by some medical schemes)  procedure 3612..  Non-xray mammograms are not yet covered by medical schemes codes: R650 for SureTouch including clinical consultation, R800 for thermomammogram.

BANNING THE PRESCRIPTION OF THE GLITAZONE ANTIDIABETIC DRUGS

 neil.burman@gmail.com

This was a bad month for Actos (Takeda-Rly Lilly)  and Avandia (Glaxo), another good month for metformin.

As indicated in this week’s NEJM, the glitazone  class of drugs sold commercially as Avandia and Actos, has now belatedly  been suspended,  restricted or black boxed  by the European – EU and the  USA- FDA- regulators  (after shocking prevarication pandering to Big Pharma), because of  promoting  heart failure, let alone visual loss- macular oedema, osteoporosis fractures,  fatal hepatitis (troglitazone deaths), and adiposity –weight gain and  cancer.; with consequently and unsurprisingly no significant reduction in all-cause mortality ..

Regulators like our own MCC  must now surely suspend ie ban the current  glitazone drugs in view of the long-accumulating list of their serious adverse effects and related deaths.. There never was or is compelling clinical reason for their prescription any more than there is or was allowing eg  the soon- banned Mandrax, Ponderax, practolol, stilbestrol, cerivastatin or the original glitazone troglitazone Rezulin on the market.

The current glitazones have  been in use scarely a decade; and  are not necessary let alone essential since:

-metformin remains the best drug ever discovered against all major common degenerative diseases including type 2 diabetes and overweight, with zero serious adverse effects in the longest (20year) randomized controlled trial ever conducted,

– with 1/3 reduction in all mortality and major chronic degenerative disease, halving of heart attacks in type 2 diabetics due to metformin’s unique combination in titrated clinical use of antioxidant, anti-lipidemic, vasodilator antihypertensive, anticancer, anti-aging, appetite- and adiposity-controlling, anti-hepatitis, antimicrobial, insulin-sensitizing, pro-fertility and fibrinolytic benefits, protecting all organ systems;

and at least halving of new diabetes in major preventative trials in “prediabetics” on four continents; and provided the dose of metformin is simply started low- at most 250mg/day

– and provided the starter dose is titrated weekly up to comfortable safe tolerance and desired effect- as must naturally be done with all chronic drugs.

In contrast to the glitazones, the latest studies  October 2010 by Evans ea   from Tayside Scotland and by MacDonald ea in the UK as a whole, showed that compared to sulphonylurea and other antidiabetics, metformin alone or combined with sulphonylurea  in +-75year old diabetics with congestive heart failure lowered all-cause mortality by 41% after 1 years and by about 30% longterm – the same outcome as in the UKPDS trial 30year followup.

From France Mouchiroud ea Sept 2010  discuss why global lifespan has risen from about 46 to 65years accross the 20th century, and how metformin (as dietary restriction mimetic) shares with rapamycin and resveratrol the slowing-down of age-related diseases.  And Li ea Sept 2010  show in experimental stroke in rats how chronic prevention with metformin was neuroprotective  via nitric oxide.

A careful population study in USA by Wertz ea Sept 2010  could find no difference in the 4.15% incidence of heart attack, heartfailure or death in  rosglitazone or pioglitazone users aged 18years or older;   and a careful study by Kaiser Permanente  Sept 2010 of all published glitazone trials confirms Pubmed search, that  after ten years of massive marketing  trials and massive unjustified use, there is  still no evidence that  the glitazones reduce all-cause mortality as metformin does, nor statistically reduce the primary usual glitazone trial endpoint of major cardiovascular event or death. 

How can glitazones have such benefits of metformin  when glitazones  are not dietary restriction mimetics but actually increase adipocytes and thus obesity and hence  cancer?  

 Instead of protecting drug companies’ and their lobbyists’  interests,  will the Regulators everywhere, including the “experts” at the  Universities – medical schools-  now act against these  unnecessary, risky,  fattening antidiabetic glitazones to protect patients?

Or will the leading medical schools and governments  continue ruthlessly  to put their massive monetary support from Big Pharma ahead of  truth, evidence and patients’ interests?