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April 2024 Table Hopping
THE FDA IS OFF THE RAILS
Like everyone else I would love to believe that the government is in place to protect citizens and provide services but unfortunately as I get older and maybe a wee bit wiser I see the things are not as cut and dried as I’d hoped. This is ,unfortunately, especially true in medicine because the medical schools and the residency programs are not driven by science alone. You can no longer have full faith and trust in the federal government agency in charge of medications and treatments. I’m not writing about the incredibly incestious relationship between the pharmaceutical industry and the FDA. That’s about politics and this column is about facts. The FDA is approving drugs based on surrogate markers , not actually patient relevant results. This isn’t a one time thing…I will show multiple very recent examples. I don’t want to be the guy critical of big government and big pharma but this stuff could potentially affect a lot of patients and people aren’t getting this perspective readily elsewhere.
Here’s a great excerpt from an article published in one of the many JAMA variants entitled “Review Of Evidence Supporting US FDA Drug Approvals”. “Our results highlight a trend toward less rigorous standards for novel drug approvals that has evolved over the past few decades. In contrast to 2016, when 4 of 20 products (20%) were approved based on a single trial, single studies justified 65% of the 2022 approvals. In 2016, 55% of products were approved based on 3 or more studies, in comparison with 11% in 2022.1 “ The long and the short of this is that drugs are being approved with less and less rigor all the time. I’m going to give three examples from three different fields of medicine on how broken the system is. This review also pointed out that despite the regulatory requirements many drug trials do not get published so the real world efficacy of these drugs cannot really be easily ascertained.
One of my main complaints when reviewing these drug trials is all the fun and games they play with statistics …using composite and surrogate endpoints and misleading doctors with relative differences instead of absolute difference. For example if there is a drug trial with 1,000 people in each arm of the trial…test drug and placebo…Let’s say the test drug group had one heart attack and the placebo group had two heart attacks…Using relative risk you can say the drug cut the risk of heart attack by 50% but using absolute risk its one person in a thousand that benefits. What if the test drug group had more cancer diagnosis ..would they have to report that? Not really. I look for the ONE marker it’s hard to hide during anytrial…The number of deaths. The number of lives saved. Any important drug…a pill for heart disease, stroke , or diabetes should be measured not by how much lower your blood pressure is , how low the cholesterol number goes but by seeing that patients taking these drugs had less deaths. Lowering death rates , to me, is the most important marker of a drug’s effect.
Unfortunately , modern medicine has become so specialized that doctors lose focus on the big picture and just focus on their specialty. The neurologists don’t care if the drug they give you might increase heart attacks or increase cancer risk as long as it decreases stroke they are all for it. If you have a stroke the neurologist will want you on a statin because they have been shown to lower risk of recurrent stroke. The SPARCL study..High-Dose Atorvastatin after Stroke or Transient Ischemic Attack | NEJM used the highest dose of lipitor to show that it reduced recurrent strokes in patients who had a stroke. Lipitor did indeed reduce strokes ..by 2.2 percent but it doubled the number of hemorrhagic strokes which are usually worse than the more common ischemic stroke. Also total deaths and cancer deaths were HIGHER in the statin treated group. So the drugmakes the neurologist happy but using the highest dose of the drug had ZERO effect on whether you lived or died.
Sticking with cholesterol for the moment , let’s look at another recently approved drug, Bemedoic acid marketed as Nexletol. This drug was approved after only one trial that involved 13,970 patients. The FDA likes this drug because it lowers cholesterol. This next quote comes directly from the published trial “Bempedoic acid had no significant effects on fatal or nonfatal stroke, death from cardiovascular causes, and death from any cause.” That’s right, no effect on stroke, heart attack or death from any cause. ! And yet the drug was approved !
The FDA also approved Repatha. Evolocumab and Clinical Outcomes inPatients with Cardiovascular Disease | NEJM
This is another class of drugs designed to lower cholesterol and thereby lower heart attack and death rates due to CAD. This is a very expensive class of meds ( monoclonal antibodies which need to be injected ) and lowers cholesterol dramatically. Despite lowering cholesterol by an average of 60% (which is a huge reduction) there was only a slight reduction in heart events from 11.3 % to 9.8 %
there were more deaths in the group given the drug. How can the FDA approve ANY drug or intervention if the treated group has more deaths?
Speaking of more deaths in the treatment group. An independent analysis of Pfizer’s original covid vaccine trial showed also there were more deaths in the group of people who got the original vaccine than in the group who got placebo. Here’s a slide from the CDC itself showing this.
C4591001 COVID-19 BLA Safety and Efficacy Data For ACIP
How can you make it a mandatory vaccination if more people died in the treatment group than in the placebo group? I guess the infectious disease doctors would say..at least you didn’t die of covid.
Finally, and I could go on and on with examples , we have the new drugs for dementia. Now ,dementia is a real and growing problem in this country and elsewhere and we have had a real dismal track record of drug treatments for this with hundreds of trials not producing meaningful results. Big Pharma is focused on the plaques in the brain which can be seen on scans . We now know these plaques are a sign of the disease not the cause of the disease. Aducanaumab was the first approved drug in 2021 but is already being taken off the market by the manufacturer Biogen. Lilly has a drug, donanemab, which did not get approved inJanuary 2023. Finally there is Lecanamab made by Eisai which was approved July 2023. Like the other drugs , Lecanamab had very little clinical benefit, had significant side effects (i.e. bleeding in the brain) and made an important subset of demented patients worse! Somehow this doesn’t matter to the FDA but it does to me. I’m not sure what to do about all this except remain skeptical as always. Don’t be so quick to look for an answer to your health problems from a pill, look at your lifestyle. That’s where the real changes have to be made. Until next month…get well and stay well ….JT BARRY MD
CO Q 10 AND YOU
It’s time to focus once again on a supplement. When I first heard about CO Q 10 I thought it was a scam. After all, what happened to CO Q 1 through 9? However , as I did more reviews of the basic physiology of the cell, the cell membrane , and the electron transport chain responsible for creating energy in our cells , there it was ! CO Q 10 is a powerful fat soluble antioxidant that also has anti-inflammatory properties and plays a critical role in energy production . It’s found throughout your body in cell membranes but it’s most abundant in the heart, liver, lungs, kidney, spleen, pancreas and adrenal glands. Apparently production of CO Q 10 peaks around the age of 25 then begins to decline so that by the age of 65 your body makes only about half the amount. CO Q 10 exists in two forms ubiquinone and ubiquinol the latter is the reduced form that’s more easily absorbed but both forms are used by the body so don’t sweat that small stuff.
According to a review in the Journal of Pharmacy and Bioallied Science C0 Q10 is essential for the health of virtually all human tissue and organs. In some lists it is the third most consumed dietary supplement. Vitamin D usually tops these lists and for good reason but that’s another column. C0 Q10 protects the cellular membranes from oxidative stress induced by free radicals. Supplementation with 60 mg to 500 mg for 8 to 12 weeks can significantly reduce Tumor Necrosis Factor Alpha, Interleukin 6 and C Reactive Protein, all important markers of inflammation.. CO Q 10 is involved with cholesterol metabolism, regeneration of vitamin C and E, maintaining liposomal pH , sulfur metabolism, gene expression and amino acid metabolism.
Cardiac muscle cells have about 5,000 mitochondria per cell. Mitochondria are where C0 Q 10 concentrates. For further comparison, mitochondria make up 35% of the volume of cardiac tissue and only 3% to 8% of the volume of skeletal muscle tissue. In one study, 102 patients with atrial fibrillation were divided into two groups; one was given CO Q10 supplementation while the other group was given a placebo, after a year 12 people in the placebo group had a fib compared with only 3 people in the COQ10 group. Furthermore, a systematic review and meta-analysis of cardiovascular risk factors spanning 884 randomized control trials with 883,627 participants showed decreased all cause mortality in those taking the supplement.
CO Q10 acts directly on the endothelium lining our blood vessels and can directly lower your blood pressure. CO Q10 also decreases aldosterone ,a hormone that makes you retain salt and water research thereby also lowering blood pressure so there is a direct and indirect effect on blood pressure. Studies suggest CO Q10 can reduce ischemic lesions and improve outcomes after stroke. Interestingly, if you suffer from migraine headaches, CO Q10 may play a preventable role in that condition. A meta-analysis of five studies found CO Q10 was more effective than placebo for migraines.
Now, a major problem with CO Q10 is that it is blocked by statins. These are cholesterol lowering drugs like lipitor , crestor, pravachol, etc which doctors give out like candy because a number on a sheet of paper is higher than they like. So you lower your cholesterol number ( which I assert has little or nothing to do with heart disease but that’s another column) but you also block the beneficial effects of CO Q 10. Statins lower CO Q10 because they block the HMG coenzyme reductase enzyme involved in cholesterol production. The problem with blocking this enzyme is that it also blocks production of other important compounds including CO Q10. So , patients taking statins, and that’s most of you, should be supplementing with C0 Q10. Of course , check with your doctor or cardiologist but be prepared for a blank look because they dont bring this up in med school.
The body makes its own CO Q10 but it goes down dramatically as you age. You can get some CO Q10 from food as well, especially wild caught salmon, mackerel, sardine, eggs and organ meat. Good luck with that …I will take a capsule thank you. Now if you’re going to take CO Q10 as a supplement you have to avoid any CO Q10 that has vegetable oil in it. The unsaturated fat will damage the CO Q10 and it will not work properly.
You can take your health for granted or you can work actively to maintain this incredibly complex bio-electrochemical system we call the body. If you are curious, why not try the supplement and see if it gives you more energy or more vitality. There seems to be no real toxicity at the recommended levels. Of course, check with your health care provider yada yada yada.
Until next month…get well and stay well……
JT BARRY MD
February 2024 Table Hopping
Well, it’s February so love should be in the air. Valentine’s day is coming up so what medical advice do I have for you on this occasion? First, if you are waiting around for one day a year to express your affection to someone you are missing the proverbial love boat. Increasingly , modern medicine is recognizing the critical role that stress and social isolation have on your mental and physical health. All those little pills in your cabinet may not actually do you as much good as a long walk with friends. Dr Malcom Kendrick in his book The Clot Thickens points out a study wherein they used advanced computing methods to really investigate the factors leading to heart disease. Of the top ten causes, six were related to social isolation and stress !
We in the medical profession put way too much emphasis on the pills because it’s easy for everyone. Easy for us and easy for you but wrong. Ask your doctor who put you on the statin drug for your cholesterol, instead of working on your diet, how much longer you will live if you take the statin. According to a study published in the prestigious British Medical Journal “ The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.” PMID: 26408281. That’s right , published studies show you will live 4 days longer taking a statin. Dr Micheal Gregor from NutritionFacts.org has a great video that shows that medication really only makes a 5% difference in health outcomes…95 % comes from lifestyle .
https://nutritionfacts.org/video/The-Actual-Benefit-of-Diet-vs-Drugs/ and here’s a great video by him specifically regarding statins.
https://nutritionfacts.org/video/are-doctors-misleading-patients-about-statin-risks-and-benefits/ Ok, to move away from the heart and back to love..don’t expect any love making tips from me but I can give you a few suggestions as to how to improve your sex life. First off, regular exercise makes sexual performance better. Second, there are safe supplements to help with your testosterone levels including DHEA, DIM , and fenugreek. Yes, women have testosterone as well so I am not just speaking to the male readers.
If your testosterone levels are low , make sure you get checked out for sleep apnea as it’s a well known cause of low testosterone, along with alcohol, obesity, diabetes and narcotic use. Third, if you need to use viagra or cialis you should understand that erectile dysfunction is your penis’s way of saying you are not living right. As an aside…using goodrx coupons which are free on the internet at their site will drastically reduce the cost of these pills.
My son recently got engaged and I was wondering if he was looking for any advice on marriage. So far he hasn’t asked but if he does I will relate the lyrics from the old Charlie Pride song…”Kiss an angel good morning and love her like the devil when you get back home.” Don’t be blase about the most important person in your life.
Maybe you don’t have a special person in your life. All the more reason to stay connected to others via some organization or club/ group. There’s the Optimists, the Kiwanis Club, the Rotary, and church groups galore. Be a part of something bigger than yourself.
Until next month..get well and stay well
JT BARRY MD
January 2024 Table Hopping
It’s the beginning of the year and there must be untold columns, blogs, and podcasts preaching some type of resolution. Not me. Not this column. Resolutions put too much pressure on you. Some people change by taking baby steps and some people change by taking giant leaps…which one are you? As someone more eloquent than I said … .change comes from desperation or inspiration which won will persuade you? Unfortunately it’s desperation for most people, a new cancer or heart disease diagnosis CAN be very motivating but even then most people don’t really change their underlying habits.
We doctors suck at motivating people. Even though focusing on diet and exercise, sleep and stress should be the fundamental issues you deal with when you go to the doctor, we usually focus not on the underlying problem but on a medication to treat your symptoms. Watch the great video by Dr Michael Gregor https://www.youtube.com/watch?v=P0y-lO2YpuQ It’s entitled “the actual benefit of diet versus drugs”. It will be an eye opener for you. I shared this video at a Monday meeting we have at the office to review issues with the staff and I hope it will persuade some of my providers to look at your health differently. Sure, it’s very easy for doctors and very easy for patients to just take a pill to cover up the symptoms but the pills usually have very little impact on your health and underlying condition whereas changing your lifestyle can have a very very dramatic effect not only on symptoms but on the underlying disease process. You can take a pill to treat your indigestion or you can embark on the often frustrating mission of figuring out what’s causing the indigestion. Same thing for blood pressure, diabetes, headaches, etc.
So, trying to get you to change via inspiration rather than desperation seems like the better choice. As I said, doctors are not trained to motivate people so you are on your own in this regard but you are not without resources. My most successful patients ( and by success I mean in terms of health improvement) motivate themselves DAILY with something they read, or watch. Maybe it’s something inspirational, something informative or something challenging. All these options are available one click away on that device of yours. Of course, you know me, I think the cellphone has been transformative in the way we live and learn and its capacity to help you improve your health is only equaled by the damage it’s doing to us culturally.
Dr Robert Lustig addresses this beautifully in his book The Hacking of the American Mind which he summarizes in this lecture. https://www.youtube.com/watch?v=x4sRsb0a30Y. For something more local try Tim Smith of smiletherapy.com based right here in Camillus He will send you daily emails that inspire, amuse and get you thinking. It makes a great gift for that certain someone in your life….you never know what to get your grandkids anyway …why not try this?
Personally, I like watching short motivational videos like Arthur’s Inspirational Transformation https://www.youtube.com/watch?v=qX9FSZJu448. If that doesn’t get you thinking and moving maybe nothing will.
I hope this year you will find some way to improve your health and I hope it doesn’t stem from desperation. Focus on improving your health day by day now or focus on your illness and disabilities down the road.
Until next month…get well and stay well……JT BARRY MD
DECEMBER 2023 TABLEHOPPING
Well, it’s that time of the year to dispense with strict medical advice and lean into the holiday. SInce I’m an old heterosexual white male I am sure I am completely out of touch. I am happy to have new holiday experiences but I am drawn to my traditional favorites. My wife and I watch the same holiday movies, listen to the same holiday music etc. We have done the Lights on the Lake a bunch of times and often take in the Syracuse Stage show that’s holiday themed. One year we saw a play at Syracuse Stage one week and listened to a lecture by the original author of the same play a week later. We never miss the Solstice Celebration whenever someone produces that. We are down for seeing live Xmas shows of all kinds and we also never miss the DeSantis Christmas Show. Previously at the Palace but now ensconced for the second year at the Landmark Theater. The show is Sunday Night December 11th. It’s live holiday music from one of the last big bands in the area with great vocalists who really bring the holidays home. . What’s not to like? Don’t get your Mom another sweater, get her the gift of a night out together. Doesn’t have to be this show…there’s lots of shows now and throughout the year. As I have mentioned on the radio show I read a study recently that looked at what really made people happy and it wasn’t money it was time together with others in conversation especially over meals. Give someone a gift certificate to a restaurant you want to support or you know they like. Better yet, go out to dinner with them. Avoid the french fries of course.
Holidays are stressful and you better believe stress kills. So why not try to reduce your stress by expanding your social network. Some of you may be spread too thin already but most of my patients as they get older have a smaller and smaller social network and that’s not a good thing. Use the holidays as an excuse to get together and go from there. Is there a Christmas gift better than seeing a smile on someone’s face?
Speaking of happiness …Do you know there is a real difference , a biochemical difference between pleasure and happiness? Pleasure involves the dopaminergic parts of the brain and happiness involves the serotonergic parts of the brain. There is a great video by Dr Robert Lustig entitled “The Hacking of the American Mind” which you can find on Youtube.
Get outside, enjoy the cold while we have it because it will warm up in 7-9 months. Go for a walk ,safely , with someone and get some time outside. It’s very good for your immune system, your hormonal system, the cardiovascular system etc. Check out the sleigh rides at Highland Forest for that unique experience or try the ice at the rink downtown. If you want to be a force for good in the Universe, leave a note in someone’s mailbox if you like their Christmas decorations.
Sorry , none of my suggestions involve an app or swiping left or right…You don’t need the internet for any of the events I suggested. .I did tell you I was a traditionalist. Merry CHristmas and don’t forget the reason for the season. Until next month…get well and stay well……
JT BARRY MD
OCTOBER 2023 TABLE HOPPING
IVERMECTIN WINS AGAIN
Covid is still with us because it’s a corona virus and these viruses have been around longer than we have . Just look at the label of the Lysol can. They are bringing back the mask mandates without any metrics at all . The Governor is recommending vaccinations even when the Cleveland Clinic has shown that the more vaccinations you get against Covid the MORE likely you are to get the infection. What’s next ? Recently the FDA was forced to admit that it was not inappropriate for physicians to prescribe Ivermectin to prevent or treat covid. Of course they have spent the last few years vilifying doctors who were using it off label and convinced ( with financial incentives ! ) the major medical organizations like the AMA to condemn its use. Now that yet another publication has shown the dramatic benefits of ivermectin it should be clear that THESE GOVERNMENT AND ORGANIZATION POLICIES RESULTED IN MORE DEATHS than if prescribing Ivermectin had been allowed. If we had just trusted the doctors on the front lines of fighting this outbreak we would have saved more lives than all the other therapeutics combined. That’s a national tragedy.
The latest study is a report from Peru from October of 2020 showed a 74% reduction in excess deaths in the 10 Peruvian states where Ivermectin was used most extensively .Adidttionally there was a 14-fold reduction in nationwide excess deaths when Ivermectin was readily available and the 13- fold increase in excess deaths in the two months after Ivermectin use was restricted..
And it wasn’t just Peru, the largest state in India, Uttar Pradesh ,with a population of 229 million showed the cumulative total of covid-19 deaths per million in population from July 7th 2021 to April 1st 2023 was 4.3 in Utah Pradesh as compared to 70 in all of India and 1,596 in the United States. Those are astonishingly different numbers.
A similar series of events occurred in the Brazilian city of Itajai which has 220,000 people. Dr Peter Kory and 8 co-authors published a paper on the results of using Ivermectin prophylactically . 113,000 residents elected to take Ivermectin. Those who used Ivermectin had a 44% reduction in covid infection , a 68% reduction in mortality and a 56% reduction in hospitalization compared to those who did not. Meanwhile, a study from Japan demonstrated that just 12 Days After doctors were allowed to legally prescribe Ivermectin to their patients, cases dropped traumatically.
Let’s remember this drug is on the World Health Organization’s “essential medication” list ,in fact, according to the literature , since 1987 3.7 billion doses of ivermectin have been used among humans worldwide
So, it’s been proven to be helpful in India, Brazil, Peru , and Japan amongst others and what did we do in America? We vilified doctors who tried to prescribe It off label. The USDA tweeted “ You’re not a horse you’re not a cow seriously you’all .. stop it”. On August 16th 2023 the FDA was forced to tweet “Healthcare professionals generally may choose to prescribe any approved human drug for an unapproved use when they determine that unapproved use is medically appropriate for an individual patient. “ That’s a win for the doctors.
Of course ,you can trust the American Society of Health System Pharmacists, the American Pharmacist Association and the American Medical Association as well as almost every other Medical Society warned that these drugs should not be used. What would the difference in death and hospitalization be in America had physicians who had the interest and courage to do so been allowed to routinely prescribe Ivermectin off label. It’s been estimated that 40% of all drugs dispensed in America are used off label. Off label doesn’t mean wrong.
Fundamentally , Ivermectin works by binding to the SARS Co V-2 Spike protein, limiting the virus’s mobility and infectivity. It’s best known for its antiparasitic effects but it’s also demonstrated antiviral and anti-inflammatory properties and an in vitro study demonstrated that a single treatment with Ivermectin effectively reduced viral load 5,000 times in 48 hours in cell culture. Also, a meta-analysis in the American Journal of Therapeutics showed the drug reduced infection by an average of 86% when used preventively
Disturbing it is that Merck ,who is a major manufacturer of ivermectin , was downplaying its effectiveness at the same time that it was developing its own patented ( and much more lucrative) covid-19 therapeutics.
As always , even in medicine , follow the money. Had there been any evidence that these repurposed drugs worked there would be no way to authorize the experimental treatments including the vaccines . Will we ever get the people in power to admit they were wrong and their decisions cost American lives. I’m not holding my breath but I am holding my prescription pad and look forward to the next pharmacist calling with a problem with my prescribing off label.
Any and all of the references below will show you the evidence.
Chamie J J, Hibberd J A, Scheim D E (August 08, 2023) COVID-19 Excess Deaths in Peru’s 25 States in 2020: Nationwide Trends, Confounding Factors, and Correlations With the Extent of Ivermectin Treatment by State. Cureus 15(8): e43168. doi:10.7759/cureus.43168
https://swprs.org/who-preliminary-review-confirms-Ivermectin-effectiveness/
Do your own research. Its your body and it should be your choice. Until next month…get well and stay well
JT BARRY MD
SEPTEMBER 2023 TABLE HOPPING
IGF1
I’m an advocate of trying to use blood work to find out as much as possible about a person . You cannot judge a book by its cover. You can look healthy but be metabolically inflexible. Most healthcare providers are still using blood tests that are 30 years old i.e. total cholesterol and hemoglobin A1c. Measuring insulin and insulin resistance, measuring the ratio of the omega-3 and omega-6 fatty acids in your system, routinely measuring markers of inflammation like CRP and Homocysteine ,I think, are a more modern approach to assessing your health. Both Dr Gundry and Dr Furhman use this test on a regular basis.
One new metric is insulin like growth factor number one…aka IGF1. As the name States it’s like insulin but its level in your body doesn’t just reflect the carbohydrates in your diet like insulin does . Instead it reflects a variety of measures including carbs but is thought to be affected by protein intake. So insulin measures carbs and IGF1 measures your protein intake. There is debate in the medical /nutrition world between those who think we need more protein to prevent the sarcopenia of aging and those who feel proteins are inflammatory and need to be restricted. It turns out that not all proteins are equal in their effects on the body. Animal protein i.e. meat and dairy appear to raise the IGF1 level more than plant derived protein. There is a metabolic pathway called mTor that is activated by animal protein and adults do not want this pathway stimulated. The low protein group says you don’t need more than about 30 grams of protein a day and the high protein group says you should have 1 mg per pound ie a 170 pound person should take in 70 grams of protein.
Insulin-like growth factor is produced in the liver and is triggered as a result of growth hormone stimulation. You want to actively grow when you’re younger but when you achieve adulthood further growth becomes undesirable. Imagine if we all just kept getting taller and taller and bigger and bigger as we got older it would make for interesting nursing homes. So, growth hormone is a youth hormone. In the sense that it’s highest when you’re young like testosterone. Unlike testosterone, supplementing growth hormone can be a dangerous undertaking because it may stimulate the growth of cancer. Likewise, higher LGF1 levels have been linked to increased risk of certain cancers.
In the past , measuring IGF1 levels were used primarily in pediatrics to assess the growth rate of children but a growing number of people looking at inflammatory processes in the body are using it as a marker for adult health as well. Lower is generally better but there is a U shaped curve ….very low and very high numbers are both bad for different reasons. Too low and you’re not making enough protein and building enough to be healthy. Too high and you’re promoting cancer. Overall, it’s better to have as low a level as possible until you et over the age of 70. After that you want it to be a little higher so you don’t have muscle wasting. The medical literature is full of references to insulin-like growth factors promoting multiple different types of cancer. it may be in fact the link between high sugar diets and accelerating cancer growth. We know that cancer cells need sugar to make energy and grow. At the same time the high sugar levels may elevate IGF1 which acts directly on the tumors. Here’s the appropriate reference ..PMID: 16087968 Here’s another reference to the link between milk intake and prostate cancer…the link is ..IGF1 .PMID: 28361446 In the Nurses’ Health Study, premenopausal women with IGF-1 levels higher than 207 had a substantially higher risk of breast cancer. Likewise, In the Physicians’ Health Study, there was an increase in prostate cancer risk once IGF-1 increased above 185 ng/ml.
A high IGF level is linked to accelerated aging , premature aging and to an increased risk of multiple cancer. .Obviously , IGF1 levels are affected by your age as well as your carbohydrate intake , protein intake ,BMI, liver disease ,and diabetes .Protein intake is well known to be a stimulant for IGF1 but the type of protein matters. Meat and dairy have more concentrated and complex proteins than plants do and it appears that IGF1 is higher in people who have more meat and dairy in their diet. So, if you want to keep your IGF1 low you may want to vary/shift your protein intake.
Luckily, just like with Vitamin D., you can easily and fairly cheaply have your levels of IGF1 measured. The sweet spot is about 150 but is age normalized and you can use the lab value as a reference point and change your diet and see if this marker changes as well. Maybe animal proteins and dairy inflame you in some way and raise your IGF1 levels , maybe they dont….This is another metric you can reference as you change your diet and see your numbers change. Your health care provider is not familiar with this test and will discourage you from ordering it. It’s your health and your health care dollar….just tell the doctor you are trying to measure your health with different metrics like Insulin levels , Omega 3/6 levels and IGF1 levels and to humor you. Tell him to use Metabolic Syndrome or Insulin Resistance as a diagnosis since 80-85% of Americans have these conditions and it’s likely you do as well. Even if you have to pay directly for the test , my lab people tell me it’s a cheap test and I intend to use this test repeatedly on my patients along with the Omega 3/6 test and fasting Insulin to assess their diet and their health. You can too !
Until next month….get well and stay well. JT BARRY MD
AUGUST 2023 TABLE HOPPING
PURITY OF ESSENCE MANDRAKE !
Perhaps you’ve become aware of the plot by certain elected officials to purchase from China a toxic chemical which is a toxic waste byproduct of manufacturing and directly injected into our water supply. Conspiracy theory? Well, if you consider fluoride a toxic chemical as I do, then this isn’t a conspiracy it’s a fact! I checked on the web and OCWA puts fluoride in our water supply. The American Dental Association says fluoride is essential to the healthy teeth of the children of our nation. it’s so critical that it has to be put in our drinking water. Unfortunately, after really looking at the evidence, not just the guidelines ,the science just doesn’t support their statements and as you read below the people who oppose fluoridation have great credentials and nothing to gain by stating their views. Personally , before requiring everyone to drink this additive or to take a vaccine for that matter you better have grade one proof that this is safe and effective. I don’t believe those criteria have been met for fluoridation and I’m not alone in this belief.
I have a good friend who’s responsible for bringing fluoridation of the water to his local community.. I present to him the counter-manding evidence that suggests fluoridation actually produces a small degree of mental retardation in children and this has been shown over and over again. Here’s a link to an article in the Journal of Environmental Health just published in 2019 that reviews this issue and substantiates the fact that negative neurological effects are occurring at routine fluoridation levels. That’s right, fluoridation causes a degree of mental retardation. PMC6923889. My doctor friend was confronted with this just tunes me out. He won’t believe it. He can’t believe it. He trusts the ADA. Well ,if such a prestigious organization, steeped in science, says it’s okay it must be all right. Of course , he never did any independent investigation, just trusted the government and the ADA .
First off ,man didn’t start getting cavities until the Neolithic era. The ancient skulls of our long distant forefathers rarely had cavities until we started eating grain products around 10-15,000 years ago. We started eating grain products and our bones got weaker ,our stature shrank, and we got cavities. Yes, Paleolithic and Mesolithic skulls showed signs of cavities but not anywhere near to the extent and the degree as from the last 10,000 years. Ancient man did not fluoridate. So, it’s the diet that increases cavities, not the absence or presence of fluoride in the water. Giving fluoride to children in the form of toothpaste is one thing, fluoridating the water for the consumption of all is another thing.
The ADA website will tell you that Fluoride is safe and is a natural substance. What they’re putting in the water is not elemental Fluoride, they’re putting in a fluoride compound that is actually ,as mentioned previously, the toxic waste from certain manufacturing processes.The most pervasive type of fluoride being added to municipal water is hydrofluorosilicic acid. This is a neurotoxic industrial waste byproduct of aluminum ,steel ,cement ,and phosphate fertilizer Industries. This chemical damages the immune system, digestive system,respiratory system, kidney, liver, and thyroid. This is what we’re buying from the Chinese and injecting into our water supply.
Here’s a direct quote from the CDC regarding the strength of evidence for fluoridation of community water “Despite the strengths of early studies of the efficacy of naturally occurring fluoride in community drinking water, the limitations of these studies make summarizing the quality of evidence on community water fluoridation as Grade I inappropriate (Table 1). The quality of evidence from studies on the effectiveness of adjusting fluoride concentration in community water to optimal levels is Grade II-1. So, from the CDC itself we have the above paragraph that clearly states that fluoridation of community water does not have a grade one indication (that’s the highest grade you can get) and it’s the grade you should have in order to add something to the drinking water. I’m not saying that fluoride doesn’t reduce cavities .I’m saying that fluoride should be in the form of toothpaste and topical applications, not something put in the water for everyone. There is a well known side effect of excessive fluoride called fluorosis. This is discoloration of the teeth. Fluoride has to be administered in a very tiny dose and if you trust our officials to oversee this I would like to sell you some water from Detroit or Flint Michigan.
Okay let’s look at some of the people that opposed this addition to our water supply. Let’s start with Dr Robert Carlton, he’s the former scientist for the EPA . “It is my best judgment, reached with a high degree of scientific certainty, that fluoridation presents unacceptable risks to public health, and that the government cannot prove its claims of safety.” He goes on to say that fluoridation “is the greatest case of scientific fraud of this century if not of all time” and this is coming from a guy who worked in the government in this industry.
How about Nobel Prize winner Avrid Carlsson ? “Fluoridation is against all principles of modern pharmacology. It’s really obsolete.” and “Those Nations that are still using it should feel ashamed of themselves, it’s not.. It’s against Science actually”
Then there’s Dean Burk. He worked at the National Cancer Institute as a senior chemist. He was head of the cytochemistry laboratory when he retired in 1974. He also taught biochemistry at the Cornell University Medical School from 1939 to 1941.He was a research master at George Washington University. Burk was a close friend and co-author with Otto Heinrich Warburg. He was a co-developer of the prototype of the Magnetic Resonance Scanner. Burk published more than 250 scientific articles in his lifetime. .Burk considered fluoridation as “mass murder on a grand scale.” Here’s a beautiful short YouTube video where he gives his opinion.
On April 12th 2010 Time Magazine listed Florida as one of the top 10 common household toxins and described fluoride as both neurotoxic and potentially tumorigenic if swallowed.
Well, how well does Fluoride work at preventing caries? In the mid-1980s the World Health Organization, using data from 39,000 school children and 84 areas around the country , showed no statistically significant difference in rates of tooth decay between fluoridated and non-fluoridated cities.
Ty Bollinger in his book Monumental Myths of the Modern Medical Mafia and Mainstream Media has a great chapter about fluoride. In his book chapter 31 it goes through the history of the introduction of fluoride into the drinking water which unsurprisingly was heavily sponsored by industry.
Another great resource for this topic is the Fluoride Action Network website. fluoridealert.org . Here are a few paragraphs describing how most of the countries of Europe don’t fluoridate and yet their cavity rate is very similar to ours and has decreased in a similar manner despite not using fluoride… “Although the U.S. Centers for Disease Control hails water fluoridation as one of the “top ten public health achievements of the twentieth century,” most of the western world, including the vast majority of western Europe, does not fluoridate its water supply.
At present, 97% of the western European population drinks non-fluoridated water. This includes: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Northern Ireland, Norway, Portugal, Scotland, Sweden, Switzerland, and approximately 90% of both the United Kingdom and Spain. Wikipedia confirms that these countries don’t fluoridate: Croatia, Estonia, Hungary, Iceland, and Latvia. Although some of these countries fluoridate their salt, the majority do not. (The only western European countries that allow salt fluoridation are Austria, France, Germany, Spain, and Switzerland.)
Despite foregoing “one of the top ten public health achievements of the twentieth century,” tooth decay rates have declined in Europe as precipitously over the past 50 years as they have in the United States. This raises serious questions about the CDC’s assertion that the decline of tooth decay in the United States since the 1950s is largely attributable to the advent of water fluoridation.”
Fluoridation is not an issue for me because I live on well water and drink water that has been through a reverse osmosis filter and then I add minerals. I also have my well tested for impurities on a regular basis. If I was served by the Onondaga County Water Authority I would have questions about what they’re putting in my water. I think we should take Fluoride out of our water supply. I wish I could trust what I am told by major corporations and foundations and organizations like the ADA and the AMA but I’ve learned ,unfortunately, that I can’t . I have to do my own research and you have to as well.
Until next month get well and stay well
July 2023 Tablehopping
SPINACH SMOOTHIES SURPRISE
I have written before on the dangers of seed oils. These machined, ultra processed inflammatory oils like corn oil, canola oil, grape seed oil etc are probably still in your cabinet. Today I write about a danger in your fridge. High oxalate foods. Veggies you thought were super healthy can in fact be supertoxic and may be accounting for all those odd symptoms you have. Oxalates are natural compounds like lectins and nightshade that act to protect plants. Once ingested they form tiny and not so tiny crystals all over the body . Crystals might be nice on a necklace but they are not so nice in your kidneys and oxalates are a major component of many kidney stones. The bad effects from these substances have been known in the medical literature for over 150 years . The signs and symptoms of hyperoxalosis are protean but include irritable bowel syndrome, reflux, hypothyroidism, diabetes, allergies,mast cell activation, raynaud’s syndrome, headaches, arthritis,gout,tinnitus, genital pain, and kidney stones just to name a few. Different people absorb the oxalates at different rates and the manifestation of hyper oxalate states can obviously be very different in each person.
Especially at risk for overload are people with a diet low in calcium and other minerals including dairy-free and vegan diets. Frequent use of gut irritating foods including beans, bran, whole grains and quinoa. Also, a history of repeated use of antibiotic or antifungal medications and long-term use of nonsteroidal anti-inflammatory medications ,obesity, diabetes, irritable bowel, bariatric surgery and poor kidney health all predispose to oxalate overdose.
As mentioned in her new book, Toxic Superfoods Sally K Norton, most of the alternate milks are high in oxalates including almond milk , soy milk etc . Also, to my dismay ,I found out from reading the book that using high doses of supplemental Vitamin C is a potential significant source of oxalate and high oxalate foods like spinach, rhubarb buckwheat, tea,beet juice sweet potatoes and beet greens are a major instigator of chronic inflammation. I may have to rethink my advice about vitamin C supplementation at least in people who don’t feel well.
Many of you who really don’t know much about oxalates will perhaps remember the cleaner Zud cleanser …it was a scrubbing powder used to clean pots and pans. This is oxalic acid and prolonged skin contact can cause serious damage.
Unfortunately, there is no clear set of symptoms that proves a person has oxalate excess and there is no particularly reliable urine or blood test. There is a 24-hour urine collection you can do but it is only reliable if the results are high. Many people with clearcut hyperoxylate syndrome have short high spikes that produce the damage but the 24 hr collection is within the normal range. Therefore, since there is no reliable blood test or urine test it’s up to the physician to make the diagnosis or to suggest the diagnosis based on the clinical complaints of the patient. Classic signs of oxalate overload include cloudy urine ,crystals in the urine , recurrent yeast infections, episodic irritable bladder, recurrent kidney stones, periodic joint pain or weakness ,unexplained digestive distress or abdominal pain ,unexplained brain fog or mood problems, signs of vasospasm including Raynauds, unexplained pain such as burning mouth and tooth pain or burning in the genitalia . Also, slower and incomplete recovery from injury or surgery, low bone density or unexplained skin problems may be manifestations of oxalate excess.
Oxalates are generated in the body in small amounts by the usual metabolic processes but during times of metabolic stress oxalate production increases. Sally K Norton describes three key features that increase this stress… #1 is the use of the seed oils .. canola corn,corn oil, cottonseed oil to name a few. #2 is excessive sugar and starch in the diet and #3 is excessive calories overall. Oxalates are produced by biochemical reactions in the body so you generate about 12 mg a day of oxalates and then dietary oxalate sources make up the rest and if that total goes above 25 mg kidney damage is done.
Sally K Norton’s solution is based first of all on switching to low oxalate foods and navigating the flairs that happen as you mobilize the crystals. She then recommends a Five Point plan that includes #1 rest and Vitamin D, #2 mineral supplementation including calcium, potassium, magnesium, sulfur , and trace minerals #3 citrates, #4 B complex vitamins and not too much of the vitamin C and finally #5 avoid too many probiotics, motrin type meds and antibiotics.
So, if you feel great ignore me as always but if you don’t have the health you want why not go on a low oxalate diet for a month or two and see how you feel. It’s not a deprivation diet, it’s a substitution diet. You can reference Ms Norton’s book or contact her on the internet for a consultation. If you go low oxalate you may at some point have your symptoms actually worsen…that’s actually a good sign that you are mobilizing the oxalates and the symptoms will resolve over time.
So, one more thing to worry about in your diet OR a possible answer to all your undiagnosed issues. The book Toxic Superfoods is an excellent reference for you. Until next month…get well and stay well.
Why We Test Insulin Blood Levels
Customers who order our blood test panels often ask why we measure fasting insulin.
One reason is that higher fasting insulin levels are correlated with lower life expectancy’ and increased risks of cancer2-5 and cardiovascular disorders.6-8
Insulin production is regulated by blood sugar levels and hormones. Fasting insulin increases in response to insulin resistance.9,10
At first, higher insulin levels can initially help drive glucose out of the blood into cells.10
As insulin resistance worsens, even greater insulin secretion fails to adequately normalize blood glucose.10
A missed opportunity for early diagnosis occurs when fasting insulin is omitted from blood panels that measure glucose and Al c.
Higher levels of insulin can temporarily reduce glucose and Al c in a way that masks glycemic control issues.10
In other words, glucose and A1c may appear “normal” on blood test results. But without testing fasting insulin, this may create a false sense of security by not recognizing that the “excess” insulin is helping to keep glucose and Alc within ) acceptable ranges.11
Before full-blown type II diabetes manifests, subop¬timal glycemic control is associated with increasing risks of the most common diseases12 of aging.13-16
Further, worsening glycemic control can silently contribute to diabetes, leading to peripheral nerve damage (neuropathy), chronic kidney disease, and/ or loss of vision (retinopathy).17
Newly diagnosed diabetics often ask why so many morbidities afflict them so quickly. The answer is these pathologies were festering for years as a result of suboptimal metabolic control, which could have been identified earlier with proper blood tests.
Some studies have shown that fasting insulin levels are a more accurate predictor of cardiometabolic risk, compared to tests for insulin resistance.18,19
One of the most serious global health problems today is metabolic disorders related to obesity and insulin resistance.20-2 Effective methods (diet and exercise) can slow or halt progression to type II diabetes—but prevention is critical.
That’s why it’s essential to include fasting insulin with glucose and Alc blood testing to get a more accurate understanding of your glycemic status.
Type II diabetes is surging higher worldwide among all age groups.
The Centers for Disease Control and Prevention is running public service ads (one copied on this page) warning that one in three American adults is at risk for prediabetes.20
The term “prediabetes” can be misleading.
Few realize that the initial stages of glucose imbalance inflict severe tissue damage. This happens before full-blown type II diabetes is officially diagnosed.6
These pathologies are not limited to adults. There was an astounding 95% increase in Americans under age 20 living with type II diabetes between 2001-2017.22
Need for Early Intervention
Most cases of type II diabetes begin when cells slowly become resistant to insulin.20
When this occurs, glucose buildup in blood causes the pancreas to secrete higher levels of insulin to force glucose into cells. This temporarily helps compensate for insulin resistance in target tissues (e.g., skeletal, muscle, liver).
During the period of insulin resistance, weight gain may be an outward sign of loss of glycemic control. This happens as elevated levels of glucose + insulin contribute to unwanted fat storage.1,23
Weight gain and physical inactivity increase the risk of developing insulin resistance.2
As insulin resistance worsens, insulin levels often rise as the pancreas attempts to compensate and literally force glucose into target tissues that have become resistant to the action of insulin at a cellular level.1
If a blood test reveals high fasting insulin before glucose and Alc become elevated, this provides an opportunity to identify diabetes earlier in the process, before extensive damage occurs.
Published data suggest elevated fasting insulin can be a useful diagnostic tool for identifying early-stage insulin resistance.24
One study found insulin resistance to be the most important predictive risk factor in the development of coronary artery disease.25
Other studies recognize the prognostic value of fasting insulin and suggest that hyperinsulinemia (high fasting insulin) is often both a result and a driver of insulin resistance.16
A consistent association exists between hyper¬tension (high blood pressure) and elevated insulin.26
Mechanistic factors have been identified to explain why tissue damage associated with “excess” insulin and insulin resistance causes blood pressure to spike.27
Kidney Damage
Chronic kidney disease is surging, coinciding with an increased prevalence of obesity, hypertension, and diabetes.
Insulin resistance and hypertension predispose to premature atherosclerosis28,29 and other pathologies that contribute to chronic kidney disease.21,32
Cardiometabolic syndrome, (a constellation of metabolic dysfunction characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and intra-abdominal obesity) is associated with an increase in cardiovascular disease33,34 and kidney failure.35,36
Recognition of the role of insulin resistance and hyperinsulinemia in cardiometabolic syndrome provides a rationale to measure fasting insulin blood levels.
Based on the currently available data, we believe that fasting insulin above 5 pJU/mL is likely suboptimal. Steps that can be taken to improve metabolic health include a healthy, plant-based diet low in simple sugar, processed animal products, and saturated fat, and high in nutrients that help support metabolic health.37
Physical activity is also important for metabolic health.
Along with these lifestyle changes, and if appropriate for an individual based upon his/ her unique health needs, the use of medications under a physician’s care, including mefformin38,39 and/or an SGLT2 inhibitor40.41 like Jardiance® can further improve metabolic health before full-blown type II diabetes manifests.
Advanced-stage kidney disease is currently irrevers¬ible. Identifying causative risk factors early with blood tests that include fasting insulin can enable one to take corrective actions in time.
Cancer
Insulin has direct and indirect effects on cancer cell progression, proliferation, and metastasis.42,43
Studies investigating the association between hyperinsulinemia and cancer-related mortality have been inconsistent. Reasons might include the upper-limit reference range used to define hyperinsulinemia.
For example, the standard reference range for fasting insulin begins at 2,6 uIU/mL and extends to a startling high of 24.9 ulU/mL.”
Life Extension® long ago urged readers to target fasting insulin below 7.0 ulU/mL with optimal fasting insulin below 5.0 ulU/mL.
Today’s laboratory reference ranges don’t define hyperinsulinemia until fasting insulin rises above 24.9 ulU/mL. This is 3-to-5-times higher than what we consider optimal.
A study found lung cancer incidence doubled in men in the highest quartile of fasting insulin compared to those in the lowest insulin quartile. The conclusions from this study were:
“Higher fasting serum insulin concentrations,
as well as the presence of insulin
resistance, appear to be associated with
an elevated risk of lung cancer.”45
A gender-based subgroup analysis of seven different studies found significant association between fasting insulin and cancer mortality. The risk of cancer mortality in men with high insulin levels is almost double as compared to those having lower fasting insulin levels.42
Ignorance regarding “optimal” fasting insulin levels might be obscuring the impact of high, but “normal” insulin resistance markers on cancer risk and overall cancer mortality.
Why the controversy?
Life Extension° has published articles over the decades about the disease risks associated with excess fasting insulin.
Yet there are inconsistencies in the literature and in medical opinion as to what levels of fasting insulin increase disease risks.
One impediment in reaching consensus is varying definitions.
Hyperinsulinemia and Cancer
A massive review article (369 references) published in 2021 describes the health risks and mechanistic dangers of excess insulin.46
What follows is an excerpt from this review titled: “Hyperinsulinemia in Obesity, Inflam¬mation and Cancer”:
“Hyperinsulinemia was associated with a 2-fold risk of cancer death.47
This increase of cancer mortality is also observed in people with normal body weight if they had hyperinsulinemia.48
Therefore, hyperinsulinemia is associated with increased risk of both cancer incidence and death. However, unlike hyperglycemia, there is no widely accepted insulin concentration to define hyperinsulinemia, so it is difficult to compare across studies. Nevertheless, the rationale to study the contribution of hyperinsulinemia to cancer is strong.”
Hyperinsulinemia is sometimes defined as:46
“The amount of insulin in blood being
higher than considered normal.”
With laboratory reference ranges defining “normal” as high as 24.9 ulU/mL, doctors who test fasting insulin may not realize the risks in patients with higher than optimal insulin levels.
We believe fasting insulin levels above 5.0-7.0 ulU/mL may indicate cellular insulin resistance, yet today’s laboratory reference ranges define normal as between 2.6 and 24.9 ulLi/mL.
A better definition of hyperinsulinemia is a condition in which:
“There are excess levels of insulin circulating
in the blood relative to glucose.”
Even this definition can make interpretation of blood test results challenging since the majority of Americans today are overweight and prone to large fluctuations in fasting glucose and insulin levels.
Even thin people can suffer from insulin resistance, which is another reason for testing blood for fasting insulin.
A mass education program about insulin resistance is urgently needed, along with knowledge that it can be detected early by properly interpreting fasting insulin, glucose and Alc blood test results.
What you can do today!
Insulin resistance can be reversed by aggressive dietary and lifestyle changes, including increases in physical activity.40,49-54
Nutrients with glucose-lowering effects can help in combination with diet and more physical activity. For some this is not enough, and for these individuals, medications like metformin and/or an SG LT2
Hyperinsulinemia is a risk factor for other diseases.
Excess insulin and insulin resistance cause deleterious changes in many biochemical pathways that can lead to a number of degenerative diseases and potentially life-threatening metabolic consequences.
inhibitor may also be needed to optimize metabolic health. SGLT2 inhibitors are sold under brand names that include Jardiance®, Farxiga®, Invokana® and others.
An AMPK-activating drug called metformin improves insulin sensitivity and can reduce fasting insulin levels indirectly, largely as a result of improvement in peripheral insulin sensitivity at the cellular leve1.49,55
Sodium-Glucose Co-Transporter 2 inhibitor (SGLT2 inhibitor) drugs increase urinary excretion of glucose from blood. This drug class helps reduce the progression of chronic kidney disease in patients with type II diabetes and reduces adverse cardiovascular outcomes in many of these patients.56
Some studies show SGLT2 inhibitors reduce fasting insulin, likely a result of the reduction of excess blood glucose.57-69
The first step, however, is blood tests that measure glucose, Alc and fasting insulin.
We suggest you target:
- Fasting Glucose between 80-86 mg/dL
- Hemoglobin A1c between 5.0%-5.4%
- Fasting Insulin <5 plU/mL
While these numbers are not achievable by everyone, you can at least lower them to safer ranges by initiating steps to improve glycemic status.
A popular blood test panel outlined on the next page includes Al c, glucose, fasting insulin, lipids, C-reactive protein, and other measures.
Commercial labs charge about $2,000 for these tests, but once a year we discount the popular Male and Female Panels down to $224.
You can order these tests 24 hours/day by calling 1-800-208-3444 or visting www.LifeExtenson.com/bloodtests
I hope this editorial explains why fasting insulin is included in many of our comprehensive blood test panels.
The article on page 24 of this issue describes an easy-to-take fiber approved by the FDA in 2020. One of the benefits found with this soluble plant fiber is reduced glucose and insulin blood levels.
For longer life,
Cellular Insulin Resistance
The cells of many people with impaired glycemic control tend to be more resistant to insulin-stimulated glucose uptake than those with normal glucose tolerance.
The ability of insulin to stimulate cellular glucose uptake varies widely among individuals.
Resistance to insulin-stimulated glucose uptake and compensatory hyperinsulinemia represents a basic defect in many patients in the early stage of type II diabetes.1
As the condition worsens, insulin-producing pancreatic cells fail, thus some type II diabetics to require insulin injections.1
Increases in pancreatic insulin production can temporarily prevent elevations of glucose and Alc. This does not mean that this compensatory (hyperinsulinemic) response is benign.
Early-stage diabetic development (and related complications) is predictable by including fasting insulin with conventional blood test panels.