Doctor to Doctor, An E-Newsletter

The Cardia Study

2008-01-21T10:47:00.001-08:00

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Action against Bioidentical Hormones

2008-01-14T06:29:00.000-08:00

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Acomplia for Weight Loss

2008-01-12T08:20:00.001-08:00

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Body Composition in Menopause

2007-04-16T10:53:00.000-07:00

Watch what Dr. Joe has to say about Body Composition and Menopause. (7:15 min.)

Rimonabant Perspective

2007-03-11T07:07:00.000-07:00

The two year results JAMA 2006 2;295(7):761-75 of treatment with 20 mg/d of rimonabant plus diet promoted modest but sustained weight loss as well as favorable changes in cardiometabolic risk factors. At year 1, compared with the placebo group, the rimonabant 20 mg group produced greater mean reductions in weight (–6.3 kg; P<.001) and waist circumference (–6.1 cm; P<.001).

The rimonabant 20 mg group also produced greater changes in levels of triglycerides (% change, –5.3; P<.001) and increases in HDL cholesterol (% change, 12.6; P<.001), as compared with placebo. Subsequently, the weight loss achieved during year 1 was maintained during year 2 in the patients continuing to receive rimonabant 20 mg.

A limitation of the study, pointed out by the authors was the limited data in minority groups, with the population predominantly white female.

DVD For Newly Diagnosed Families

2007-03-03T06:52:00.000-08:00

Doug has a very product here. I’m sure you will find this worth while.

DVD SUPPORTS PARENTS OF KIDS NEWLY DIAGNOSED WITH DIABETES

Shock. Fear. Confusion. Guilt. These are common reactions when parents are told that their child has Type I diabetes. They learn that there is no cure, so its a life sentence for the child. At the same time, they are overwhelmed with medical information about the disease as well as about blood testing, insulin shots and new dietary routines. But what about the initial emotional impact of this diagnosis on those parents? Too often, little is done to help parents cope.

Moving Forward With Diabetes is a new informative video that addresses the emotional journey faced by parents of children newly diagnosed with Type I diabetes. It offers support to parents with insights, stories, advice and reassuring messages from parents who have been through that difficult first year following the diagnosis. Topics include: facing the diagnosis, managing diet and testing, finding support, dealing with schools and normal activities, re-establishing a normal life, teaching responsibility to the child, and coping with emotions. There is plenty of helpful advice and lessons learned. Their children also offer advice to parents and talk about living with diabetes.

This 72-minute program, on DVD, retails for $30 (US). The exclusive retailer during the initial release is Amazon.com. A preview video and details are available on the company's Web site. The target audiences include parents, health care professionals, diabetes educators, support groups and others who interact with families of children with diabetes. This program does not offer medical advice.

Moving Forward With Diabetes is from Arnold Creek Productions, Inc., an award-winning media producer based in Portland, Oregon. They previously released I Have Diabetes Too! which presents children talking to their peers about diabetes and their lives. Arnold Creek specializes in educational and inspirational media on health and sustainability.

The Power of Probiotics - Keys to Optimal Health

2007-02-26T11:00:00.001-08:00

We have been suggesting Probiotics for the abdominal discomfort and bloating that can occur with the use of Byetta. Christine has been an excellent partner for nutritional counseling for those with diabetes and weight loss needs.

Dr. Joe

The Power of Probiotics - Keys to Optimal Health
by Christine Rosche,MPH,CBT - The Light Living Program to Optimal Nutrition and Weight

Balancing Your Intestinal Flora

Your intestinal tract contains more than 500 species of bacteria. The right ratio of good bacteria to bad bacteria (80% -20) needs to be maintained in the intestinal tract for optimal immunity and health.

If the bad bacteria outnumber the good guys and yeast is prevalent, a condition called Dysbiosis can occur. Dr. Eli Metchnikoff, early in the 20th century stated that: "disease begins in the intestinal tract because of an imbalance of intestinal bacteria. A major part of the immune system is in the intestinal tract."

Dysbiosis weakens your ability to protect yourself from disease-causing microbes, which are composed of low-virulence organisms. Unlike salmonella, which causes immediate food-poisoning reactions, low-virulence microbes are insidious. Published research in functional medicine and functional nutrition lists Dysbosis as the underlying cause of constipation, arthritis, auto-immune diseases, B12 deficiency, chronic fatigue, skin disorders and early stages of breast and colon cancers.

What causes Dysbiosis or imbalanced bacteria in your intestinal tract? Antibiotics, medically necessary at times, simultaneously kill both harmful and beneficial bacteria throughout your digestive system, mouth, vagina and skin. This leaves you more vulnerable to bacteria, parasites, yeast, fungus that are resistant to the antibiotic that was used.

Pro-Biotics (Meaning Pro Life, Supportive Bacteria in your Intestines)

Research by leading functional medicine doctors recommend taking a good quality ProBiotic product twice daily for 3-6 months after a 10 day course of antibiotics. This helps you replenish the "good bacteria" in your intestines that were killed off by the antibiotic.

Other factors that cause dysbiosis, or imbalanced bacteria in your gut, is constant high levels of stress, exposure to manufacture chemicals, envronmental pollution, poor food choices, oral contraceptives, surgery, and the use of certain drugs, including pain killers.

Some microbes produced by dysbiosis may hurt the intestinal lining directly by damaging the brush borders. They can then become absorbed into the blood stream, causing system-wide effects.

How to Chose the Right Probiotic for You

In my clinical nutrition practice, I do a Comprehensive Digestive Stool Analysis (CDSA) or a Probiotic Evaluation Test. Its a simple stool test that tells you the specific levels you have of the beneficial flora, the imbalanced flora in your intestines, levels of any pathogenic bacteria or yeast. In addition, it screens for malabsorption and how well you digest your food (presence of the proper digestive enzymes). We can also see if there is any intestinal permeability in the walls, or damage to the villi and brush borders of your intestines.

Once the evaluation is complete, we then chose the right Probiotic for your particular body chemistry.
It is important to distinguish which probiotic strains are the right ones for you. How much should you take of each kind and at what time of day? How long should you take each kind? At your test result appointment, the probiotic will be customized for you.

"One size fits all" does not always provide your unique daily requirement. All brands are not alike and consistently viable.

For health maintenance you need 2 to 4 billion cultures daily. For health issues, you may need 10-15 billion cultures once or twice daily.
Periodic Re-testing to see how well Probiotics working in your body is essential.

The names of the cultures that you may need are Lactobacillus Acidophilus, Bifidobacterium bifidum, lactobacillus salivarkus, Bifidobacterium Longum. We want to make sure that the cultures you take are viable, effective and produce results. Follow up testing, 6 months later, ensures that you now have the proper balance in your gut and eliminated the "bad guys" such as yeast and fungus.

Your digestive evaluation also includes an introduction on how to make cultured vegetables and kefir, another good source of friendly bacteria.

For further information on the type of Probiotic Product that is best for you or to inquire about the Evaluation of your Beneficial Gut Bacteria, please contact the office of Christine Rosche,MPH, CBT at 650-856-3151 and go to www.lightlivingprogram.com

Advantage of Vitamin D and L-Argenine

2007-01-17T06:45:00.000-08:00

The American Journal of Clinical Nutrition, Vol, 85, 1, 6-18, January 2007 has come out with an exceptionally important article on vitamin D forwarded to me by a good friend of mine, Clay Stringer. One of the authors of this study I consider to be a good friend of mine too, although I haven’t seen him in so long he probably has no memory of me, Robert Heaney, MD.

They are assuring us all that the new levels of D everyone is using is safe. In fact, they are now suggesting that we all take 10,000 IU of Vitamin D Daily, twice what I am suggesting now after we do the “Stoss” therapy.

Between the use of the D and the l-arginine which I have promoted in ever increasing amounts, my professional life has become an absolute joy. You can’t imagine how delightful it is to visit people who are steadily getting healthy rather than just coping with disease.

Bird Flu and Vitamin D

2006-11-05T07:27:00.000-08:00

Click here to listen to Dr. Joe's message about the Avian Flu and Vitamin D. (11:14 minutes)

The Power of Arginine

2006-10-23T09:16:00.000-07:00

As many of you know, I have a personal story of reversal of my hardening the arteries discovered at age 37. I had never known that it was possible to reverse hardening of the arteries until I had a follow-up CT scan five years ago that indicated that all the hardening of the arteries had disappeared.

I have never had any symptoms of cardiovascular disease. I have just finished a White Paper on the significant medical studies that show the power of L-arginine to reverse this process. It is on our website.

I am a consultant for ForMor international. There has been a change in their products steadily over the past 18 months and the Cardio Cocktail is the latest generation of what I think is an extraordinary advance in health care. Use Member Number 0131662 when you order.

I am just delighted that I don't have hardening of the arteries anymore and attribute all my success to the power of L-arginine.

ForMor is a network marketing company so if you wish to purchase some of the product you can contact our business office or the Company directly. If there are additional questions on ordering, contact us at office@endocrinemetabolic.com.

L-Arginine Link

2006-10-16T08:44:00.000-07:00

Many of you have asked for more evidence that the use of L-arginine is efficacious in reversing all heart disease if the target is the endothelial lining of the blood vessels.

This is a recent summary put on my website if you like to see what I consider to be good evidence.

http://www.endocrinemetabolic.com/about/press/index.htm

You have any questions about this don't hesitate to let me know.

Hemachromatosis

2006-09-05T05:52:00.000-07:00

In the old days, that means 2 to 3 years ago, physicians felt that iron storage problems in the disease known as hemochromatosis could cause diabetes 1. It is still probably true but it seems not to be the risk that we thought it once was.

The Annals of Internal Medicine August 1st, 2006 had two publications concerning hemochromatosis. This iron storage disease loads excessive iron in the liver, pancreas, heart, joints and endocrine glands resulting in tissue damage that can lead to disease conditions such as cirrhosis, diabetes 1, heart failure, arthropathy and impotence.

The gene that causes disorder was discovered in 1996 and it is known as the C282Y gene. It occurs twice as often in males as females and is thought to be the underlying cause of death in only 0.017 percent of all deaths. Since it is a genetically related disorder, it is well understood that it really only occurs in Caucasians and rarely people of color.

New data emphasizes more than liver damage, cirrhosis and hepatocellular cancer of the major problems. Deposition of iron in the islets of Langerhans is the method by which the beta cells are slowly destroyed. Since the treatment is a withdrawal all blood to point of depletion of the iron in the body can expect to have a decreased amount of insulin use when going through the treatment with only results in decreased amounts of insulin.

If it has been discovered in a family it is most important to receive blood withdrawal therapy to help the liver and heart from failure.

How to Use Inhaled Insulin

2006-08-29T20:28:00.000-07:00

News from Diabetes Care 2006 6;29(6):1282-7

This was an open-label, multicenter study of people with T2DM with A1cs above 8% who had been treated for 2 months with a maximal dose of a sulfonylurea which was continued at that dose throughout the trial.

Before randomization they were divided into two arms of A1c of 8-9.5% (moderately high) or 9.5-12% (very high). The addition of inhaled insulin demonstrated improved glycemic control as compared to metformin in the “very high” arm but was comparable to adding metformin in the “moderately high” arm and in the overall cohort.

An A1c below 8% was attained by 64% in the inhaled insulin and 58% in the metformin group. 25% of the inhaled insulin and 23% of the metformin group achieved an A1c below 7%. Weight gain was 3 kg with the addition of inhaled insulin with a mean decrease of 0.1 kg with metformin. No statistically significant changes occurred in the lipid parameters in either group.

Hypoglycemia occurred in 114 in the inhaled insulin (73 mild, 36 moderate, and 3 severe) and 54 in the metformin group (41 mild and 12 moderate). The rates of overall hypoglycemia (events/subject-month) were 0.31 for inhaled insulin vs. 0.17 for metformin. Increased cough was reported by 9.0% (20/222) in the inhaled insulin and 1.5% (3/201) in the metformin group. No patients discontinued due to hypoglycemia or cough.

The fact that A1cs improved more with the addition of insulin in the “very high” group is not a surprise. What is surprising is that with an average duration of known diabetes of about 8 years there was so much of a response to the addition of metformin. These data do not suggest that inhaled insulin should replace metformin in our approach to treatment but that perhaps we should consider using it early in people with high A1cs.

I am starting to use it now.

Osteonecrosis of the Jaw

2006-08-14T12:50:00.000-07:00

Osteonecrosis of the jaw affects the mandibular bone and the maxillary bone. Other sites reported have been the femoral neck and head, wrist and ear ossicles and know that this is related to "frozen bone" that has prompted concern about the bisphosphonate use in treatment of osteoporosis over the last 5 years.

Many of us have known this as avascular necrosis because certainly that's what it is. A close relationship between this and bisphosphonate therapy has given an increased interest. There have been over 3000 reported cases and over 400 lawsuits have resulted. The Wall Street Journal has focused on jawbones that "rot and die" after IV or oral therapy.

The intravenous use of the bisphosphonate puts people at greatest risk. Although absorption is only a quarter of a percent of Fosamax the half-life being 10 to 12 years makes it is the most dangerous of oral medications. The largest number of lawsuits have directed toward Fosamax.

On August 12, 2006 I had a small meeting of 10 oral surgeons, two oncologists and one endocrinologist to discuss this situation. The transcript of all that was discussed will be out in 10 to 14 days or anyone who would like a copy just send me an e-mail and I will send it to you when it becomes available.

Post Prandial Glucose

2006-07-09T20:17:00.000-07:00

The A1c is the standard of care as far as those with diabetes are concerned. New England Journal of Medicine (1993); 329: pp. 977-986. Lower A1c levels are associated with lower incidence of complications.

But when compared those treated with intensive program verses those who had conventional care of that era that had identical A1c values, the conventional group had 2.5 times the rate of retinopathy. These were people who had an A1c of over 9.0. All these data are from the DCCT noted in the reference in the first paragraph.

With further evaluation it seems that the likely difference is that the range of glucose fluctuation was greater in conventional care as opposed to those who practiced intensive care.

With all the newer ways to control diabetes with newer insulin available today, newer tests to gauge after meal glucose changes and just plain testing for glucose one or two hours after a meal, we have all the technology we need to decrease the complication rater even more.

The outcomes, complications and significance for type 1 and type 2 are discussed in the E-News for these groups discussed today. These are subscription newsletters.

Competitive Bidding for Glucose Testing

2006-06-18T07:19:00.000-07:00

This is an excellent news letter for those who are involved with diabetes on a business basis and for those who really want to “know everything”. Many behind the scenes comments and information most will never have knowledge about but is very important for those with diabetes. Here it is.

Our last topic is a bit political - the issue of competitive bidding around glucose monitoring is quietly becoming a hot topic, and this has us very concerned. Bottom line, we suddenly see a very big risk that, as a result of the new proposed rules related to Competitive Bidding for Durable Medical Equipment, that Medicare recipients (easily a third of all patients with diabetes – 20% of people over 60 have diabetes, remember…) may soon only have access to the least expensive glucose meters and strips. What?! I know. This new program is scheduled to take effect in late 2007 in 10 of the largest major metropolitan areas in the US. If this happens, people on Medicare would be stuck with the cheapest strips, not the best ones, unless the final rules are modified. In order to ensure that Medicare can consider other (read: non-price) considerations in awarding bids for glucose testing supplies (this means, in order to ensure companies will still be able to invest in patient and provider education, innovation, customer service, etc.), we urge doctors and nurses, patients, concerned individuals, and anyone who cares about patients being able to monitor their diabetes optimally to submit comments in the open-comment period that ends on June 30, 2006. We are concerned that patients, out of nowhere, are going to be wind up with the short end of the stick because they will be stuck with meters and strips made by companies who don't invest in valuable innovation, education, and other services that are important to patients and health care professionals. Please weigh in to register your thoughts.

Let them know that patients want choice and need choice and will do far better with choice! And while you’re at it, you might also let them know is that the problem is with lack of attention toward prevention and treatment, not the price of diabetes technology. We'll have a longer blog on how to make a difference here, and if you are interested in the details, please write me directly at kclose@closeconcerns.com. (BTW).

‘Til soon ~
-- Kelly L. Close
Approved by Dr. Joe, The Diabetes Doctor

Byetta Long Acting Release

2006-06-18T07:18:00.000-07:00

The full phase II data was released on Friday for Byetta LAR. Many people feel that Byetta as we know it now and this Long Acting Release (LAR) preparation will change diabetes forever.

Based on our incomplete information it appears it will change it for type 1 and 2. This project was just for type 2 and completed in Europe. Nausea remains an issue (27%) but it is lower in severity than the present Byetta preparation. No new safety issues have arisen.

All this will be released at the Annual meeting of the American Diabetes Association in June. Two doses were used, 2 mg and 0.8 mg. The HbA1c dropped 2.1% and 1.8% respectively. Weight loss continues to be significant. It’s your time.

Endothelial Inflammation as Reation to Medications

2006-06-18T07:15:00.000-07:00

Diabetes Care 29:291071-1076, 2006 had two articles on endothelial function and inflammatory marker response to two medications in the TDZ (thiazolidinedione) class that has been used to treat diabetes 2.

Now that there is more understanding of those who have no insulin on stimulation – therefore looking like diabetes type 1- can non-the-less be benefited by the use of these drugs, this information applies to those with type one and type two. The accelerator theory is useful in all sorts of ways.

The endothelium is a layer of thin, flat cells that line the interior surface of blood vessels, forming an interface between circulating blood and the rest of the vessel wall.

Inflammation is the body's response to injury. The markers include mediators and inhibitors of inflammations and potentially dangerous substances such as toxins.

Both Actos and Avandia had positive effects on the endothelium which means they were likely not only to improve the insulin sensitivity but prevent heart attacks, strokes and prevent all other manner of cardiovascular disease and small vessel disease. It’s your time.

Dangers of Bisphosphonates

2006-06-18T07:14:00.000-07:00

I have been shouting about the dangers of the bisphosphonates and bones for years and now some lawsuits may get everyone’s attention.

http://www.mpowelllaw.com/zometa-aredia-fosamax.htm

http://www.valadlaw.com/

And now it is reaching the news papers. Fosamax is the target here but any bisphosphonate is in the gun sight.

http://www.latimes.com/features/health/la-he-fosamax3apr03,1,1163782.story?ctrack=1&cset=true

Dentists have been worried about the huge failure rate of dental implants in people who have received Fosamax Osteonecrosis or the jaw is unfortunately a diagnosis they have become very familiar with.

http://www.ada.org/prof/resources/topics/osteonecrosis.asp

The treatment should be preventative in anyone who has received any agents in this class. The treatment is that used in any therapy used to grow bone mass in osteoporosis or osteogenesis imperfecta is appropriate.

L-arginine therapy in Acute Myocardial Infarction

2006-06-18T07:05:00.000-07:00

Response to JAMA 1/4/06 Vol 295, No.1, 58-64,
L-arginine therapy in Acute Myocardial Infarction

There are over 40,000 articles which are generally positive on the use of l-arginine to reverse arterial lining (endothelium) elasticity, atherosclerosis, homocysteine and viral damage. I have had 2600 patients over the last ten years with less than 0.05% having any heart disease. How did these authors come to opposite conclusions?

* They started with smaller amounts of l-arginine, 3 gm rather than the 5 grams thought to be the therapeutic amount.
* They reduced the 3 gm to lower amounts if the patients had “side effects” symptoms. They did not state who and how much.
* The source of l-arginine is from a company whose product I do not know.

Patient management had other curious notes.
* Elasticity did not change on treatment.
* Diabetes was “well controlled” – meaningless.
* Plasma l-arginine barely changed on treatment –
how little were they taking?

This is cardiologists’ research. If treatment does not change elasticity/vascular stiffness like it did for all your references shouldn't you change treatment? They quoted 6 articles in the introduction saying l-arginine improved vascular elasticity. Why not follow these articles protocol?

How long did the patients have diabetes? What were other co-morbid states? HbA1c values? What treatments were used for those with diabetes? How well were they controlled during the study? Were the cardiologists attentive to the diabetes care?

“Doctor Joe” Prendergast – January 13, 2006

Metabolic Syndrome

2006-06-18T07:01:00.000-07:00

The world is looking at the “Metabolic Syndrome” with new eyes. Insulin resistance defined it before as one of the essential factors without which you did not have the “Metabolic Syndrome”. But the Japanese study published in Diabetes Care 29: 145-147, 2006 has opened a new question.

It appears that if the patients have insulin resistance they will have increased heart disease. But if you only use waist circumference that is supposed to signal increased brown fat and insulin resistance, you do not necessarily have increased heart disease.

It may be that you just seem to have increased fat, not brown, and that’s all.

Does this signal the “Metabolic Syndrome subgroup B”?

Vitamin D in Treating Osteoporosis

2006-06-18T06:58:00.000-07:00

Diabetes Care 28:2850-2855, 2005 carried the information from Sweden that indicated an upswing in hip fractures for both men and women at age 40. The major drawback was that this was only dietary assessment and no measurement of blood levels were taken.

This is a fatal flaw but is a piece of information that might stalk you as yet another risk factor for having type 1 diabetes – as if there weren't enough.

A few years ago a paper in the Journal of Clinical Endocrinology and Metabolism pointed out that the Swedes had excessive Vitamin A, an antagonist of Vitamin D in high amounts, added in by the Government. They did not asses the A intake in the diet nor in the amount of vitamins. Any patient with chronic disease usually ends up taking vitamins when the Government says that is a good thing.

I measured blood levels of Vitamin A and D for about 18 months after the Swedish paper. Nobody had an elevated Vitamin A in the San Francisco Bay area and no one had levels of Vitamin D that got as high as the normal range.

You heard last week that Vitamin D is a strong anticancer agent so get it up to normal levels and forget about getting a hip fracture about at age 40. We now use large amounts of vitamin D to treat osteoporosis. It is much more effective than things like Fosamax, Actonel and the rest.

Endothelial Function

2006-06-17T11:37:00.000-07:00