Dr Philip Lee Miller

The Pandemic of Fear

Sun, 18 Oct 2020 20:27:58 GMT

Philip Lee Miller, MD, Editor in Chief

The Pandemic of Fear

So here we are 10 months into a worldwide pandemic. How are we doing? How was public policy formulated? How is it being implemented today? We can be ruled by fear or we can be ruled by reason and example. Fear is the coinage and watchword today. Fear destroys our capacity for critical and rational thinking and decision-making. You know the old expression, “I was so nervous I couldn’t think straight.” That is where we are today. Pursuing The Middle Path.

My pick for one of the all-time great football coaches was Bill Walsh of the 1980’s 49ers. He always scripted the first 15 plays. Everything by the book for the first 15 plays. Then he would reassess based the opposing team’s read and creative reaction. Reassess, call new plays based on today’s game. Here is where we are today. However we got here, despite all missteps, what do we do now going forward?

When I hear politicians say, “let’s follow the science” I say ridiculous. There is no such thing as “the science.” Science is a messy affair. Science is a method of inquiry and derivation of truth in the world. Science is the alternative to myth, superstition and belief. It is a matter of developing hypotheses testing all possibilities, including counterintuitive possibilities and deriving conclusions based on the results of rigorous testing.

Dissenting viewpoints

There is a definite air of medical arrogance from Dr. Fauci and the CDC. This has not been a fair and open debate. Dissenting views and approaches have been censored and arrogantly dismissed. We shun the courageously crafted Swedish approach.

My glimmer of hope is the Great Barrington Declaration. You should fully read this statement by three highly respected academic epidemiologists.

Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations.

Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.

Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.

We will return to this in a minute.

The Total Picture

So it is time for reassessment. What we are doing is not comprehensive. We are not looking at the total picture. It is a series of fitful and reactive decisions. It started with unrealistic and wildly pessimistic assumptions from Prof Neil Ferguson of Imperial College. We have not anticipated the unintended consequences — the collateral damage. As I have said from the very beginning:

The fallout from our decisions and public policy will dwarf the virus.

Please watch my Covid 19 video. From beginning to end. You cannot scan it.

Bottom line. Highly communicable. Low virulence. Please understand this. It is not about “cases.” That is the daily drone.

Contrary to what you hear, this is not the worst pandemic in our lifetime. AIDS has claimed the lives of 35,000,000 people worldwide. 1,000,000 people die of tuberculosis, worldwide every year. More people, and especially teenagers, have taken their lives in suicide since the beginning of this pandemic. Watch Childhood 2.0. Most hospitals are actually underutilized not over utilized. Cancer diagnoses, treatment and elective surgeries are being subordinated and delayed. Homelessness is on the rise. Airline travel down 90%. And the entire restaurant business endangered.

There is a Middle Way

What do we know about this virus? Quite a bit. But it eludes public policy. And it has degenerated into hopeless hyper-political hyperbolic rhetoric. If you are on the Blue Team, you are all for masks and severe restrictions. Protect me at all costs. If you are on the Red Team you don’t believe in masks or restrictions. “Don’t tread on me.”

So here is the first problem. So much of today’s discussion and debate is a series of binary choices. It’s Pink Floyd’s Us or Them.

Us (us, us, us, us) and them (them, them, them, them)
And after all we’re only ordinary men
Me
And you (you, you, you)
God only knows
It’s not what we would choose (choose, choose) to do (to do, to do)

Carl Sagan, in his wonderful book the The Demon Haunted World:Science as a Candle in the Dark lays out a series of logical propositions. In Chapter 12: Baloney Detection he talks about the excluded middle or false dichotomy – considering only 2 extremes in a continuum of intermediate possibilities. We are looking for simple answers. Science is more messy. It takes time. It takes testing. Thesis, antithesis, synthesis.

The most salient warning Carl Sagan gave us:

Arguments from authorities carry little weight – “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.

And, finally, watch this a stunning interview with WHO special envoy, Dr. David Nabarro. He was former Special Adviser to the United Nations Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change; He is now advocating the Middle Way. A more sustainable path that avoids all the economic strife and dislocation that we have been suffering.

We need to change course! Lock-downs do not work. It only amplifies human suffering.

Are Masks Protective?

If you will remember early during this pandemic there was a raging debate about the shortage of ventilators. Do you hear this plea or argument any longer? No. Then you were hearing a cry for PPE – personal protective equipment. Masks and other garments. There was a unholy shortage. Why? And then there was no longer shortage. In fact, probably a surplus. So what is the actual science of masks? This can become quite technical. And we can talk about the finer points of aerosolization, micro-droplet size, and N95 masks etc.

In the end, there is no good definitive scientific evidence that masks are fully protective. It is just another assertion.

If masks are fully protective, then why do we need to wear masks and socially distance at the same time? Why are health workers still contracting Covid 19 if they are fully protected by masks and gowns and gloves?

A mixed message

If masks are fully protective why do we walk down the street wearing a mask, but alongside is a row of restaurant tables with people not wearing masks? Since you cannot wear a mask while eating. In other words, worry about the virus in one lane, but not in the adjacent Lane.

Masks have become overly politicized. Another example of the Blue Team promotes masks. The Red Team shuns masks.

The best you can say, in the end, is masks have some utility. That’s it. That is a qualitative and not a quantitative statement. It is better than nothing. Let me repeat. It’s better than nothing.

You see people wearing masks in the center of a field. You see people wearing masks driving around in cars.

Most unfortunately, masks have become a scarlet letter. Subject to vitriolic and self-righteous indignation. Why is it that person not wearing a mask? He is a super spreader. There is a self-righteousness that supersedes rationality.

Back to the Future – The Middle Way

Just to round out this story line read How to Survive a Pandemic by Michael McGregor. Among other voluminous sources he cites the former WHO Director of Communicable Disease Surveillance Response,

history has told is that no one can stop a pandemic.

Is this true or not?

Further, he quotes,

but experts feel that not only would quarantines be wholly impractical and ineffective, they would make matters worse.

To which I fully agree.

The World Health Organization recommends against such measures, in part, given the impracticality of enforcement.

Amplifying Dr. Nabarro’s recent WHO statement and interview.

And finally, he quotes

following the 1916 polio epidemic in New York City, the head of the health department wrote that given the “countless instances of inconvenience, hardship, yes real brutal inhumanity which resulted from the application of the general quarantine, it was no wonder that so many people developed a real and most perverse ingenuity in discovering automobile detours.”

The point of McGregor’s book is, this pandemic is a dress rehearsal for a future pandemics of much more serious proportions involving the H5N1 flu virus. Really? Whoa!

So What Can You Do Now?

All disease is a host response. It’s not the virus as much as how you respond. It’s up to you to enhance your own internal health, well being and immune vigilance. This simple suggestion and admonition is so sadly missing from current public debate and policy enforcement. This is about personal responsibility and action.

The Warp speed Vaccine is not going to stop this pandemic. It is not going to save you. Remdesivir is not saving lives. Flu vaccines do not save lives.

In fact, kind reader, if you have read this so far, your chances of contracting serious illness from this virus is vanishing small.

This is insane

This is not a pandemic of childhood or younger adults. Send all children back to school immediately. Open up all restaurants and travel.

Reason (his pen name) suggests in this weeks FightAging.org Covid-19 as a disease of aging.

Stop all these country to country and state to state restrictions. We are going to have to learn to co-exist with this virus. It is like a wild land forest fire. Fire fighters know a simple fact. All they can do is contain a massive fire. Only nature eventually stops and ends massive wild land fires. So too with massive world wide pandemics.

Turn off the news. It’s no longer news. It’s groundhog day over and over. 7-8 hours sleep. Get some fresh air. Some exercise. You can safely visit your friends, children and grand kids.

Daily immune enhancement:

Vitamin D 5000-10,000 units daily
Zinc 30 mg daily
Selenium 200 mcg daily
High quality protein

And finally don’t buy into the frenzy of widespread media sensationalized fear. Strive for courageous and kind actions.

Philip Lee Miller, MD
Carmel, CA Oct 2020

The post The Pandemic of Fear appeared first on Dr. Philip Lee Miller by Philip Miller.

CoronaVirus: The Unintended Consequences

Sun, 05 Apr 2020 04:17:25 GMT

Philip Lee Miller, MD, Editor in Chief

The Set-up

CoronaVirus aka SARS-CoV-2 aka Covid-19. It has become everything. It has consumed our daily lives. The constant daily, nay hourly, haranguing of “breaking news.” The media talks about nothing else. As if life had stopped. I want to give you a different view and projection. A medical / epidemiologic / economic view. A more global and comprehensive take. The view from 10,000 feet as it were. This is going to be a longer blog.

This Virus is Striking High Density Cities

Is there a Middle Path? We know the stories about China, Italy, and now the United States. When in reality, statistical analysis tells a more sophisticated story. It is never black-and-white. In China 80% of all cases were in the city of Wuhan – Hubei Province. Virtually no cases in Beijing or in Shanghai. In Italy the vast majority of cases were confined to Lombardi. And now the United States, the vast majority of cases are confined to New York City. What is common to all of these? High density populations. In fact, there is a paucity of cases and fatalities in the entire Southern Hemisphere.

Background Resources and Historical Perspective

I want to give you more specifics about this CoronaVirus with a list of resources and technical details. This is a variant of the CoronaVirus group which has been well studied since the 1960’s. It is not new. The current mutation is the Novel CoronaVirus, SARS-CoV-2. The disease caused by this virus is Covid-19. Do you remember the SARS and MERS epidemics? Sudden Acute Respiratory Syndrome.

Let’s revisit my previous blog by putting this in proper historical perspective. This pandemic is here. It is worldwide. It is real. It has been predicted. But we must see it in perspective. Because you are being overwhelmed and I want you to see some daylight and hope.

This is not to ignore or in any way diminish the current suffering or stresses on our health delivery systems. But the world has suffered from far greater pandemics and plagues in the past. Watch this brief YouTube video from South Front – a necessary overview. You can barely see Covid-19 in this graphic. It’s like comparing Mercury to the Sun. You will have a difficult time even finding Covid-19 in this graphic.

Now look at another fine series from The VisualCapitalist worth bookmarking. It illustrates the same. Just how massive previous pandemics and plagues have engulfed the world.

And here is an up-to-the-minute link for real-time stats from WorldOMeter.

Finally, another long video graphically detailing the apocalyptic Spanish flu of 1918, following the end of World War I. It was a time of massive troop movements between America and Europe associated with widespread poverty and the devastation of war throughout Europe.

Why am I showing you all the videos links? To give you a sense of how pervasive and absolutely devastating prior pandemics were.

So why are we so fearful? How did we become so subordinated, freaked out and frantic over this current pandemic, as opposed to previous pandemics that were manifestly larger and more deadly?

Because we are overwhelmed with a sense of the unknown. Heightened by a pervasive media and social amplification. We are developing an entirely new lexicon. Newspeak. Social distancing. Shelter-in-place. We want zero risk in our daily lives.

The Bottom line: this is still a minor pandemic compared to the Black Death Plague of 1348, or the Spanish Flu Pandemic of 1918, and even more recent epidemics such as the cumulative deaths worldwide from HIV/AIDS.

What Exactly is this CoronaVirus – SARS-CoV-2?

SARS-CoV-2 originates from an animal vector – bats. We suspect it travels to Pangolins whose scales are prized in Traditional Chinese Medicine. Then humans are infected. That seems to be characteristic of so many modern flu-like and viral pandemics. Jumping from an animal reservoir to humans. Like swine flu, bird flu, SARS (civet cats), MERS (camels) and now Covid-19.

We know that this virus spreads rapidly. Scientifically and epidemiologically we look at R₀ values, how many people are infected by a single person. In other words, its multiplication factor. The ideal is R₀= 1. That flattens the curve. The current R₀ is assumed to be about 2.5. But these numbers are estimates, subject to complex differential mathematical models. We do not know how accurate these models are.

80% of all cases are considered mild cases. That is the source of herd immunity. Let me return to this concept later.

This may be a sidebar but highly recommended. If you really want to know the science beyond the headlines here is the best lecture series I have seen. He explains and shows you all aspects of this viral origin and pandemic spread. It is produced by Ninja Nerds, an unlikely face of academic knowledge. But if you watch this Ninja Nerds series on Covid-19 you will learn everything you need to know about the epidemiology and the pathology of this virus. You will be well schooled after finishing this series.

Controversies in Containment Strategies

I always look at the outliers. Why are there so few cases in India, Australia, Africa, South America, and Scandinavia? And why the differences in approach? We are told the approach in China and in Korea was draconian. Cell phones were being monitored. And yet look at this recent story showing Korea did not shut down their entire economy like we have.

from NPR news:

How South Korea Reined In The Outbreak Without Shutting Everything Down

“We’ve seen examples in places like Singapore and [South] Korea, where governments haven’t had to shut everything down,” said Mike Ryan, head of the World Health Organization’s Health Emergencies Programme. “They’ve been able to make tactical decisions regarding schools, tactical decisions regarding movements, and been able to move forward without some of the draconian measures.”

An article in Science:

Mathematics of life and death: How disease models shape national shutdowns and other pandemic policies

“Long lockdowns to slow a disease can also have catastrophic economic impacts that may themselves affect public health. “It’s a three-way tussle,” Leung says, “between protecting health, protecting the economy, and protecting people’s well-being and emotional health.”

“I’m not really sure whether the theoretical models will play out in real life.” And it’s dangerous for politicians to trust models that claim to show how a little-studied virus can be kept in check, says Harvard University epidemiologist William Hanage. “It’s like, you’ve decided you’ve got to ride a tiger,” he says, “except you don’t know where the tiger is, how big it is, or how many tigers there actually are.”

And more from the New York Times. Dr. Katz is president of True Health Initiative and the founding director of the Yale-Griffin Prevention Research Center.

Is Our Fight Against CoronaVirus Worse Than the Disease?

“So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild CoronaVirus infections, while medical resources could focus on those who fell critically ill…

A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible. With each passing day, however, it becomes more difficult. The path we are on may well lead to un-contained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.”

If you are still with me, you will find this YouTube with Dr. Jay Bhattacharya, professor of medicine at Stanford University most enlightening. Subsequent to his editorial in the Wall Street Journal. He is asking the right questions. Is our draconian approach based on faulty assumptions?

Sweden and Holland have taken a different approach. What I call the middle path. Isolate and quarantine known cases. That is what is traditionally done. That is how you treat infected patients in a hospital. Isolate and contain.

Adverse Consequences of Flattening the Curve

What has been missing in the United States is the mobilization of a centralized strategic plan. It was all in place. Now we have a patchwork of federalized responses. These are tactics, with states scrambling for limited resources. This is not a strategic plan, which flows from a designated and recognized incident commander. What we used to call a Czar. One who directs and executes the strategic plan.

Dr. Anthony Fauci is a vaunted virologist and epidemiologist. Epidemiologists are not policymakers. He should not be the face of this pandemic.

There are some very sophisticated models of viral spread based on R₀ values. This is illustrated below, with an animated graphic. Here is the link the more interactive dynamic graphic model. Please take the time to play with the interactive graph for a few minutes.

If you look at this model of increasing isolation (shelter in place) 3 critical questions arise. What is the goal?

Reduce all cases – incidence?
Reduce and mitigate hospitalizations and stress on our entire EMS system?
Reduce and mitigate fatalities — mortality rate?

Containment Duration — Light color is incidence, medium color is hospitalizations, dark color is fatalities

The answer to each of these questions might lead to entirely different strategic plans.

The incidence decreases the most. Then you see a decrease in hospitalizations. But the mortality rate decreases the least.

Our Ultimate Goal in Increasing Herd Immunity

As counter-intuitive as this may appear, decreasing the case incident rate may have negative consequences. Our goal with natural wild type immunity antibody production vs. acquired immunity through vaccination programs is to increase “herd immunity.” That is, increase the greatest number of people who have been exposed to a virus and are now immune. They can no longer spread the disease to other people. It is a firebreak. The current policy of “dampening the curve” actually diminishes herd immunity. In the long run, that is the real goal. That is what prevents the spread – enhancing herd immunity.

Dampening the curve will lower the incidence of new cases, lower hospitalizations, and slightly lower fatalities. But lengthening this curve is at the expense of prolonging economic and financial distress. That is the key concept. That is why you are seeing Congress hurriedly passing historic and unimaginable emergency legislation. Remember Andrew Yang’s promise to give us each $1000? How ridiculous that sounded? Here we are.

What is missing from these epidemiologic models is a balance between containing the viral spread and prolonging economic dislocation and total financial/economic collapse.

The Economic Fallout will Dwarf the Medical Tragedies

We will see a rise in unemployment to historic levels. Look at this graphic representation of the most precipitous DJIA slide in the stock market in history. Even if you have no interest in the stock market or have nothing invested, it is an indicator of financial distress and a prediction of economic calamity.

The more important statistic is the VIX indicator. The VIX is a measure of volatility — of panic. And this level is equal to or greater than 2008. It is a perfect storm with other indicators that I will leave to later.

What is the point? It is a plea for a middle path. What is the least amount of time of widespread quarantining vs. a disastrous total shutdown of local commerce, business and economic vitality? This cannot go on much longer. So many small businesses will fail as unemployment figures skyrocket.

This will exceed our experience of 2008. The economic consequences will eventually dwarf the medical consequences.

Prevention, Treatment, and Therapeutics

This is what all my patients are asking. What can I do for prevention? What can I do if I become sick?

The most important set of preventatives is concentrating on your optimal health and immune support. 7 to 8 hours of sleep daily. Some degree of day exercise. Healthy eating. Decreasing carbohydrate intake. Increase in your protein intake. A good nutritional supplement program. This includes adequate a quality multivitamin, Vitamin D, Vitamin K, extra selenium, extra zinc, and a good probiotic at the very least. All my patients are taking much more. as part of a robust daily routine.

Good hormonal balance, which includes optimal thyroid balance. Thyroid is the seat of your immunity.

I am not convinced that wearing masks are effective. The most effective N95 masks are in short supply and should be saved for medical workers. Washing hands and possibly wearing surgical gloves may be beneficial. I have always been wary of ATM pin pads and handle bars on shopping carts. These are simple precautions that are easy and beneficial. Avoiding all possible contaminated surfaces.

I now recommend stop watching the news! It is no longer healthy, educational or informative. You will see your stress levels fall immediately. Watch all your old favorite movies or all those new ones you have not seen yet. Read more. Take the time to do those things you have been putting off for years.

There is no definitive drug treatment for this virus except for pulmonary support, fluid resuscitation, and some possible advanced therapies directed to the loss of alveolar surfactant and accumulation of alveolar consolidation.

Many of you have asked me about the combination of Chloroquine and Azithromycin. There have been very limited studies that show some promise. But these are more anecdotal. Although I personally favor empirical approaches to medical problem solving, I do not support the use of these drugs for casual and unsupervised use. This combination should be limited for very sick hospitalized patients.

There are a number of problems with Chloroquine. Hydroxychloroquine (Plaquenil) is less toxic than Chloroquine. And in the mad rush to sequester and hoard Chloroquine or Hydroxychloroquine you are stealing vital medications from patients with advanced rheumatoid arthritis, lupus, scleroderma, or CREST syndrome who rely on these drugs for their significant disease modifying benefit.

And by the way, behind the scenes, there are conflicting policy decrees. The CDC is trying to approve “off label” use of Chloroquine and Azithromycin for life-threatening disease. On the other hand, the Medical Board of California has issued warnings that physicians using these drugs off label are being warned. We do not know whether that includes sanctions or some other bureaucratic intervention. It all muddies the waters further.

It is very interesting that in the medical profession, we have been chided for the last 20-30 years not to use antibiotics for viral syndromes. The standard dogma is “antibiotics do not treat viruses.” And yet the addition of Azithromycin is now being advocated as an adjunct. There are some theoretical aspects of Azithromycin and Chloroquine enhancing zinc absorption which enhances antiviral activity.

There is also a theoretical discussion in medical journals regarding the potentially harmful effect of ACE inhibitors and ACE blockers. This would include Lisinopril, Vasotec, Cozaar (Losartan), and Valsartan (Diovan) to name a few. It is postulated that the CoronaVirus modulates ACE receptors to facilitate viral penetration and cellular infection. This ultimate effect of this mechanism is an unknown at this time. But you may hear various discussions regarding this mode of activity.

I fall back on my anti-viral routine which has been successful in the past. At the very first sign of any viral infection. I highly recommend:

Vitamin D 50,000 units for five days.
Astragalus 1000 mg daily for five days.
Thymic protein A (Pro boost) 2 packets 3 times daily for 5 days

Now having made that recommendation, I am seeing major backorders for virtually all nutritional supplements and most especially, zinc, Astragalus and Pro boost. My recommendations still stands as soon as they are available.

In Summary:

It did not have to be this draconian. So many missteps and failures of leadership. But here we are.

One more quote from Max Brooks, son of the great Mel Brooks and Author of World War Z :

I think right now we have to be so careful about who we listen to, because panic can spread much faster than a virus. And I think in addition to social distancing, we have to practice good fact hygiene.

Take care of your own health. Don’t watch the news any longer. Watch great movies. Be with your family. Read my past blogs on nutritional routines. Support clear thinkers. You will be OK.

Send me a list of your favorite movies or books. Every one will have their own. If enough people respond I will publish later.

For sure another CoronaVirus blog will follow soon.

Philip Lee Miller, MD
Carmel, CA
April 2020

The post CoronaVirus: The Unintended Consequences appeared first on Dr. Philip Lee Miller by Philip Miller.

Influenza and CoronaVirus: A Thoughtful Response

Tue, 03 Mar 2020 21:29:18 GMT

Philip Lee Miller, MD, Editor in Chief

How should you respond to the spread of the Coronavirus? Renamed COVID-19. What is the most rational and sane response? Should we close off all the borders? Should we cancel all conferences and outdoor events? Should we cancel the Olympics? What is the real prevalence and mortality rate? The answer: this is a time for vigilance, preparation, with calmness.

This is your grand sweep of time overview. This series will be updated as this is a fast moving story.

CoronaVirus Requires Organized Incident Command

Great leaders exhibit calmness and reassurance while at the same time exhibiting the qualities of a effective incident commander. That is how massive wild land fires are fought. An incident commander is identified and the command structure is assembled. Plans are coordinated and executed purposefully with determination.

So the problem with the Coronavirus is the fear of the unknown. In the end this will portend far greater economic, commercial and societal consequences then epidemiologic or medical outcomes. We have already seen a precipitous fall in the stock market, amounting to 3-6 trillion dollars in paper losses. It will rebound, but will fall again.

We should heed the words of Franklin Delano Roosevelt. The only thing we have to fear is fear itself. You will not die. You simply need to take modest precautions.

Disease Outbreaks — Four Horseman of the Apocalypse

We are always faced with the Malthusian Four Horsemen of the Apocalypse. War, famine, pestilence and disease. They will never fully disappear.

Throughout all of human history we have witnessed great epidemiologic challenges and disasters. Leprosy, tuberculosis, the plague (the Black Death), smallpox, the pandemic flu of 1918, AIDS, SARS, swine flu, MERS, Ebola virus and now Coronavirus. It will never end.

There were numerous recurrences of the plague through out the middle ages. The worst in 1348 where an estimated 40% of population throughout Europe succumbed. That must have seemed like the end of the world. It was centuries before the germ theory of contagious disease. No one knew the source. So there were religious incantations. There were whole groups who were shunned or dispossessed. And then it stopped.

Half of Paris’s population of 100,000 people died. In Italy, the population of Florence was reduced from 110,000–120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished,^[81] and a similar percentage of Londoners may have died from the disease as well.^[67] In London approximately 62,000 people died between 1346 and 1353.^[19] — Wikipedia

During the Spanish flu Pandemic of 1918, it is estimated that nearly 1/3 of the world’s population contracted the flu. More than 500,000,000 people. It followed the end of WWI, with mass troop movements. With massive shifts in human populations. The flu actually lasted 2 years. There was a ping-pong effect between America and Europe. The stories are legion of physicians working around the clock, tending to patients without antibiotics or antivirals as we have today. That also was a draconian period of time.

But we survived.

Annual Influenza Review

Each year I compose a blog detailing the ineffectiveness of the influenza vaccine, because the flu mutates each year. The vaccine is always based on last year’s virus. It is always a guess. Effectiveness varies between 10-60%. But a more detailed look at vaccine effectiveness shows a distinct stratification according to age. Where the effectiveness of the vaccine is even dramatically less in older and frail individuals. That is why we are now giving triple or quadruple strength vaccines to older individuals.

And currently the number of fatalities from the flu, even this year, far exceeds the Coronavirus. But the flu has become displaced as the topic du jour.

Furthermore, even last week a detailed look at the viral spread in China is quite revealing. At least 80% of all cases originated in one province. From Wuhan. Virtually no fatal cases in Shanghai or Beijing. High density populations where you expect higher incident and mortality rates. You never hear about this. And with draconian infection control the rate of spread is beginning to diminish.It’s interesting a whistleblowers complaint about known Coronavirus patients disembarking from a ship in Vallejo may have been the source of the recent death. But what about all of the unprotected team members who were sent home? As far as we know none of these have succumbed.

In the end all viral and bacterial infections are a host response. If you are healthy and vigorous, your chances of contracting any illness are diminished. Those that are older and frail are more subject to pneumonia and perishing.

I am not reassured by the current administration’s haphazard and amateurish approach. This appears to be a Keystone Cops approach. There are some stars. Dr. Anthony Fauci is highly respected at the CDC.

Treatment Modalities

So here are my annual recommendations.

These were formulated for the flu but may pertain to the Coronavirus. Influenza vaccines are ineffective. Anti-virals such as Tamiflu and Relenza have immediate value if taken within the first 48 hours.

My recommendations each year are effective. [Although the usual FDA disclaimers for advocating treatment therapies are acknowledged.]

At the first sign of the flu or any viral syndrome:

50,000 units of vitamin D daily for 5 days.
Astragalus 1000 mg daily for 5 days.
Thymic protein A (ProBoost) 1-2 packets 3 times daily for 5 days.

The effectiveness of vitamin D against viral syndromes is well demonstrated. Similarly should there be any doubt of high dose vitamin effectiveness, the only known cure for severe life-threatening measles is – vitamin A.

Wash your hands. As Ignaz Semmelweis demonstrated the latter half of the 19^th century, washing the hands prevents dissemination of disease. He was able to decrease the rate of postpartum death (Puerperal Sepsis) from 40% to 5% simply by washing hands.

Stay calm. Get plenty of rest and sleep. Don’t panic.

Let me know your own observations.

Philip Lee Miller, MD

Carmel CA

March 3, 2020

The post Influenza and CoronaVirus: A Thoughtful Response appeared first on Dr. Philip Lee Miller by Philip Miller.

Telomeres, Telomerase and Senolytics

Mon, 21 Oct 2019 19:58:55 GMT

Philip Lee Miller, MD, Editor in Chief

Telomeres, telomerase and senolytics is ushering in a new era of longevity medicine and vital health. These are exciting times.

In 1994 the first ever world conference on Anti-Aging Medicine was held in small “off the strip” hotel in Las Vegas. An exciting prospect under the auspices of American Academy on Anti-Aging Medicine (A4M). The goal of that time was to aggregate the best of medical science and information into a cohesive body of high-tech preventive medicine. With the aim of prolonging life and health span. It was a heady proposal with its share of critics. It was the beginning of a new paradigm.

So many terms have been used over the years, including Integrative Medicine, Complementary Medicine, Functional Medicine, Anti-Aging Medicine, Age Management Medicine and Longevity Medicine. They share one common goal. Improving optimal health and well-being and increasing a healthy lifespan — HealthSpan.

It is all based on optimizing physiological function and cellular health and vibrancy. Through the use of micronutrients, vitamins, minerals, hormone replacement therapy, rational and scientific approaches to exercise, our focus has always been directed toward a higher goal.

Nutritional Medicine Pioneers

There have been a series of widely acclaimed nutritional constructs. Starting with Nathan Pritikin and Julian Whitaker’s advocacy of complex carbohydrates, to Michael and Mary Eades advocacy of high-protein diets (Paleo), to Dean Ornish vegan diets, to low carbohydrate diets most successfully advocated by Robert Atkins. Enter David Asprey of Bulletproof fame with refinements and banner success. Each rock star has held center stage in their time.

So where are we today? The current consensus is a low carbohydrate, ketosis generating diet with healthy fat intake as the most beneficial pursuit. This can be elaborated elsewhere.

The Holy Grail throughout human history, has been the search for eternal youth and immortality. The Shangri-La effect. In the modern age, we have been seeking “the master controller” of aging. Does this exist? Is there one gene or one gene locus that controls aging? We are closer to some vital answers. And our efforts have increased dramatically in the last 20 years and even more so in the last 3 to 5 years.

We have shifted from Anti-aging Medicine to full Regenerative Medicine. What I term Anti-Aging 2.0. A shift from high-tech preventive medicine to truly regenerative therapies. Now what form does this take?

Epigenetics Controls our DNA

Since the discovery of the structure of DNA by Watson and Crick (which should have been Linus Pauling and Rosalind Franklin), we have all been inured in the concept that genetics controls everything. But are we slave to our genetics? The answer is no.

The concept of nature or nurture was used to explain why genetics is not the master arbiter. Or incomplete penetrance with age. But exciting re-thinking of genetics has led to the new field of Epigenetics.

We now know our DNA is merely a blueprint. A blueprint alone cannot build a house or skyscraper. Architects, general contractors and workers execute the master blueprint.

So the field of epigenetics is an effort to explain how various interactions and signaling processes turn on or off master genetic controllers or suppressors. And … who controls the controllers?

The most important concept to keep in mind is balance throughout our life. There is always the process of “blastic” vs. “clastic” activities. A blastic activity build muscle and bones whereas is “clastic” activities clear away old dead tissue. Our bones throughout life are constantly being remodeled. Hormones must be balanced.

This higher level of balance throughout life is delicately controlled by repressor or suppressor genes or expressive genes. As we age, this balance is subject to environmental and psychological stress, foods, EMF, chemicals, inflammation, oxidation and glycation. Such is our modern environment.

Telomeres and Telomerase Hold Great Promise

There are two highly innovative threads of exciting research and experimentation in small innovative groups. Telomeres and telomerase is based on the concept that our DNA loses ability to replicate at a cellular level because of frayed end caps. The telomeres. This explains the vaunted Hayflick limit — that cells cannot divide indefinitely.

Teleologically a specific gene (hTERT) controls the expression of telomerase that can repair these end caps by lengthening our telomeres. It is not normally expressed. It does seem to be expressed in high amounts in tumor cells, but not all. And it is expressed in the germ cell line — the immortal cells that we pass from generation to generation.

Senolytics — Clearing Senescent Zombie Cells

At the other end is a highly dedicated group of experimenters and researchers in the rapidly expanding field of senolytics and senescent medicine. Ergo the SENS project by Aubrey de Grey. Based on the concept that as we age, we accumulate more and more “zombie cells”. These are senescent cells that lose vital function, but “hang around” expressing inflammatory and potentially toxic influences.

If we could only clear these senescent cells, the current thinking is revitalization and growth of healthy, normal cells is enhanced. This is a simplified view worth expanding in later blogs.

Mayo Clinic Research with Dasatinib and Quercetin.

The Mayo Clinic has conducted seminal research and experiments with Dasatinib and Quercetin (D&Q) in mice studies showing significant repair of the aging process. Further work with senolytics has been carried out at the Buck Institute in Marin. Now we know there are additional Senolytic agents including Fisetin and Rapamycin. When used in small doses at infrequent intervals, experiments have shown either age regression or repair of aging effects.

Telomerase and Senolytics – A Unified View

The most elegant approach to synthesizing these major trends and pathways is to visualize a continuum. Combining the effects of telomeres, telomerase and senolysis.

adaptation with kind permission from Michael Fossel of Telocyte

As we age, there is a critical time that no one has specifically identified where genomic instability is most critical. I think this is probably at age 50-60 years of age. At this critical juncture cells could be rejuvenated with telomerase inducers or senolytics, thereby preventing cancer progression and enhancing regeneration and rejuvenation. I want to thank Michael Fossel for the kind use of this most powerful graphic. His work at Telocyte is really exciting. Start by reading his latest book — The Telomerase Revolution. And even today more late breaking stories from Marie Blasco’s lab in Madrid

I am synthesizing this unified theory and vision of age regression and regenerative therapies. Can we now think about living to 120 or more? What are the challenges? You can start by reading the weekly blog by “Reason”: fightaging.org. Future blogs to expand this discussion in more detail.

Calling all seekers and discoverers. A video production will be available soon.

Philip Lee Miller, MD

Carmel, CA

Oct 2019

The post Telomeres, Telomerase and Senolytics appeared first on Dr. Philip Lee Miller by Philip Miller.

Estrogen and Migraine Headaches

Tue, 06 Aug 2019 20:08:12 GMT

Philip Lee Miller, MD, Editor in Chief

Does estrogen benefit or exacerbate migraine headaches? Common knowledge in the medical literature is that estrogen may increase the frequency and severity of migraine headaches. This has not been our experience.

Estrogen is a vasodilator. And, therefore, should prevent the constricted phase of migraine headaches.

So let me tell you a clinical story. A 52-year-old postmenopausal female patient went to see her gynecologist. On pelvic ultrasound her endometrial (uterine lining) thickness was 4 mm. At her age a “normal” endometrial thickness is <4 mm. Anything greater > 4 mm is considered “thickened” and therefore some cause for concern. It is assumed that her age there is no hormonal stimulation of the endometrium. This requires an expanded discussion.

She was advised to stop her estradiol estrogen therapy. So she weaned herself off her estrogen over 1 to 2 weeks. But then began experiencing an increased frequency of migraine headaches. So much so that she began taking the anti-migraine medication, Imitrex, every day. Now the upper recommended frequency of Imitrex is no greater than 9 tablets monthly. That is because Imitrex is a vasoconstrictive that can cause significant systemic vascular ischemia — lack of oxygen delivery.

And sure enough she began to experience a rapid heart rate with some chest pain. She went to her local emergency room where she was diagnosed as a sudden and new case of atrial fibrillation. She was given some intravenous Diltiazem which should have slowed and reconverted her heart rhythm. This was unsuccessful after two doses. So the attending staff decided she should be cardioverted. This requires sedation and an electrical shock to the chest to convert the heart to a normal rhythm. She was then referred to a cardiologist for further workup.

Needless to say, a dreadful and “shocking” series of events. OK. Pun intended.

I have postulated over the last 25 years that the final common pathway of estrogen is choline production. Choline is vagotonic. That will slow the heart and increases normal and healthy secretions. During menopause estrogen levels decline and so do choline levels. The body reactively increases dopamine levels. This is what we call a sympathetic discharge. This is experienced as hot flashes, night sweats, nervousness, anxiety, cognitive difficulties, itching and in this case cardiac arrhythmias. All of these have been reported in postmenopausal women in their fifties.

We reinstituted her estradiol patch, changing every 3 days to maintain adequate levels. And in this situation prescribed very low dose Inderal – a beta blocker.

The headaches have ceased. An unfortunate situation where estrogen withdrawal was not indicated and led to a series of rather distressing and significant consequences.

Lessons to be learned. Estradiol estrogen has over 400 vital functions.

Philip Lee Miller, MD

Carmel, CA

Aug 2019

The post Estrogen and Migraine Headaches appeared first on Dr. Philip Lee Miller by Philip Miller.

Relative Risk vs Absolute Risk Reporting

Mon, 27 May 2019 03:59:45 GMT

Philip Lee Miller, MD, Editor in Chief

I have written often and spoken repeatedly to so many of my patients about relative versus absolute risk. This is so widespread in the medical literature, scientific literature and even in all advertising. I am always waiting for that “aha moment” when you understand how relative risk management is chicanery. It is used to sell you product. To amplify, inflate or conflate results.

I am prompted to write this blog by a recent meta-analysis published in JAMA Neurology May 13, 2019 with the title Frequency of Intracranial Hemorrhage With Low-Dose Aspirin in Individuals Without Symptomatic Cardiovascular Disease A Systematic Review and Meta-analysis. Sounds ominous, doesn’t it? Low-dose aspirin, increasing the risk of brain hemorrhage? Especially to all of you are using low-dose aspirin (81 mg) as a preventive measure.

In June 2015, I had previously published on my own analysis of all the major statin studies showing negligible benefit. So let’s expand upon this discussion. Let me bombard you with numerous examples.

Analyzing Statin Studies and Efficacy

My favorite reference is Calculated Risks by Gerd Gigerenzer. This is such a powerful book. Simply stated and elegantly presented examples of the misuse of risk analysis, and other statistical games. Let me quote briefly from his analysis on use of Pravastatin — a commonly used statin for “prevention of cardiovascular disease.”

“Absolute risk reduction: the absolute risk reduction is the proportion of patients who die without treatment (placebo) minus those who die with treatment. Pravastatin reduces the number of people who died from 41 to 32 in 1000. That is the absolute risk reduction is 9 and 1000, which is 0.9%.

Relative risk reduction: the relative risk reduction is the absolute risk reduction divided by the proportion of patients who die without treatment. For the present data, the relative risk reduction is 9÷41, which is 22%. Thus, Pravastatin reduces the risk of dying by 22%

The relative risk reduction looks more impressive than absolute risk reduction. Relative risks are larger numbers than absolute risk and therefore suggest higher benefits than really exist. Absolute risks are a mind tool that makes the actual benefits more understandable. – Gerd Gigerenzer

This really drives the point home. Exactly as I had previously written.

Low Dose Aspirin and Intra-Cranial Hemorrhage

Now let’s look at the recent JAMA Neurology 2019 article.

I will quote the results showing relative risk ratios (RR). Hazard ratio (HR) is nearly the same measure often quoted. A RR or HR value of 1.5 = 50% increased risk. Either of these are the most commonly cited statistics in all the medical studies.

Here is an abstract of the results of the study. And so frequently that is all you will see and believe. Because most people, including even most physicians, will not read or analyze the paper. We are too busy.

RESULTS: The search identified 13 randomized clinical trials of low-dose aspirin use for primary prevention, enrolling 134,446 patients.

Pooling the results from the random-effects model showed that low-dose aspirin, compared with control, was associated with an increased risk of any intracranial bleeding (8 trials; relative risk, 1.37; 95%CI, 1.13-1.66; 2 additional intracranial hemorrhages in 1000 people), with potentially the greatest relative risk increase for subdural or extradural hemorrhage (4 trials; relative risk, 1.53; 95%CI, 1.08-2.18) and less for intracerebral hemorrhage and subarachnoid hemorrhage.

CONCLUSIONS AND RELEVANCE Among people without symptomatic cardiovascular disease, use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage, and heightened risk of intracerebral hemorrhage for those of Asian race/ethnicity or people with a low body mass index. — Meng Lee et al

The key phrase here is overall increased risk.

So let me excerpt just one portion of data from the study to show you why the conclusion is inaccurate and essentially bogus. The true incidence was tiny. So relative comparisons are nearly meaningless.

Pay attention to the extreme right hand column, highlighted in yellow, which shows my added absolute risk. This column is absent from all medical papers.

Relative vs Absolute Risk Graphic

Now let me illustrate even more graphically. It is all dependent on the sample size and true incidence. What is the difference between relative and absolute risk or statistics with a sample size of 10, 100, or 1,000? It is the entire story. This first graphic shows a relative risk reduction of 50% across 3 sample sizes. The large yellow arrow shows an equal risk reduction across these sample sizes.

This is how they fool you. The relative risk reduction is independent of the sample size.

Now let’s look at the absolute risk reduction across these 3 sample sizes.

It should become much clearer. The absolute risk reduction (large yellow arrow) becomes almost invisible as the sample size increases. That is the take-home message today. Absolute risk reduction is entirely dependent on the sample size and incidence. It is also, incidentally, what is necessary to determine the “numbers needed to treat (NNT).” How large a sample size is necessary in order to arrive at meaningful results? To find at least one event.

Poor Medical Reporting

I had previously quoted work by the highly respected Douglas Altman, D.Sc., in a short editorial in JAMA 2002. Where he writes:

there is considerable evidence that many published reports of randomized controlled trials (RCTs) are poor or even wrong. Despite their clear importance. The results of several reviews of published trials briefly summarized in table 1. Poor methodology and reporting are widespread. — Douglas Altman, D.Sc.

He was such a tireless advocate of improving medical reporting, improving peer review and exposing the inadequacy of most published papers.

Two months months later in the Aug 2002 Scientific American, Benjamin Stix quoted this erudite statistician with his own comments on poor medical reporting. Essentially lambasting (or exhorting) the entire medical literature community

MEDICAL REPORTING
Only the Best

Advertising campaigns routinely hype the most flattering claims to sell their products. Evidently so do papers in medical journals. Researchers at the University of California at Davis School of Medicine found too much emphasis given to favorable statistics in five of the top medical journals: the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Annals of Internal Medicine and the BMJ. The study, which looked at 359 papers on randomized trials, found that most researchers furnish a statistic only for “relative risk reduction”–the percentage difference between the effect of the treatment and a placebo. Just 18 included the more straightforward absolute risk reduction. If a treatment reduced the absolute risk from, say, 4 to 1 percent, it appears more impressive to present only the relative reduction of 75 percent. Researchers also failed to show other statistics that provide a more nuanced picture of the results of clinical trials. The article is in the June 5 Journal of the American Medical Association.(full pdf) —Benjamin Stix [emphasis added for clarity – ed.]

Coda

Those of you who are followers of Dr. Peter Atia have also been treated to this same discussion of risk management, risk analysis, and poor statistical methodology.

So next time you read a headline — drug reduces risk 43%, a vitamin increases risk 14%, this carnow accelerates 30% faster, or whatever, you will have a better appreciation of risk and performance.

“We won’t get fooled again” — The Who

Philip Lee Miller, MD

Carmel CA 93923

The post Relative Risk vs Absolute Risk Reporting appeared first on Dr. Philip Lee Miller by Philip Miller.

Is Your Body Digital or Analog?

Sun, 07 Apr 2019 22:25:16 GMT

Philip Lee Miller, MD, Editor in Chief

We live in a digital age. Do you think of your body as digital or analog? Answer this simple question. Do you wear a modern digital watch or a traditional analog watch?

Why do I ask these questions? Because it shows how you can look at the time and space in different ways. An analog watch does not need to be exact or precise. A quick glance and you know exactly where you are in a diurnal 24 hour cycle. You a relational picture. A digital watch simply gives you a notion. It does not tell you anything in a relation to the day. Your brain takes a few extra steps converting that to a perceived notion.

Similarly, the problem I see constantly, day by day, is labwork with arbitrary lower and upper boundary values. All my patients asked me, “well, is that value normal?” To which I frequently say, “there really is no such thing as normal.” There is only optimal and acceptable. And normal changes decade by decade. Normal for an 80-year-old would not be normal for 35-year-old.

Another easy to understand this analogy is your car. When do decide to pull into your favorite gas station. When is your panic time to fill up your tank? Do you wait until it’s ¼ full? Until it’s 1/8 full? Or wait until the dire warning light tells you only have 20 more miles left before you run out of gas. Just how proactive are you with your car?

You can look at your body in the same way as your automobile. If laboratory values are “low normal” they are low. And will show you something in the following graph. But first, let me expand upon the title of this blog. Are you digital or analog?

Because of time constraints and poor learning habits all lab work is conventionally seen as digital or binary. You are either in the box or out of the box. It’s a very simple calculation. It removes all guesswork, estimates, finesse and discretionary thinking from medical lab analysis. There are capricious cutoff values that are usually set at 1 to 2 standard deviations above the median value. The mistake made by virtually every conventional physician is evaluating values as “in range.”

But lab values represent our human physiology. We are all individuals. And all these optimal values are better represented by skewed binomial distribution curves. Seen as part of a continuum — all the way from low to optimal to high. It is far more physiologic and rational to look at all your lab values as a continuum that fall on a distribution curve. And most often the curve is skewed to the left or right.

This is the basis of Functional and Anti-Aging medicine.

So let’s look at these illustrations taken from my own real data over 12 years. Data from 8000 samples of the hematocrit. That is the percentage of red blood cells in the serum. It is vital for oxygen carrying capacity. A low hematocrit is a measure of anemia. And that is not a healthy state. Re-read my blogs on iron deficiency anemia.

Now let’s say your value is just slightly above the lower cut off with the green stars. But then you rerun the lab today or tomorrow which will always be slightly different and suddenly the value might be just slightly below the lower level cut off with the red stars. In the first instance you are “in the normal range.” In the second instance you are now out of range. What is the difference between these 2 values? Essentially nothing. So the entire practice of looking at lab values in range is neither functional nor rational. You want to be looking at all lab values as an optimized value on a continuum.

So this then is the difference between digital / binary medicine and optimized functional medicine.

Let’s finished with one more example. Vitamin D is one of the few lab tests were values are denoted in more rational ranges.

15-25 ng/ml is deficient.
25-33 ng/mL is insufficient.
33-100 ng/ml is sufficient.
100-150 ng/mL is considered excess.
And >150 is considered toxic.

Although, in reality, vitamin D is never toxic. Another wild misconception that dates back decades.

You can see how much more rational these multiple discrete ranges are.

So when I speak with my patients, we are always looking for optimal values not lab data points that are necessarily in range or out of range. And furthermore, I take a Grandmaster view of laboratory. I look at balances, relationships. I see a picture of overall health or dysfunction. Not a list of disparate lab values.

So that is your challenge. Do you see yourself as digital or analog? Maybe in the next 20-30 years after The Singularity, when we all have various bionic components, the answer to this question might change. My answer for today is — your body is analog.

Food for today’s thought.

Write me with any questions, thoughts or comments.

Philip Lee Miller, MD

Carmel, CA 93923

The post Is Your Body Digital or Analog? appeared first on Dr. Philip Lee Miller by Philip Miller.

Is Cholesterol the Culprit?

Tue, 11 Dec 2018 00:42:15 GMT

Philip Lee Miller, MD, Editor in Chief

Probably as long as you can remember, cholesterol is “known” to be the cause of cardiovascular (heart and blood vessel) disease. Does dietary cholesterol cause heart disease? What about familial super high cholesterol? Does that cause heart disease? The short answer is – probably not. Let’s expand. I have written extensively on the subject in the past.

Cholesterol has been studied since the early 1900s. Initially in fits and starts. John Goffman studied cholesterol in the 1950s at Donner labs in Berkeley. There was no interest. So he turned to other pursuits. The cumulative effects of low level radiation. Lipid research picked up in the 1970′ and 80’s.

Remember, the admonition to limit your egg consumption consumption? Or fats? You should reduce fats to reduce your weight. We have now found it didn’t work. My good friend Dr. Ron Rothenberg famously quips, “cholesterol: found at the scene of the crime – not guilty.” How do we prove this assertion?

cholesterol: found at the scene of the crime – not guilty. — Dr. Ron Rothenberg

Rudolph Virchow in the 19^th century postulated that most human disease is a result of inflammation. Most especially cancer, but probably vascular disease as well. Later Sir Thomas Sydenham postulated, “a man is as old as his arteries.” So we have historical precedents for the cause of cardiovascular disease– inflammation.

“a man is as old as his arteries.” — Sir Thomas Syndenham

When I was young medical student, we looked at total cholesterol. Over time the entire picture has evolved with more and more refinements and “precision.” So we now look at LDL, HDL, and VLDL. These are actually lipoprotein carriers of cholesterol and not cholesterol itself. LDL cholesterol is transported to the heart initially for repair. HDL is the reverse cholesterol transport system carrying cholesterol away from the heart. This has come under more intensive scrutiny in the last few years.

Further refinements have followed, including Lp(a), LpPLA2, myeloperoxidase, hs-crp, homocysteine, uric acid, and now particle counts. Let me return to this in a minute.

The goal of conventional cardiologists is reducing LDL numbers to less than 100 mg/dl or for “at risk” patients – as low as 60-80 mg/dl. Does this make any difference?

Dr. Daniel Steinberg was one of the most notable researchers in lipidology while I was at UCSD School of Medicine. He wrote The Cholesterol Wars. A good read for its historical content. At one point, he notes, “we almost lost the battle until statins arrived.” Which implied that severe dietary restriction alone was insufficient to reduce cardiovascular morbidity and mortality. Statins were much more potent. We could lower LDL more aggressively. But is reduction of LDL successful? I contend not. Statins are anti-inflammatory. They do not work by simply lowering LDL levels as much as mitigating inflammation.

That is why statins may actually have the greatest effect and benefit surrounding the acute period of a myocardial infarction.

Berkeley Heart Lab (BHL) pioneered the concept of LDL particle sizing. This has drawn more recent attention and acclaim. BHL developed the notion of pattern typing using an expensive and laborious gel electrophoresis process. Which, in its day, superseded the expensive and neglected ultracentrifuges used by John Goffman. He had access to the warehoused ultracentrifuges that were originally designed to refine uranium during the super secret Manhattan Project at Berkeley Lawrence Lab and Sandia Labs.

Pattern A is characterized by low triglycerides, high HDL and large, fluffy LDL particles which are presumably less atherogenic. That is, they cause less vascular disease. A pattern B is characterized by high triglycerides, low HDL and small dense atherogenic LDL particles.

So we think particle sizing and LDL size may be a good marker of future pathology or disease. Again, large and fluffy LDL particles are less dangerous. Small dense LDL particles are far more pathogenic and atherogenic. This may be an impaired paradigm.

Dr. Robert Superko, co-founder of BHL, has been lecturing and advocating since the early 1990s on the danger and pathogenicity of Pattern B. He was aggressively trying to raise HDL and thereby lower heart disease with high dose Niacin. Empirically, we do see patients who have high HDL’s are at less risk. Unfortunately, therapeutic trials to increase HDL with niacin or experimental drugs (torcetrapib) have not been successful. I have often asked why is that? That may be the subject of a future blog. Milano A1 and HDL2b.

It is very likely we are missing or misinterpreting this picture. The real risk is high triglycerides which are carbohydrate induced, increasing the risk of diabetes and glycation. A series of events leads to increasing hemoglobin A1c levels (glycation), arterial stiffening, hypertension, and increased cardiovascular disease.

The most unfortunate, but glaring example was Tim Russert. He was known to have normal cholesterol but very high triglycerides. He died at the age of 58. Quite premature. What is the lesson here? Pattern B may be a biomarker for glycation because of its increase in triglycerides which are associated with higher carbohydrate intake. We see this as increased hemoglobin A1c levels.

Glycation is the end result of AGE products – Advanced Glycation End-Products. Which, by the way, was one of the postulates of my book the Life Extension Revolution: Growing Older without Aging.

Now let’s add another seriously overlooked cause of cardiovascular disease. Adhesion molecules. VCAM-1 is the most notable. Vascular Cell Adhesion Molecule. These adhesion molecules are highly active in cancer and in cardiovascular disease. It initiates a cascade of inflammatory responses where white cells and macrophages are drawn (recruited) into an inflammatory process forming arterial plaque. The end result of this inflammatory process is aggregated white blood cells and macrophages. That is soft plaque. This is, in essence, a pustular aggregation within the arterial wall. Somewhat like acne on the face, but rather in the intimal-medial aspect of your arteries.

Most unfortunately, Medicare and most insurance companies who follow suit, do not reimburse or recognize advanced cardiovascular risk factors. Most of the medical community does not see cardiovascular disease as an inflammatory process. We are stuck in an old paradigm that overindulgence of fat and cholesterol causes heart disease. There is no incentive economically or even medically to go beyond simple LDL measurements. Guideline derived, algorithmic medicine is short-circuiting our progress.

“without deviation from the norm, progress is not possible” – Frank Zappa

The real test of pathogenicity is imaging studies. Carotid intimal medial thickness (CMIT) measures arterial wall thickness and developing plaque. Superfast (EBT) CT scans (HeartScan) scores calcium load in your coronary (heart) arteries. Even a simple blood pressure measurement gives you valuable clues about arterial compliance and glycation. This is directly visualizing actual disease.

LDL and cholesterol is a bad predictor of eventual cardiovascular disease and events.

Empirically, I have seen this most vividly in specific cases. Extremely high familial LDL levels with entirely normal vascular studies. And extremely low LDLs associated with repeated coronary artery blockages requiring stents.

Now, I want you to read my detailed review of the major cholesterol studies that I published here in June 2015. This shows the results of all the major statin induced cholesterol lowering studies using absolute statistics and not relatives statistics. There was virtually no survival advantage on a population basis from statins. On an individual basis, there may be lives saved. But on a population wide basis there was no change. Totally contrary to what you have heard. What physicians believe or “know.” But it is based on rigorous statistical analysis using absolute and not relative statistics.

Bottom line: We need to change the paradigm.

We should be using new and more appropriate biomarkers for risk determination based on an inflammatory profile.
Triglycerides may be more pathogenic than cholesterol.
Low carbohydrate intake. Carbs are killing us. Don’t overeat.
Moderate exercise.
Stress reduction.
Update and revise our entire therapeutic protocols.
Look at diabetic risk using HgA1c as a glycation biomarker.
High dose fish oils.
Appropriate anti-oxidants.
Prevent heart attacks and strokes with my natural anti-coagulant routine.

Let me know what you think.

Philip Lee Miller, MD

Carmel , CA

December 7, 2018

The post Is Cholesterol the Culprit? appeared first on Dr. Philip Lee Miller by Philip Miller.

2018-2019 Flu Vaccine, Prevention and Treatment

Thu, 15 Nov 2018 02:32:45 GMT

Philip Lee Miller, MD, Editor in Chief

This is my seasonal flu post. One that I update each year. Here are current recommendations and controversies regarding influenza vaccinations, prevention and treatment. I am going to give you a slightly expanded version this year related to last year’s flu vaccine post. In short, I have never been a proponent of flu vaccinations. I am middle of road on vaccinations. You really want polio, measles and mumps and tetanus every 10 years. For high risk exposures you want Hepatitis B vaccination. But we are over vaccinating our children and even pets.

Influenza is a seasonal epidemic viral syndrome that usually starts in December and lasts until approximately February or March. In the past, I would begin to see large number of acutely ill patients pouring into my Urgent Care clinics in October and November. I eventually termed this the “pre-flu” syndrome. Something approximating the flu but not the full-blown symptom complex. The true flu is manifest as fever, shaking chills, severe achiness (myalgias), and malaise. You feel really sick. This is more than a common cold.

Now the problem with flu vaccination recommendations is dependent on who makes the recommendation and for what population. I am going to make a recommendation for you specifically. This is in contradistinction to a public health official who epidemiologically makes decisions for large populations. They are concerned about “herd immunity.” Higher rates of immunized people decreases the spread. At least that is the theory.

There is no universal flu vaccine

The challenge has always been how to formulate this year’s flu vaccination. There is no universal flu vaccination. That is the basic dilemma. Influenza A is the more virulent strain mainly affecting adults. Influenza B affects mainly children. Influenza mutates by “antigenic drift” from year to year. It can even mutate during incubation. In most years, there is a “minor antigenic drift.” In some years there is a “major antigenic drift,” in which case far more people fall ill because they have not never been exposed to the current strain. And thus it is more virulent. A pandemic.

Flu Strains

Epidemiologists classify influenza with two attributes. H attribute (hemaglutinin). And N attribute (neuraminidase). H1N1 and H3N2 are targeted this year. So the recommended quadravalent (4 strains) flu vaccine being manufactured this year targets:

A/Michigan/H1N1

A/Singapore/H3N2

B/Colorado 2017 B/Victoria 87

B/Phuket 2013 B/Yamagata 88

Because we do not know the precise strain that will prevails this 2018-2019 season, it becomes our best educated guess. What is the most likely strain based on recent world wide observations. The selection process may begin in February of the current year. This gives enough lead time for sufficient vaccination stocks to be replenished each year. This takes time. It is all the guess. Again, the primary dilemma is – there is no universal flu vaccine. That is the holy grail. Research scientists are busy trying to develop this.

Vaccine Effectiveness Rates

Seasonal Influenza Vaccine Effectiveness, 2004-2018

Last year it was said that the flu vaccine was only 10% effective. In retrospect, the CDC published an average for all age groups of 40%. Here are the reported rates of effectiveness for the last 14 years. A more detailed breakdown by age for 2016-2017 shows even more variability. All these statistics are somewhat irrelevant. What is more relevant is the flu vaccination most often less than 40% effective. So the recommendation is based on, “well, it’s better than nothing.” I can’t think of hardly any other medication in use today were the rationale is, “well, it’s better than nothing.” Surely there must be a stronger argument and rationale to the widespread public campaign to “get your flu shot now.”

Recalling my days in Urgent Care once again in the early 1990s, it was common knowledge that “there is no medical treatment for the flu.” So you must get a flu vaccination. This always puzzled me because there was indeed a medication that treated the flu. Symmetrel (Amatidine). This was discovered by happen stance when so many Parkinson’s patients who were treated with Symmetrel for “the shakes” had a much lower incidence of the flu. I began using Symmetrel with rewarding success.

Anti-Virals now available

Today, we have a developing stable of anti-influenza virals. That is Tamiflu, Relenza, Rapivab and the newest Xofluza (Baloxavir). So you have a choice. You can have the flu vaccine in various forms. You can defer any vaccination and be treated with any of a number of antiviral drugs. Or there is a natural routine that I have developed over the years. Empirically quite effective.

My recommendation for a natural approach

Miller Anti-Viral Regimen

Vitamin D 50,000 daily x 5 days

Astragalus 1000 mg daily x 5 days

Thymic Protein A (TPA) 1-2 packets 3 times daily x 5 days

So what do I recommend? I have been a proponent of aggressive doses of vitamin D which is known to prevent seasonal flu syndromes. At the first sign of any viral illness or especially the flu, start taking vitamin D 50,000 units for 5 days. Yes that is high dose. Astragalus 1000 mg daily for 5 days and a proprietary product called Thymic Protein A (ProBoost). One packet 2-3 times daily for 5 days. This is a highly effective routine. And most effective when started in the first 48 hours. Sometimes this routine is so effective that after one or day, you may feel totally resolved and stop the routine. 2 to 3 days later, the virus is even stronger. So a 5 day routine is highly recommended.

Now let me know your thoughts and experiences.

Philip Lee Miller, MD
Carmel, CA 93923
Nov 2018

The post 2018-2019 Flu Vaccine, Prevention and Treatment appeared first on Dr. Philip Lee Miller by Philip Miller.

Vitamin D and Osteoporosis Prevention

Tue, 09 Oct 2018 05:39:34 GMT

Philip Lee Miller, MD, Editor in Chief

Vitamin D is back in the news again.

You may have seen recent news claiming vitamin D supplementation fails to prevent osteoporosis, fractures or falls. Published in the Lancet — a Systematic Review and Meta Analysis paper dated October 04, 2018 from the Department of Medicine, University of Auckland, New Zealand and the Health Services Research Unit, University of Aberdeen, Scotland, UK. They conclude and state at the end of a complex meta-analysis

“we believe there is no justification for more trials of vitamin D supplements with musculoskeletal outcomes because there is no longer equipoise about the effects of vitamin D on these outcomes.”

Rather strong conclusion designed to forestall any further investigation or discussion. Really?

Now personally, I owe my interest in vitamin D supplementation to my good friend Dr. William Grant of SunArc. And work that has been done by Dr. Mark Connell, who founded the Vitamin D Council headquartered in Marina del Rey, California. Both are superb sources of ongoing vitamin D research.

A meta-analysis is a literature review of all relevant resource papers. It suffers from specificity and accuracy of database key words, capture and design. It is limited by various assumptions, and highly intricate statistical conventions. Studies are excluded or included based on assumptions of the authors.

One of my current criticisms of all these citations is failure of a popular news article to actually cite the source. So we cite here. Effects of Vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis and trial sequential analysis. You will have to pay to actually read this paper. So, I will summarize for you.

The paper is exhaustively written and detailed. But suffers from a number of limitations and dubious pharmacologic assumptions.

First, it is stated that there was no difference between high-dose vitamin D and low dose vitamin D. What defines high-dose and low dose? Low dose was <800 units per day. High-dose was >800 units per day. I always have issue with “greater than” or “less than” because of a lack of specificity. >800 could be 801, 1000, 5000 or 50,000. You don’t know. <800 could be 799, 700 or 100. To be somewhat facetious. But it is highly important because we don’t know from their study. What would be the ideal dose of vitamin D? Who decided on this magical 800 units number?

In fact, that is where 80% of all medical and scientific studies fail. Who chooses the ideal dose? On what basis is an ideal dose determined?

I often use a facetious example of Lipitor. Lipitor will lower your cholesterol. More specifically, your LDL values. I could design an experiment using 1 mg of Lipitor for one year. You will see no benefit. It is too low. A study using 1 mg would conclude Lipitor is a worthless drug. In the other hand, let’s use an arbitrary dose of 100 mg of Lipitor for a study. After one year I would conclude this is a highly toxic drug causing muscle pains, memory losses and liver abnormalities. A drug that is too dangerous. So at some point, scientists determined that the ideal dose of Lipitor is 10 to 40 mg. With a certain segment of the cardiology community is using extremely high doses of 80 mg.

Dose-response. A fundamental tenant of good pharmacologic design and use.

Now back to vitamin D. We are told that the levels achieved were were either >50 nmol/l or >75 nmol/l. Again we have the problem with the specificity of “greater than.”

Furthermore, most commercial clinical labs report in ng/ml not nanomoles/l. So >50 nmol/l = >20 ng/mL and >75 nmol/l = >30 ng/mL. What does this mean?

Vitamin D testing (using GC/MS/MS) is one of the lab tests that that is rationally graded on a continuum. Not simply high or low cutoffs. <15 ng/ml is (severely) deficient. 15 to 30 ng/ml is insufficient. 30 ng/ml to 100 ng/ml is sufficient. > 100 ng/ml is excess. And >150 is considered toxic. Never mind, that it is not toxic.

So that this meta-analysis using a “high value” of >75 nmol/ml ( >30 ng/mL ) is not high. It is barely therapeutic. Just barely at the very lower limits of therapeutic. Like driving a car with a 1/4 tank of gas.

Personally, and in the Anti-aging / Nutritional Medicine community a consensus seems to be a daily dose of 5000 units is the average starting dose for the overwhelming majority of our patients. Aiming for 60-80 ng/ml blood values. That seems to be the ideal dose and value. There are individual variations so that some of our patients will require 10,000 and 15,000 or as high as 20,000 units daily to achieve good therapeutic levels. In rare cases patients only need 3000 units. But clearly 800 units is nearly useless.

So this meta-analysis suffers from so many shortcomings. A meta-analysis is a poorly controlled study because it is a retrospective look at a host of studies all probably suffering from experimental design weakness. Then there is the highly intricate retrospective statistical conventions excluding and including various studies for capricious reasons. Starting with a completely capricious and arbitrary dose and level. And finally, we have no idea whether blood levels were drawn at one time during a study or weekly or monthly or the beginning or the end. Most likely levels were drawn very infrequently and then assumed to be constant through the study. Probably None of these studies were carried longer than one year.

Finally, Vitamin D alone is probably insufficient to enhance bone integrity and prevent osteoporosis. Empirically, I have observed osteoporosis is prevented by a combination of estrogen or testosterone vigor, vitamin D3, vitamin K2, the right balance of calcium and magnesium, and light weight bearing exercises. A study simply looking at the efficacy and levels in potency vitamin D will never prove the assertion that osteoporosis cannot be prevented by vitamin D.

There are some political considerations. The US Preventive Services Taskforce specifically recommended against Vitamin D supplementation to prevent fractures or falls. They intentionally excluded all of the known experts in vitamin D. Of which there are only 4 or 5 notable vitamin D researchers in the world.

So beware. This meta-analysis or study does not prove that vitamin D is either inadequate or useless. I personally recommend vitamin D at least 5000 units daily, Vitamin K2 15 mg, 800-1000 mg calcium 200-600 magnesium, weight-bearing exercises and evaluation of your hormonal status. This is simply a starting point. There is considerable variation from patient to patient. That is why you need expert advice and counsel. Reference my earlier blogs on Osteoporosis Prevention. And the importance of Vitamin K2.

Reader beware.

Philip Lee Miller, MD

Carmel CA

The post Vitamin D and Osteoporosis Prevention appeared first on Dr. Philip Lee Miller by Philip Miller.

How CEOs respond to a cancer diagnosis

Fri, 27 Jul 2018 17:19:02 GMT

Philip Lee Miller, MD, Editor in Chief

In a recent contribution entitled This Doctor Believes Entrepreneurs Manage a Cancer Diagnosis Better Than Most I responded with the following. It is the substance of a much larger discussion we should have. “I have a diagnosis of cancer.” Now what?

Cancer Risk Benefit Management

All CEOs make decisions based on only 75% of the evidence. You never have 100% of the evidence. What you have stated here is that CEOs become active and not passive participants. The greatest danger of all cancer therapies is the infantilization of the patient. “Just follow instructions.” “Don’t ask too many questions.” All cancer therapies are algorithm and guideline driven.

In more than 12 years as a cancer surgeon, I have noticed that what defines these patients is their ability to compartmentalize and marshal resources forward.

They quickly clear their heads, get the facts and make decisions.

Ask questions. Never assume. Consider risk-benefit ratios of all therapies. Seek out integrative sources of cancer information. All statistical probabilities are population-based. And, therefore, frequently misleading. You are an individual with your own set of probabilities. No physician should ever tell you you have x number of months to live.

I know something of which I speak. I have lost 2 dear siblings to cancer in the last 2 years. So this becomes a personal note. Take charge. Move into the driver seat. The referenced article is highly revealing. All these CEOs make their cancer decisions dispassionately. As if it were another person or a relative they were advising. Pick a point far in the future. Visualize it as your goal. “I want to see my grandson or my granddaughter graduate from college.”

Tell me what you think.

The post How CEOs respond to a cancer diagnosis appeared first on Dr. Philip Lee Miller by Philip Miller.

Treat and Prevent Iron Deficiency Anemia

Fri, 25 May 2018 06:32:53 GMT

Philip Lee Miller, MD, Editor in Chief

This is the last in our series on Iron Deficiency and Iron Deficiency Anemia. In parts I, II, III, and IV, I talked about all aspects of the essentiality of iron. How to diagnose iron deficiency anemia. Various controversies surrounding iron supplementation. And the relationship of iron to various inflammatory states including cancer. Let’s recap this series with specific treatment routines. If you want to skip direct to treatment click here.

Enter Functional Medicine

I want to introduce one more refining and overriding concept. A new paradigm shift in medicine. Functional Medicine. We need to rethink the entire subject of iron deficiency and anemia. How and when do we recognize the condition of iron deficiency and progressive anemia? And then what triggers our decision to treat – or prevent?

Functional Medicine is a systems biology–based approach that focuses on identifying and addressing the root cause of disease. Each symptom or differential diagnosis may be one of many contributing to an individual’s illness. — from the Institute for Functional Medicine

Binary vs. Optimal Choices

In America I see two competing medical paradigms. Structural pathologic medicine based on illness and disease. And functional medicine which is based on dysfunction, suboptimal values with the goal of restoring health and wellness. The goal is not identical. It leads to totally different approaches for you, the patient.

The functional approach to iron therapy realizes various degrees of iron deficiency rather than a binary choice. “In the box” or “out-of-the-box.” You’re either low or you are high. In reality virtually all medical paradigms follow a normalized distribution. A continuum from very low to very high. The goal is always optimal — in the middle — values. This is a concept stressing to all my audiences 20 years.

Fortunately, a new model is proposed and advocated in a major publication in the Austrian literature. This paper lays out guidelines for treating iron deficiency anemia in cancer patients using absolute (AID) and functional (FID) iron deficiency. Seemingly two sets of criteria.

Anemia is common in cancer patients [2]. From a practical viewpoint, two forms of iron deficiency need to be differentiated: absolute iron deficiency (AID) and functional iron deficiency (FID). AID is defined by a TSAT < 20 % and a serum ferritin level < 30 ng/ml in otherwise normal individuals, while in cancer patients a higher cut off level of ferritin levels should be applied (< 100 ng/ml). FID is defined by a TSAT < 20 % and serum ferritin levels of > 30 ng/ml in normal individuals and of > 100 ng/ml in cancer patients.

Great. Here is a clear path. The Austrian literature articulates a major shift in modern medical thought. That is my purpose in writing series for you. Iron therapy is anti-angiogenesis preventing neo-vascularization.

Challenging Standard Definitions

I see so many patients who are relatively anemic and are symptomatic. But they still fall within the “normal range.” And are therefore dismissed. Not falling within the treatment guidelines. Ready for the paradigm shift?

Now remember from the previous blogs that iron deficiency will proceed anemia. So here is the continuum of iron from fully sufficient to deficient that precedes anemia . This is a functional view. We want optimal values.

Anemia appears only after more severe iron deficiency progresses. Once iron falls to more severe levels.

Conventionally, your diagnosis of anemia must meet these standard criteria. Hematocrit values < 35% (women) or <40% (men). Or Hemoglobin values <13 in men or <12 in women. Remembering that hemoglobin is oxygen carrying capacity.

But in reality, you won’t be diagnosed or treated until values fall even much lower. At that point you are really sick.

See figure 2 for “normal values.” You want optimal values.

	Men	Women
RBC Count (million/ug)	4.2 – 5.9	3.6 – 5.5
Hemoglobin gm/dl	13 – 17	11 – 15
Hematocrit %	40-52%	34-46%

Treatment Options

This is a re-cap and wrap-up of the previous blogs. All preceding blogs give you a more in depth look at all the issues of iron therapy.

How do we treat knowing that earlier intervention is essential? The total daily dose for severe cases is 180 mg of elemental iron. I usually use lower doses. You will need increased doses of magnesium to prevent constipation.

Heme vs non-heme iron sources in food.

Heme based sources of iron is the most efficient. Best source is red meat or chicken livers or sardines. Non-heme sources, plant based is a less efficient source of daily iron.

Iron Salts

Ferrous sulfate 325 mg (65 mg elemental iron) three times daily. The preferred form. This may raise hepcidin levels thereby decreasing efficient absorption.³
Ferrous gluconate 325 mg (12 mg elemental iron) three time daily
Ferrous fumarate 325 mg (107 mg of elemental iron) three times daily

Iron chelates

AminoIron – 18 mg elemental iron as bis-glycinate
Reacted Iron – 29 mg elemental iron as ferrous bis-glycinate

Iron Infusions

Ferric carboxymaltose (injectafer) — the most potent and effective for severe cases and those not responsive to oral consumption.
You will need to find a sympathetic and creative hematologist to administer and infuse parenteral (im or iv) iron. A hematologist who is willing to treat early and not late in the process.

Philip Lee Miller, MD

Carmel, CA

May 24, 2018

Iron metabolism and iron supplementation in cancer patients: Wien Klin Wochenschr (2015) 127:907–919 DOI 10.1007/s00508-015-0842-3
Ludwig H, Müldür E, Endler G, et al. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24:1886–92.
Iron Dosing for Optimal Absorption: NEJM Journal Watch Oct 30 2015.

The post Treat and Prevent Iron Deficiency Anemia appeared first on Dr. Philip Lee Miller by Philip Miller.

Five Quick Health Tips

Sat, 28 Apr 2018 07:35:22 GMT

Philip Lee Miller, MD, Editor in Chief

Five Vital Health Tips

Here’s a quick overview of five health recommendations that can make a huge difference in the your health and longevity. These are not easy recommendations. But think how you can start these today.

1. Never drink tap water. Obviously, tap water varies from locality to locality. We certainly have catastrophic examples in the past such as Love Canal and more recently Flint, Michigan. But even in the Silicon Valley the groundwater is contaminated. Toxic chemicals are leaching into the water supply. This is not widely discussed but it is known by those who monitor toxic dump sites. This would even include water at restaurants. Always ask for bottled water or sparkling water.

Stiff plastic bottles such as Fiji Water is healthier than more flexible bottled water. The more flexible, squeezable bottles contain Bisphenol A (BPA) plasticizers. Glass bottles are ideal and preferred. I prefer San Pelligrino.

2. Avoid microwaving your food. Ideally, never microwave. I know that we live in a fast paced culture where the microwave oven is convenient and the fastest approach. So if you must microwave here are some very important suggestions. Never ever microwave in the native plastic container with plastic top. Remove the contents of the frozen dinner and place in a Pyrex bowl with a Pyrex top. Glass is inert. Microwave energy cooks food by heating water molecules. You will find that food is cooked more easily without “browning.” And never stand near a microwave.

3. Remove all the chlorine from your shower. Chlorine is highly oxidative. Not good for youthful skin or hair. Chlorine is quite toxic. Chloramine is even worse. I know that your shower will remain much cleaner when chlorinated. I highly suggest using a dechlorinating filter.

The easiest filter is purchased from CustomPure. You replace the showerhead with a CustomPure filter that will remove all chlorine for at least six months. You will see the difference in your skin and hair quality. You absorb more chlorine in the shower than drinking water.

4. Cell phones are potentially dangerous. I know this is ubiquitous. Every age group is now using cell phones. Why would I even broach this subject? No studies to date have been conclusive. But irregular microwave pulses create disturbing patterns on functional MRI patterns. There is a high suspicion that cell phone microwave energy is toxic to brain cells.

Lyon, France, May 31, 2011 ‐‐ The WHO/International Agency for Research on Cancer (IARC) has classified radiofrequency electromagnetic fields as possibly carcinogenic to humans (Group 2B), based on an increased risk for glioma, a malignant type of brain cancer associated with wireless phone use. Int Agency Research on Cancer 2011

In summary, this study provides evidence that in humans RF-EMF exposure from cell phone use affects brain function, as shown by the regional increases in metabolic activity. It also documents that the observed effects were greatest in brain regions that had the highest amplitude of RF-EMF emissions (for the specific cell phones used in this study and their position relative to the head when in use), which suggests that the metabolic increases are secondary to the absorption of RF-EMF energy emitted by the cell phone. Further studies are needed to assess if these effects could have potential long-term harmful consequences. Jama Network 2011

I personally limit my use of cell phones is much as possible. Never place a cell phone in your pocket. Again, I know that this may seem totally impractical. So the use of earbuds and not Bluetooth devices is one way of eliminating this energy.

5. Get more sleep. The ideal is still 8 hours of sleep. Sleep is restorative and rejuvenating especially REM sleep. There are newer studies showing that sleep deprivation increases insulin resistance thereby increasing the possibility of diabetes. Sleep deprivation probably shortens lifespan. Again, I also am not perfect. I have the same problem. Try to retire earlier by one hour. And possibly wake up 30 to 60 minutes later in the morning.

Laboratory and epidemiologic evidence supports an association between short sleep duration (< 7 hours per night) and the risk of diabetes, and also between poor sleep quality and the risk of diabetes. We will explore putative mechanisms for these relationships. Cleveland Clinic Journal of Medicine

So much loss of daytime vigilance is related to lack of sleep. This is why sleep apnea at night is such a major phenomenon. Try to exercise later in the day. Do not eat late in the day. Add some magnesium at night. Remove all electronics from your bedroom.

This tip sheet is guaranteed to enhance your quality of life and lifespan. These are big challenges our modern world. Not easily accomplished because we are so used to each of these “conveniences.” So make these changes one at a time. You will be happy you did.

The post Five Quick Health Tips appeared first on Dr. Philip Lee Miller by Philip Miller.

Facebook and Privacy

Sat, 24 Mar 2018 15:49:29 GMT

Philip Lee Miller, MD, Editor in Chief

I have been warning everyone for the last 20 years about privacy issues. Nobody seemed to care much. We had an early warning from Jeffrey Rothfeder, Privacy for Sale: How Computerization Has Made Everyone’s Private Life an Open Secret published in 1992. This was before the Internet was born in its current GUI format.

To prove how we were losing privacy even 26 years ago he was interviewed on a major show. The interviewer asked him just how fast he could find information on anybody. Okay. Give me a name. She said give me some information on Dan Rather. At that time was well known that Dan Rather was a very private individual offscreen. Rothfeder was able to find very detailed personal information about Dan within five minutes. Everyone was stunned.

Freedom’s just another word for nothin’ left to lose — Janis Joplin

But nobody cared much. I wonder whether this harks back to the famous line from Janis Joplin, “freedom’s just another word for nothing left to lose.” Early in life no one cares about privacy because there’s nothing much to lose. As we grow older there are more secrets to hide. Whether it be personal secrets, wealth or private information.

Now the problem with Facebook is a shared responsibility. You all give up so much information to Facebook without actually considering how this can be used or weaponized against you. All the information you provide can be shared even secondarily through friends. None of it is private.

Don’t believe Zuckerberg or Cheryl Sandberg of Facebook. None of this information is private. They don’t have sufficient safeguards. Remember, their goal is to sell information. That is how the accumulate wealth.

It proliferates. I have often seen various websites where the log-in offers you the possibility of a personal email with a password or alternatively, as a courtesy, just sign in with your Facebook or your Google account. More information is now being gathered. Every time you sign in using Facebook incredible information is being gathered.

Safeway

Even Safeway has been a master of information gathering. You know your Safeway discount card. The one that you swipe every time you go to the supermarket? That is another portal of information gathering. They know exactly when you are buying. What you are buying. Profiling your buying habits to the cent. Incredible amount of information has been gathered that can be shared. And don’t believe that they anonymize this. I don’t believe it.

Nothing is free. So all of you who are using gmail or hotmail or yahoo email are not sending private mail. All this email is probably being surveyed, stored and sold. SSL SMTP is slightly more secure.

So Facebook becomes a shared responsibility. No doubt, Cambridge Analytica was harvesting this stolen information from Facebook in Machiavellian and sinister ways.

Free Email?

If you care, my suggestion is never use gmail or hotmail or Yahoo mail. Your own personalized email address is very simple. You can purchase your own vanity email address from GoDaddy dirt cheap. And you can use Go Daddy as your portal.

Personally, I have gone to the trouble of programming my own personal email server. Not something that I recommend for casual use. It took 2 to 3 months to perfect. But once perfected it is entirely private and nearly hack proof. Because the safeguards are so intensely strong.

So the overriding question remains, how much do you value your own privacy? How much are you concerned about the selling of your personal information?

I can tell you that even valid email addresses are being widely spoofed. Even though my email addresses are 100% certified with 3 widely accepted keys (DKIM, SPF and DMARC), last year one of my more common email addresses was being spoofed at the rate of 150,000 times weekly! No one cares. Everyone says nothing can be done. I don’t believe this. Not enough people care.

Spoofing is another form of identity theft. Where hackers are using your email address. To be honest, even I have never been able to understand how this is done. I only know through surveillance, it is very widespread and unknown to most of you.

Credit Cards

You know that credit cards are being stolen at an increasing rate. The new embedded chips are an improvement.

HIPAA

In medicine we have been dealing with privacy issues protected by HIPAA. The Health Insurance Portability and Accountability Act. It is designed to thoroughly protect your health information.

But this one has the opposite effect. Unintended consequences. It is overly stringent with onerous safeguards and expensive fines for “violations” or “incursions.” It aims to protect your health information. But it actually hinders normal and timely communication between healthcare providers. And it does not protect against sharing information outside of the country.

All demonstrating that protection of privacy is an extremely complex issue. But it is a vital topic that needs constant vigilance.

Happy safe computing

The post Facebook and Privacy appeared first on Dr. Philip Lee Miller by Philip Miller.

My Daily Personal Nutrition Routine

Wed, 14 Mar 2018 08:14:17 GMT

Philip Lee Miller, MD, Editor in Chief

People ask me what is your personal nutrition routine. What do you take on a daily basis? What supplements and micronutrient do you take yourself?

Personal Goal

A personal goal and my mission for all of you is health and well-being. Longevity with vigor. Protection from cognitive decline. Prevention of diabetes, arthritis and cardiovascular disease. Growing older without aging.

It was the famous English physician Sir Thomas Sydenham who said.

” you are as old as your arteries.”

Arterial health is a major goal. This is why we have advocated CIMT testing of carotid artery health here in our office.

My daily routine starts upon arising (on an empty stomach) with fat soluble nutrients. This included high doses of vitamin E, vitamin K2, vitamin D3, 1 tablespoon of fish oil, thyroid, phosphatidylserine and Nattokinase to prevent heart attacks and strokes. These fat soluble nutrients are more efficiently absorbed with fish oil. They are taken on an empty stomach so they do not interfere with oatmeal for breakfast.

There is a 45 to 50 minute hiatus. Checking my morning email. Followed by morning shower after which I apply my first dose of testosterone cream.

Breakfast

Breakfast is Bob’s Red Mill gluten-free oatmeal. Cooked to my best consistency over a gas stove.

Now my first protein shake of the day. The protein shake is highly fortified with 2 scoops of whey-based protein, 1 teaspoon of carnitine, one tablespoon of phosphatidylcholine, 1 scoop of d-ribose, and l-deprenyl for cognitive enhancement. This is the most efficient and leanest source of high quality protein. The protein shake can be mixed with Odwalla orange juice or your favorite base.

Breakfast is fortified with a array of vitamins and micronutrients. Yes, it’s a hand full. Selenium, zinc, Nutrient 950 multivitamin, DHEA, Orthomolecular Diaxinol, Orthomolecular 4Sight, vitamin B2, folate, B12, and Alpha lipoic acid. It’s quite a handful but each of these is designed to improve immune function, cardiovascular function, energy and cognitive function.

Lunch

Lunch is a very lean affair with my second protein shake of the day. Another 2 scoops of whey-based protein, 1 teaspoon of carnitine tartrate and orthomolecular gluco-shield. It is a quick, lean and efficient source of energy.

Dinner

This carries me through the day until 5:00 or 6:00. Dinner is a lean source of protein including fish, chicken or organic source of beef with some vegetables most especially broccoli and carrots. My preference at night is a combination of chocolate Rice Dream and chocolate Hemp Milk.

At night I might cheat with a tiny source of extra carbohydrate. The goal is always low carbohydrate, high-protein. This is not exactly a ketogenic diet.

Ketogenic diets do promote weight loss. I am still concerned about the quality of fats being advocated in ketogenic diets including large amounts of butter, cheese, bacon, sausage and other sources of potentially inflammatory omega-6 oils. The source of another blog soon.

Dinner is also supplement with a Nutrient 950 multivitamin, Diaxinol, 4Sight ginkgo biloba, extra magnesium and Alpha lipoic acid. Alpha lipoic acid is a stellar antioxidant and prevents diabetes.

Bedtime

Just before retiring at night I take an extra magnesium and my second dose of Nattokinase.

Coda – Ask Jack

Does that sound like too much? We could have asked Jack LaLaine. He was our supreme laboratory experiment. He took all known supplements and micronutrients for well over 50 to 60 years.

Jack once said, “I can’t die, [he most famously liked to say]. It would ruin my image.”

We all want happy longevity in a chaotic world. The ultimate goal of a preventive physician is set an example.

Thank you for listening. Now what are you taking? Drop me a line.

Philip Lee Miller, M.D.

Carmel California

The post My Daily Personal Nutrition Routine appeared first on Dr. Philip Lee Miller by Philip Miller.

Looking for Prescription Drug Medication information

Thu, 08 Mar 2018 19:42:03 GMT

Philip Lee Miller, MD, Editor in Chief

How do you personally find valuable and appropriate information about prescription drug medications today? What is your best source? How do you balance the need to know with overly cautious or scary warnings? Even I have difficulty locating information unless I use a physician-only proprietary database such as Epocrates.

Today I want to introduce you to Consumer Safety, a valuable source of drug information. This site provides notable “black box” warnings. The really serious adverse effects that you might want to know. This is my initial recommendation.

But let’s look at some history. A trip through past publications of thorough and objective drug information.

Historical Precedents

I have been a subscriber to the Medical Letter since the day I entered Medical School. This is the best and most objective source of new drug information. It is a biweekly newsletter now with an online presence. But there are limitations. It is ponderous and laborious technical reading. And their recommendations never include more creative approaches or uses. What we call “off label” use.

In the mid-1980s I took a brief respite from emergency medicine. I was an early pioneer in CD-ROM technology. Depending on your age, you may or may not recall this was the earliest days of the first IBM PC and the first generation Apple computers. My mission at that time was programming drug information databases for easy retrieval and presentation. CD-ROM was a new and promising technology of electronically based information. I envisioned (in my mind’s eye) the advent of book sized electronic retrieval of prescription medication information and prescribing. This was decades before the advent of the iPad. I also learned a valuable lesson at that time. Never be too far ahead of the curve.

It was a fascinating journey. I had intense discussions with all the leading publishers of drug information at that that time. Starting with the first loose leaf Drug Interactions publication that originated at Stanford. Then engaging discussions with the publisher of Facts and Comparisons. That was the best source of drug information and the one used most frequently by every good pharmacist. I traveled to Rocklin, Maryland to meet with the marketing chief of the US Pharmacopeia. Still the gold standard for drug information and standardization. Similar to the USP was the American Hospital Formulary Service (AHFS) Drug Information. All these publications have morphed into online sources.

Current Sources

In today’s world a Google search will most often take you to WebMD or Drugs.com. They are minimally helpful because of legal and FDA concerns. Most often they will caution you to “check with your physician or healthcare provider.” The whole point of online searches is an independent source of information.

Personally, I use Epocrates most often. There is no one single “best” source. It depends on your search criteria. What do you want to know?

Finally, you may also want to know about herbal preparations. While I was working on the CD-ROM project I was also a reviewer for the American herbal pharmacopeia which is a project still in process after decades. These are very dedicated people with scant funding sources. The monographs are well researched and highly enlightening. The German E commission is another reputable and exhaustive compendia.

I started with a recommendation for consumer safety. All these sources are a rich array of prescription herbal medications. Email me with any further suggestions or comments.

A personal plea. If you find this information useful, enlightening or revealing, please pass on to friends and relatives. This blog is a portal for guides to your health and well-being. We challenge all assumptions. A second look at topics of major interest for you.

Help us increase our readership.

Then go to Fullscript for all your supplement and micro-nutrients updates.

The post Looking for Prescription Drug Medication information appeared first on Dr. Philip Lee Miller by Philip Miller.

Not So Random Thoughts on Aging

Sun, 04 Mar 2018 20:48:52 GMT

Philip Lee Miller, MD, Editor in Chief

Why Are Baby Boomers Dying Prematurely?

I am a pioneer antiaging/age management physician. I co-authored the best-selling book on the age management – The Life Extension Revolution: the New Science of Growing Older without Aging. I was the founder of the Los Gatos longevity Institute rebranded as California Age Management Institute. These credentials are well known.

I have been giving serious thought and reflection on an alarming dichotomy of generations. It appears that so many individuals who were born in the 20’s and came of age during the Great Depression and World War II are living well into their 90s. They are living forever. I have wondered what is it that promotes this longevity? This even includes survivors of horrific POW and Concentration camps.

Meanwhile, baby boomers are dying prematurely in their 50’s, 60’s, and 70’s. Notable names like Leon Russell, Glenn Frey, Tim Russert. The list grows every day.

At first I thought these were all entertainers. Like the premature death of Jim Morrison, James Dean, Andy Kaufman, Marilyn Monroe, Jerry Garcia and Janis Joplin. But I have also seen a number of my own medical school classmates pass well before their time.

So what is it about those who grew up and came of age during the Depression and World War II?

They lived a less stressful life. There were no microwaves, cell phones, television, DVDs, Internet, computers. Before there was traffic congestion with cosmopolitan smog and more recently invisible and lethal EMF smog. They ate sparsely. They ate healthy foods that were enriched in non-depleted soils. From “victory gardens.” They did not overeat because there were no fast food restaurants. Modified caloric restriction. Food was expensive.

Generational Age Categories

An interesting headline published by the WJ Schroer shows these descriptive categories.

Depression-era — born 1912 – 1921
World War II — born 1922 -1927
Post-War Cohort — born 1928 – 1945
Baby boomers — born 1946 – 1965 (early and late waves)
Gen X – born 1966 – 1976
Gen Y or Millennial’s – born 1977 – 1994
Generations Z – born 1995-2012. These are not Millennial’s. These are the victims of the most recent Florida shooting.

Each one of these generations is characterized by an ethos and environmental factors. It must have an effect on aging and longevity. I often talk about life attitudes that can be characterized by decades.

20-year-olds are fearless and have no concept of limits. Evel Knievel dare devils , Olympic athletes and Army recruits. 30-year-olds have a glimmer of age limits but it is fleeting.

40-year-olds begin to sense time is beginning to take its toll and are the most motivated and dedicated to achieving optimal health and well being. 50-year-olds are more aware of non-infinite mortality. 60 year olds sense the quickening of the sands of time.

70-year-olds are well aware of time limits. 80-year-olds are either highly motivated to passing the 90-year-old barrier or are totally accommodated to the facts of their own mortality. 80-year-olds either are either marking time or actively engaged in longevity prolongation.

The Challenge for You

How do you characterize yourself? In what generation do you find yourself? In what decade do you find yourself? What are your goals and aspirations? What are your hopes and most fervent desires? What motivates you? These are vital questions at all ages but gather increasing importance with advancing age.

I hate the term senior citizen. It makes me want to blurt out, “right on, junior citizen.” My mother-in-law hates the term the Golden Years. So did my mother. They refer to it more often as the Rust Years not the Golden Years.

This dichotomy between Depression-era/WWII babies and Boomers needs more study and thought. It is today’s challenge to you. What do you want to do? We most definitely live in highly challenging times.

Epilogue

As Jerry Garcia said, “What a long strange trip it’s been.”

“It’s not the destination, it’s the journey” – Ralph Waldo Emerson

The post Not So Random Thoughts on Aging appeared first on Dr. Philip Lee Miller by Philip Miller.

Iron Deficiency Signs and Symptoms -Part IV

Mon, 19 Feb 2018 05:37:57 GMT

Philip Lee Miller, MD, Editor in Chief

Symptoms of Iron Deficiency Anemia:

Iron is essential for oxygen carrying capacity. Iron deficiency and anemia decreases oxygen delivery to all major organs of the body. Most especially the brain, heart and muscles. Iron deficiency manifests with easily identified symptoms and conditions. Here is a quick overview followed by a more detailed description.

Mental Fatigue and Cognitive Impairment.

Iron is an essential cofactor for neurotransmitter and myelin synthesis. Brain neuronal cells require iron for DNA synthesis, mitochondrial respiration, and other vital processes. As with each of these conditions, iron deficiency anemia reduces tissue oxygenation. The brain is vitally dependent on O2 and glucose.

Pale (pallid) or Yellow (sallow) Skin.

Here is a comparison of a well perfused (red blooded) iron sufficient hand with an anemic iron deficient hand. This is simply a visual sign of arterial oxygenation saturation. Well oxygenated and perfused blood is red. Technically, we can measure arterial pO2, pCO2 and pH. The pO2 is the partial pressure of oxygen.

Pulling the lower eyelid revealing the conjunctival inner surface. This reveals a lack of normal capillary perfusion. While I was an Emergency Physician we also used another rapid test. Pressing a fingernail watching for rapid reperfusion or capillary refilling.

Unexplained Fatigue or Lack of Energy

Heart Failure in Susceptible Individuals with Heart Disease

In individuals with a weak or failing heart, iron deficiency anemia stresses heart function. Diminished oxygen saturation requires more rapid blood flow to keep up with oxygen requirements. This increases heart rate. We call this tachycardia. This tachycardia in turn stresses an already weakened heart. The heart is, after all, a large muscular organ. Lack of oxygen leads to myoglobin deficit. It is a circular set of reactions as seen in figure 5

figure 5

Pagophagia – Craving for Ice or Clay

This is an interesting phenomenon. And it is not well scientifically explained. It is possible this increase in alertness is a response to the fatigue of iron deficiency anemia.

Sore or smooth tongue and cheilitis

A smooth tongue. The “angles” of the mouth show signs of angular cheilitis. This appears to be an inflammatory condition. In the past I thought this was a vitamin deficiency.

Brittle nails or hair loss

Another interesting phenomenon indicating the need for iron in hard connective tissue synthesis. A poorly explained phenomenon. We think this may be related to injury to the nail plate – the origin of nail growth. Somehow this may be more susceptible to damage or injury with iron deficiency anemia.

Restless Legs Syndrome

Restless legs is an annoying condition that disturbs healthy and regenerative sleep. It is nearly synonymous with “periodic limb movement.” This is an important observation during a thorough sleep study. Iron deficiency as a cause is becoming more recognized. Iron infusions are quite dramatic in their ability to completely resolve this condition. In the past we have treated this condition with Mirapex, a dopamine agonist, more commonly used to treat Parkinson’s Disease.

Additional Symptoms:

Here are further manifestations mostly related to more rapid arterial blood flow in response to diminished oxygen availability:

Shortness of breath or chest pain, especially with activity (dyspnea)
Unexplained generalized weakness (asthenia)
Rapid heartbeat (tachycardia)
Pounding or “whooshing” in the ears (pulsatile tinnitis)
Headache, especially with activity (exertional headache)

So let’s move on to the final episode: treatment of iron deficiency and anemia.

Part I, Part II, Part III

The post Iron Deficiency Signs and Symptoms -Part IV appeared first on Dr. Philip Lee Miller by Philip Miller.

Iron Therapy – Part III

Wed, 31 Jan 2018 05:23:29 GMT

Philip Lee Miller, MD, Editor in Chief

We talked about the essentials of iron metabolism, iron uptake and iron control in part 1 and 2. Now let’s try to unravel the mystery of iron therapy.

In reading through the literature it is obvious this is a very complex subject. Far more complex than is usually admitted. And I have alluded to many controversies where another binary choice is offered. Either you are leery of iron therapy because it is dangerous and unhealthy or you are an advocate of the multiple benefits of iron.

It’s not an easy choice. I am showing you why iron is so important and beneficial. But first let’s delve into the reactive aspects of iron. So we can come to a happy and more beneficial conclusion.

Free Radicals and Reactive Oxygen Species (ROS)

There is a major and ongoing controversy. Oxidative versus antioxidant therapies. The literature and current belief is replete with references to iron promoting free radicals or ROS (reactive oxygen species). In other words, iron would be considered unhealthy because of its pro-oxidative properties. Consider the “Fenton reaction. Adding Ferric Iron + Hydrogen Peroxide to form Ferrous Iron + Free Radical Oxidative Species.

Figure 2

Now I have always maintained the action of antioxidants is overly simplified. There are structures that should be protected from reactive oxygen species. Namely cell wall structures, mitochondria and DNA. On the other hand, white blood cells depend upon highly reactive oxidative zones to kill bacteria or to have anticancer properties.

Oxidative Therapies vs. Anti-Oxidant Therapies

The debate rages on. I have many colleagues who are strenuously pro-oxidative advocates. They treat cancer and other infectious processes with hydrogen peroxide and/or ozone (triple oxygen) therapies.

One of the prevailing theories of aging is oxidation. It is one of the four pillars of aging in my book Life Extension Revolution. That is, oxidation hastens aging. Much like metallic iron oxidizes and rusts. I have always postulated that over-oxidation is unhealthy.

There is newer thinking that is evolving. It is possible that a small amount of free radicals or reactive oxidative species actually engages and causes a protective and homeostatic reaction. There is a process called hormesis. A small amount of poison introduced in a system stimulates a protective response.

So that a small amount of oxidative free radicals actually induces a beneficial reaction. But the system can become overwhelmed with too many reactive species in which case there is a negative and pathologic effect.

Chemotherapy and Radiation Therapy

Chemotherapy and radiation therapy are examples of highly reactive oxidative reactions that kill cancer cells. That is how they work. So here we have the ultimate example of oxidative therapy. But it is not specifically targeted. So that there is collateral damage. Killing normal cells as well as cancer cells.

And there is a prevailing caution in the oncology community that antioxidants should not be used during chemotherapy or radiation therapy. It might cancel effects of these cancer therapies. This has never been proven to be true. It is only an unproven presumption.

Iron as a Pro-oxidative element

Now why this discussion? Because it assumed that free iron is so highly reactive and potentially oncogenic (causes cancer). Or it promotes and feeds cancer. But within the context of the above discussion, I contend that this has never been definitively proven. It is simply the prevailing theory. This is the genesis of iron causing cancer.

There is definitive no proof that free radicals de novo (by themselves) cause cancer. There is no proof that iron by itself causes cancer. Just like my highly controversial assertion that cholesterol does not cause cardiovascular disease and hormones do not cause cancer. Over time these assertions are gathering more merit.

Why Iron Therapy

The post Iron Therapy – Part III appeared first on Dr. Philip Lee Miller by Philip Miller.

Iron Regulation Part II: Transport Signaling

Sun, 21 Jan 2018 08:51:40 GMT

Philip Lee Miller, MD, Editor in Chief

All these years I was trying to understand the relationship between serum free iron, bound transferrin iron, storage as ferritin iron and anemia. What is the control mechanism? What is the cause of iron deficiency? How is that related chronic anemia? How much lab data do we need to determine true iron status? OK. So let’s review iron cycling through each body compartment.

Bivalent Iron

You want lab data that measures all these forms of iron transport and storage for a complete and accurate assessment.

Iron exists in two states (bivalent). Ferrous Fe² iron is a reduced state which is more easily absorbed. Ferric Fe³ iron is the more reactive oxidized state. It is less easily absorbed. Ferric iron generates free radicals which can damage tissues and DNA. I will show you later why the more reactive form of iron generates so much controversy.

fig 5

Figure 6 shows the traversal of iron into various key compartments. Here is what is important.

Iron Transport

Dietary iron in the ferrous form is transported across the gut (enterocytes) into the blood stream. Intra-vascular ferrous iron is enzymatically converted to the more reactive ferric iron by ferroxidase. It is then bound to Transferrin. This carrier binding protein transports iron throughout the blood to various tissue sites.

Iron then enters the cells of the liver, spleen, muscle and bone marrow. Inside each cell, iron is bound to Ferritin. This storage protein is capable of binding large quantities of ferric iron. By encapsulating ferric iron, it protects cellular components from reactive free radical damage.

Ferritin is key. I stressed this in part I. Remember, ferritin can also represent inflammation.

The most important compartment is entrance into the bone marrow. That is where red blood cells are manufactured. It is the incorporation of iron into erthryocyte (red blood cell) hemoglobin that is critical for oxygen carrying capacity. Remember, anemia results in oxygen deficit at the cellular level.

Myoglobin is essential for muscle oxygenation. Most especially the muscles of your heart. Hemosiderin is denatured ferritin.

fig 6

Here is the take home message. You want lab data that measures all these forms of iron transport and storage for a complete and accurate picture.

Hepcidin — Master Controller of Iron Regulation

Now here is my recent discovery and “aha” moment. Hepcidin (1) is the x-factor that I had been missing. It is a liver derived protein that has pro-homonal signaling activity. It is a key regulator of iron absorption. [From the latin hep = liver and cidin = killing.]

Hepcidin, a peptide hormone which is mainly synthesized in the liver, was discovered in 2000. It reduces extracellular iron in the body by several mechanisms: 1) It lowers dietary iron absorption by reducing iron transport across gut mucosal cells (enterocytes); 2) It reduces iron exit from macrophages, the main site of iron storage; and 3) it reduces iron exit from the liver. In all three instances this is accomplished by reducing the transmembrane iron transporter ferroportin. — Wikipedia

fig 7

How Hepcidin Controls Iron Absorption

Any signal that increases hepcidin levels decreases iron absorption. Contrariwise, any signal that decreases hepcidin will increase iron absorption

I know. It’s complex picture. But simply put, hepcidin determines efficiency of iron absorption. Any signal that increases hepcidin levels from the liver decrease iron absorption. Contrariwise, any signal that decreases hepcidin will increase iron absorption. You can see in fig 7 that the genetic abnormality hemochromatosis is characterized by a deficiency of hepcidin activity. This causes an accumulation of abnormally toxic iron levels. Inflammation is a major signal for increased hepcidin activity thereby causing anemia.

Hepcidin is a regulator of iron metabolism. Hepcidin inhibits iron transport by binding to the iron export channel ferroportin which is located on the basolateral surface of gut enterocytes and the plasma membrane of reticuloendothelial cells (macrophages)…

Inhibiting ferroportin prevents iron from being exported and the iron is sequestered in the cells.^[9]^[10] By inhibiting ferroportin, hepcidin prevents enterocytes from allowing iron into the hepatic portal system, thereby reducing dietary iron absorption …

Increased hepcidin activity is partially responsible for reduced iron availability seen in anemia of chronic inflammation, such as renal failure.^[11]— Wikipedia

That’s a quick overview and background of the complexity of iron transport and control. So how do we correct these deficiencies and improve your iron status? There is a rich array of opinions, guidelines and approaches. That is the subject of the next part III. So stay with me.

Hepcidin – the Iron Regulatory Hormone, Clin Biochem Rev. 2005 Aug; 26(3): 47–49.

To be continued in Part III — How and Why to treat iron deficiency anemia

The post Iron Regulation Part II: Transport Signaling appeared first on Dr. Philip Lee Miller by Philip Miller.

Dr Philip Lee Miller

The Pandemic of Fear

The Pandemic of Fear

Dissenting viewpoints

The Total Picture

There is a Middle Way

Are Masks Protective?

Back to the Future – The Middle Way

So What Can You Do Now?

CoronaVirus: The Unintended Consequences

The Set-up

This Virus is Striking High Density Cities

Background Resources and Historical Perspective

What Exactly is this CoronaVirus – SARS-CoV-2?

Controversies in Containment Strategies

Adverse Consequences of Flattening the Curve

Our Ultimate Goal in Increasing Herd Immunity

The Economic Fallout will Dwarf the Medical Tragedies

Prevention, Treatment, and Therapeutics

In Summary:

Influenza and CoronaVirus: A Thoughtful Response

CoronaVirus Requires Organized Incident Command

Disease Outbreaks — Four Horseman of the Apocalypse

Annual Influenza Review

Treatment Modalities

Telomeres, Telomerase and Senolytics

Nutritional Medicine Pioneers

Epigenetics Controls our DNA

Telomeres and Telomerase Hold Great Promise

Senolytics — Clearing Senescent Zombie Cells

Mayo Clinic Research with Dasatinib and Quercetin.

Telomerase and Senolytics – A Unified View

Estrogen and Migraine Headaches

Relative Risk vs Absolute Risk Reporting

Analyzing Statin Studies and Efficacy

Low Dose Aspirin and Intra-Cranial Hemorrhage

Relative vs Absolute Risk Graphic

Poor Medical Reporting

Coda

Is Your Body Digital or Analog?

Is Cholesterol the Culprit?

2018-2019 Flu Vaccine, Prevention and Treatment

There is no universal flu vaccine

Flu Strains

Vaccine Effectiveness Rates

Anti-Virals now available

My recommendation for a natural approach

Vitamin D and Osteoporosis Prevention

How CEOs respond to a cancer diagnosis

Cancer Risk Benefit Management

Treat and Prevent Iron Deficiency Anemia

Enter Functional Medicine

Binary vs. Optimal Choices

Treatment Options

Heme vs non-heme iron sources in food.

Iron Salts

Iron chelates

Iron Infusions

Iron metabolism and iron supplementation in cancer patients: Wien Klin Wochenschr (2015) 127:907–919 DOI 10.1007/s00508-015-0842-3

Ludwig H, Müldür E, Endler G, et al. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24:1886–92.

Iron Dosing for Optimal Absorption: NEJM Journal Watch Oct 30 2015.

Five Quick Health Tips

Five Vital Health Tips

Facebook and Privacy

Safeway

Free Email?

Credit Cards

HIPAA

My Daily Personal Nutrition Routine

Personal Goal

Breakfast

Lunch

Dinner

Bedtime

Coda – Ask Jack

Looking for Prescription Drug Medication information

Historical Precedents

Current Sources

Not So Random Thoughts on Aging

Why Are Baby Boomers Dying Prematurely?