Wednesday, September 29, 2010

Dr. Judi's Dream Team

Hello! I'm Jason, Dr. Judi's son. I do occasional technical work on her blog so I have the access to sneak in as a guest writer while while she's busy healing. She knows nothing about this; hopefully she'll forgive my intrusion.

I invite you to consider being a part of Dr. Judi's Dream Team.

My mother, Dr. Judi, is a very busy woman. She spends an incredible amount of her time and her heart on healing people. She knows the trust that people put in her and works hard to be an excellent doctor so she can help her clients. This includes spending more time with clients than most doctors, staying on the cutting edge of medical advances so that she can offer the best solutions, and being open to proven solutions, whether or not they fit within the current culture of medicine.

In doing this Dr. Judi has developed a strong reputation for success with difficult-to-diagnose and chronic conditions. Client after client with problems like diabetes, fibromyalgia, autism, environmental illnesses, and anxiety disorders have experienced real relief through her work. But you already know this—that's why you read this blog.

What you may not be aware of, is that she has also discovered a variety of barriers to healing deeply entrenched in the traditional medical establishment. Barriers that she has had to work through herself in order to reach the level of success that she has. Barriers like compartmentalized specialization, a lack of awareness of the heavy impact of emotions on health, and a focus on isolated data rather than on whole people.

Dr. Judi really wants to change this. Because of her success, she has so many more people that want to see her than she has time to see. Her waiting list for appointments is often months long. She just doesn't have enough time herself to see them all.

For over a decade, Dr. Judi has been steadily working on a private dream, a vision of starting a Medical School/Healing Center. This Medical School/Healing Center would be designed to remove these barriers from the medical establishment and to create healing opportunities for many more people than she can treat herself. By shifting medical education's focus from rote memorization and intense competition to results-based healing, she can plant the seeds for a generation of doctors that connect with their patients as a rule, rather than as an exception. By exposing students to global medical research, she can open their eyes to astounding results that are being achieved in other countries. Yes, this would also be a research school, applying hard numbers and statistics using cutting edge methods like Active Control Study Design to alternative medicine to see what is a real opportunity, and what is snake oil.

Dr. Judi had an opportunity to test out part of her vision while she was an Area Medical Representative for the LDS Church in South America. A number of missionaries for the LDS Church were ending their proselyting early because of mental, emotional, and physical health issues. They couldn't find help out in the mission field, so they were returning home for medical treatment, with varying degrees of success. Dr. Judi (Hermana Moore at the time) was living in a hostel near the LDS Temple in the area, and began a program of having missionaries with significant health issues stay there at the hostel where she could work on an intense, whole person healing program with them, for a period of a few days to several weeks. After her program started, the number of missionaries going home because of unsuccessful medical care dropped drastically. Almost without fail, every missionary that went through her program was able to successfully complete their proselyting commitment.

Dr. Judi isn't unfamiliar with teaching in medical schools. A few years after she graduated from medical school herself, she was asked to return to that same school to teach other students. And she has served on the Utah Licensing Board of Osteopathic Physicians, the licensing body that determines who is and is not qualified for a D.O. medical license in the State of Utah.

This isn't just some vague desire. Over the past decade, Dr. Judi has met with a variety of people who have wanted to fund her project. She was approached by Utah Valley University officials (when it was UVSC) to see whether it would work to open the school in association with the university. She has been in negotiations with a number of people on purchasing land to start the school. She has contact with experienced, qualified professionals that want to teach at her school.

Unfortunately, my mother doesn't have the time to work on all these projects. To write business plans and proposals, to manage a non-profit entity that would head up the project. To raise funds and negotiate real estate purchases and establish marketing strategies. All of her time is taken up healing her clients.

Dr. Judi needs a team of experienced, qualified people that see the incredible possibilities that lie in her vision, her dream, and are willing to step in and pick up a part of the load to make it happen. People who have had success creating big projects from the ground up. People who see the need for change and growth in the medical establishment, and who are ready to take action to make it happen.

Dr. Judi knows what needs to be done. But she can't do it herself. You, however, may have the experience, the skills, the contacts to move her vision forward. Or you may know someone who does. Are you interested in being a part of Dr. Judi's Dream Team?

Jason

P.S. I love you, Mom!

Friday, September 24, 2010

How are Environmental Toxins Affecting Our Children?

This CNN special shows how the many chemicals in our food, water and environment are affecting our children. I urge you to watch it.

TOXIC AMERICA:

http://www.fliqz.com/aspx/permalinkblank.aspx?vid=da7b1310d17940cd9785f79a52464b4d

Until we meet again,
Dr. Judi

Sunday, September 12, 2010

Are Statins Beneficial in Preventing Heart Disease?


If you are taking a statin drug to prevent heart disease even though your cholesterol levels may be normal, think again.

The following is quoted from Family Practice News, Volume 40, Issue 12, Pages 10-11 (July 2010):

Studies Dispute Statins Benefits for Prevention

The only large clinical trial to find that statins reduce mortality in patients taking them for primary prevention—a group that comprises 75% of statin users—was so seriously flawed that its conclusions were termed “clinically inconsistent” and invalid by one group of researchers and “extreme and exaggerated” by another, according to separate reports.

In the first critique of the 2008 JUPITER (Justification for the Use of Statins in Primary Prevention) trial, Dr. Michel de Lorgeril of Universit√© Joseph Fourier and Centre National de la Recherche Scientifique, Grenoble, France, and his associates, analyzed the methods and findings of this only major study to claim that rosuvastatin produced a striking decrease in mortality in low-risk patients who have no evidence of coronary heart disease. These findings, which immediately provoked controversy, “have undoubtedly propelled many healthy persons without elevated cholesterol levels onto long-term statin treatment,” Dr. de Lorgeril and his colleagues said.

First among its major flaws, JUPITER was terminated early and apparently without proper justification according to the study's own protocol prespecifications. Early termination, a practice confined largely to industry-sponsored trials, tends to introduce biases that exaggerate the benefit and minimize the long-term harm of the treatment being assessed, according to the researchers. In this case, it also meant that the study was stopped just as mortality curves between the statin group and the control group had begun to converge, “suggesting that the borderline significant difference between groups may have disappeared” if follow-up had not been prematurely terminated, they wrote.

The main justification for terminating JUPITER was explained as an “unequivocal reduction in cardiovascular mortality” with statin therapy. Yet the JUPITER investigators did not include data on cardiovascular mortality in their published report. Readers would have to infer this result by extrapolating from data on a table. When examined closely, however, that data showed identical cardiovascular mortality between the treatment groups.

“Such a lack of effect on cardiovascular mortality [together] with a strong effect on nonfatal complications strongly suggests a bias in the data set and should have led to the continuation of the trial rather than to its premature ending,” Dr. de Lorgeril and his colleagues asserted.

Second, the ratio of fatal to nonfatal MI was so low as to be “incredible.” In particular, the case-fatality rate in the placebo group was only 8% when it would be expected to be about 50%, “a clinical inconsistency that suggests a major flaw in the study.” Moreover, the case-fatality rate with rosuvastatin was 29%, which implies that the “beneficial” drug actually tripled the case-fatality rate, they noted.

Third, JUPITER failed to explain why a strikingly high number of deaths—19 of 31 deaths in the rosuvastatin group and 25 of 37 deaths in the placebo group—were attributed to cardiovascular causes other than MI or stroke. Proponents of the JUPITER study argued after its publication that this referred to causes “such as aneurysm rupture.”

“Would this mean that in the same period of time there were 6 fatal infarctions and 25 fatal aneurysm ruptures in the placebo group? This is highly unlikely,” Dr. de Lorgeril and his associates said.

JUPITER also failed to report data on sudden cardiac deaths, which is surprising given that this is “the simplest and most reliable diagnosis in cardiology” and that it usually comprises 65%-70% of total cardiac mortality. “The way sudden cardiac death is reported—or not reported—may be a good indicator of the quality of the methods used in a trial,” they noted.

Equally important to these methodological flaws, the JUPITER trial involved several conflicts of interest.

“It was conducted by a sponsor with obvious commercial interests. Nine of 14 authors of the JUPITER article have financial ties to the sponsor. The principal investigator has a personal conflict of interest as a co-holder of the patent for the C-reactive protein test” that figured prominently in the rationale for statin therapy.

In addition, the monitoring board that made the decision to halt the trial early was chaired by an investigator who “has been and still is involved in many other industry-sponsored lipid-lowering trials,” Dr. de Lorgeril and colleagues said (Arch. Intern. Med. 2010;170:1,032-6).

“In conclusion, the results of the JUPITER trial are clinically inconsistent and therefore should not change medical practice or clinical guidelines.” Given that all 12 of the other large cholesterol-lowering trials conducted so far have failed to show any benefit from statins as primary prevention, it appears that “the presumed preventive effects of cholesterol-lowering drugs have been considerably exaggerated,” they said.

In the second study, Dr. Kausik K. Ray of the University of Cambridge (England) and his associates performed a meta-analysis of 11 randomized controlled trials that assessed the effects on all-cause mortality of statins versus a placebo or control therapies on all-cause mortality. They restricted their analysis to data on high-risk patients with no known cardiovascular disease and included previously unpublished data, “to provide the most robust information to date” on statins as primary prevention in this patient group.

The meta-analysis involved 65,229 men and women in predominantly Western populations, with approximately 244,000 person-years of follow-up. There were 2,793 deaths during an average of 4 years of follow-up.

All-cause mortality was not significantly different between patients taking statins and those taking placebo or control therapies. This suggests that “the all-cause mortality reduction of 20% reported in JUPITER is likely to be an extreme and exaggerated finding, as often occurs when trials are stopped early,” Dr. Ray and his colleagues said (Arch. Intern. Med. 2010;170;1024-31).

This meta-analysis shows that statin therapy as primary prevention in high-risk patients is less beneficial than is generally perceived, and it can be inferred to be even less helpful in low-risk patients.

One of Dr. de Lorgeril's associates served as an expert in litigation involving the pharmaceutical industry (not involving rosuvastatin). Dr. Ray and an associate reported financial ties to the majority of companies that market lipid-lowering agents; other associates reported ties to Pfizer Inc., Astra Zeneca, Bristol-Myers Squibb, and Merck & Co.

My Take
Both Critiques Are On-Target
These two critiques offer valuable insights and likely will reignite the long-simmering controversy over the use of statins as primary prevention of cardiovascular events.

Dr. de Lorgeril's critical analysis highlights several anomalies in the JUPITER trial data. In particular, early termination of the study allowed for inflated estimates of benefits, understated harms, allowed the findings to be published earlier (and hence used to advantage in marketing), and reduced the cost of the trial—which all significantly benefited the industry sponsor and a financially invested research team.

Tens of billions of dollars of revenue for the sponsor over the patent life of the drug were at stake in the JUPITER trial, as well as potentially millions of dollars in royalties for the principal investigator. And with three-quarters of statin users taking the drugs for primary prevention, enormous revenues are at stake.

The analysis by de Lorgeril et al. clearly demonstrates why research must be free of incentives to find a particular desired result.

Dr. Ray's report presents what is to date the cleanest and most comprehensive meta-analysis of pharmacological lipid lowering for prevention.

The results make it clear that for primary prevention in the short term, statins' benefits are very small. And in the long term, although sincere advocates on both sides will try to convince us otherwise, we really must admit that we do not know.

LEE A. GREEN, M.D., is in the department of family medicine at the University of Michigan Medical School, Ann Arbor. He reported no financial conflicts of interest. His comments appeared in an editorial (Arch. Intern. Med. 2010:170;1007-8).

From Archives of Internal Medicine

PII: S0300-7073(10)70742-8
doi:10.1016/S0300-7073(10)70742-8


Dr. Judi here: Statin medications have a lot of side effects which have an insidious onset and are hard to tell that the statin is causing them, including muscle pain and memory loss.

Other studies have shown that the best benefit from statins comes from those with high cholesterol and high cardiac c-reactive protein between the ages of 40-60. It is interesting to note that the elderly do not receive benefit from lowering their cholesterol. In fact, those with the lowest cholesterol have higher death rates than those with higher cholesterol. So when your doctor tells you that the statin drugs are the new wonder drug, look at benefits vs. the risks, do some research, and determine what is best for you.

Until we meet again,
Dr. Judi

Nutrients and Cancer Treatment



The following article was taken from Dr. Charles B. Simone's website, www.drsimone.com. Dr. Simone is an oncologist and immunologist who has practiced integrative medicine for his cancer patients for 40 years, and runs the Simone Protective Cancer Center. This article talks about the nutritional needs of the cancer patient, and the prevention of cancer through nutrition. I urge all to take serious note of the scientific studies he discusses that prove the importance of nutritional supplementation in the prevention and treatment of cancer.

NUTRIENTS AND CANCER TREATMENT
by Charles B. Simone, M.MS., M.D.,
with Nicole L. Simone, B.S.E., Charles B. Simone, II
copyright© 1999 Simone Protective Cancer Center

While thoroughly engrossed in basic science at the National Cancer Institute as a Medical Oncologist and Tumor Immunologist, I found new direction as a result of contacts with cancer patients. One of my first patients was a Vice President of the United States who was dying of malnutrition secondary to his cancer-as do 40% of all cancer patients. Later, a man my own age with a rare cancer asked if I would keep him alive until he saw the birth of his child. Intensive chemotherapy cleaned out the cancer, but he failed to improve. As a last resort, I gave him high doses of antioxidants and other vitamins and minerals that quickly produced a seemingly miraculous, although temporary result. The man saw the birth of his child.

Today's oncology care


Cancer will emerge as the number one cause of death in the United States by the year 2000. Despite the enormous effort to combat cancer, the number of new cases of nearly every form of cancer has increased annually over the last century. Still worse, from 1930 to the present, despite the introduction of radiation, chemotherapy, and immunotherapy with biological response modifiers, despite CT scans, MR scans, and all the other new medical technology, lifespans for almost every form of adult cancer have remained constant, except cervical and lung cancer. This means, there has been no significant progress in cancer treatment.

Although chemotherapy and radiation therapy continue to have a role in cancer treatment, they produce morbidity. Nutritional modification, including the use of antioxidants and other nutrients, and proper lifestyle factors can dramatically decrease morbidity and side effects of chemotherapy and radiation therapy as well as increase response rates. Some reports have shown that nutritional and lifestyle modification can actually increase survival. It has been proven that chemotherapeutic agents and radiation therapy reduce the serum levels of certain nutrients, especially antioxidants. The decreased levels of these antioxidants result from lipid peroxidation.

Augmenting treatment with nutrients

Do vitamins and minerals interfere with chemotherapy and/or radiation therapy? I am frequently asked this by patients because they have been advised not to take supplements during treatment. The scientific literature has clearly addressed this question:

1. The early clinical studies were performed at the National Cancer Institute using an antioxidant called N-acetyl cysteine that was found to protect the heart from the cardiac toxicity of adriamycin, but did not interfere with the tumor-killing capability of the drug. An antioxidant, dexrazoxane (ICRF-187), protects the heart from the effects of adriamycin without affecting the antitumor effect. Cellular studies, animal studies, and human studies demonstrate that vitamins A, E, C, and K, beta-carotene and selenium, as single agents or in combination, all protect against the toxicity of adriamycin and enhance its cancer-killing effects.

2. In vitro cellular studies and animal studies using vitamins C, A, K, E, D, B6, B12, beta-carotene, selenium, or cysteine as single agents or in combination given concomitantly with chemotherapy, or tamoxifen, or interferon alpha-2b, or radiation, or combinations of these modalities show the same effect: Increased tumor killing and increased protection of normal tissues.

3. Human studies involving over 1,960 patients have been done using single or multiple nutrients in combination with systemic treatment and/or radiation treatment demonstrating that nutrients produce a higher response rate, lower side effects, and even increased survival.

4. An increase in survival for cancer patients is uncommon with any treatment. But an increase in survival has been demonstrated for patients who received vitamin A or antioxidants in combination with chemotherapy or radiation therapy. This finding was observed for patients with myelodysplastic syndromes, breast cancer, gastric cancer, oral cavity cancer, and upper aerodigestive cancers. Patients who were given beta-carotene and anthaxanthin while undergoing surgery, chemotherapy, and radiation lived longer with an increase in disease-free intervals. And antioxidant treatment with chemotherapy and radiation prolonged survival for patients with small cell lung cancer compared with patients who did not receive antioxidants.

5. The effects of one chemotherapeutic agent, methotrexate, can be reversed with folinic acid, which is an analog of folic acid. Folic acid itself does not reverse methotrexate's effects. In order to reverse the effects of methotrexate, folinic acid has to be given in high doses. Folinic acid cannot be obtained over-the-counter. It is only available by prescription.

Efficacy of antioxidants

Antioxidants neutralize harmful chemicals called free radicals that occur in the body and constantly arise from fatty foods, smoking, alcohol, environmental pollutants, toxins, carcinogens, iron, smog, and radiation. Free radicals attack vital cell structures and cause damage contributing to the development of certain disease (i.e., cancer, cardiovascular, arthritis, cataracts).

Antioxidants protect normal cells and other tissues by fighting free radicals and the oxidative reaction that is caused by free radicals. Antioxidant nutrients include beta-carotene, vitamins C and E, selenium, copper, zinc, bioflavonoids, and cysteine. There are now more than 200 studies that shown antioxidants can help decrease the risk of developing cancer.

One of the most recent investigations took place in Linxian, China. Researchers from the Cancer Institute of the Chinese Academy of Medical Sciences teamed up with researchers at the United States National Cancer Institute and studied nearly 30,000 adults, randomized over a five-year period into four different groups receiving different nutrients during that period. Here is a brief summary of the study:

It was the first large-scale intervention trial in a prospective randomized fashion to demonstrate that three antioxidant nutrients together-beta-carotene, vitamin E, and selenium-significantly reduced total mortality (9%) especially from all cancers (13%) and particularly stomach cancer (21%).

These antioxidant nutrients also prevented the risk of cancer in humans.

These antioxidant nutrients substantially reduced the prevalence of cataracts in the oldest patients (aged 65 to 74 years).

These antioxidant nutrients also reduced the mortality from stroke. Many other studies demonstrated similar findings, including the Finland Study, the Switzerland Study, the Hawaiian Study, and studies involving people at high risk for developing endometrial cancer, breast cancer, cervical cancer, small cell lung cancer, oral pharyngeal cancer, and others. All studies show that protection is conferred to those who consume antioxidants and other nutrients.

Studies of pre-cancerous conditions

Scores of studies, from all over the world, have shown that antioxidants can decrease the risk of pre-cancerous lesions from developing into a full-blown cancer.

The Linxian, China study investigated 3,300 patients with esophageal dysplasia which is a precursor to developing esophageal cancer. The same team of researchers from China and the United States examined the results of the study, which was an intervention study, the best type of clinical design. The group that received the multiple vitamin-mineral supplement daily for six years had:

lower mortality from esophageal and upper stomach cancers (8%)
lower mortality rate in general (7%)
lower rate of death from cancer in any site (4%)
lower risk of dying of a stroke (38%)

While the duration of this trial was very short (six years) and the doses of the nutrients were far too low compared to other trials, the patients who took the supplements had much better results than the control group of patients who took no supplements. Other studies show that people who have colon polyps, abnormal cervical Pap smears, or other pre-cancerous conditions, all do better and can reverse the trend toward a cancer if they take certain antioxidants and other nutrients.

But what about beta-carotene specifically? There have been reports from the CARET and ATBC studies that beta-carotene increased the incidence of lung cancer in heavin heavy smokers who drank alcohol and were exposed to asbestos. I want to address this issue with the following thoughts:

1. Over 200 studies have demonstrated that beta-carotene is safe and can lower the risk of developing cancer and cardiovascular disease.
2. All intervention studies show that beta-carotene and other nutrients can decrease cancer rates and cancer progression.
3. A total of 22 epidemiological studies that included 400,000 smokers and nonsmokers have shown those who had a high blood level of beta-carotene had a lower incidence and mortality of lung cancer. None of these studies reported any association with an increased incidence of lung cancer. In fact, the reduction in risk was even more pronounced in smokers than in nonsmokers.
4. The principal investigator has publicly said that the findings are too preliminary to discuss and the data were not statistically significant.
5. The smokers in these studies who had high beta carotene serum levels at the start of the study had the lowest incidence of lung cancer.
6. Most of the study participants were alcoholics, and all of them ate a high fat diet – both risk factors dramatically and independently increase the risk of developing cancer..
7. beta carotene did not increase the risk of lung cancer for those who smoked less than 20 cigarettes a day and drank little or no alcohol.
8. To my knowledge, no information was gathered concerning other lifestyle risk factors that also would contribute to a poor outcome.
9. Beta-carotene works most efficiently at the early stages of carcinogenesis, not at the later stages when a cancer is already formed – as was the case with the patients in the CARET and ATBC studies. Cancers are started between 10 and 20 years before symptoms occur or our technology can detect them.

The fact remains, beta-carotene:

is the most powerful antioxidant.
neutralizes singlet oxygen, a powerfully damaging chemical.
enhances immune system function.
is very safe and nontoxic.

It is important to rely on the synergism of all the antioxidants, including the carotenoids, and also the B’s, etc., as well as lifestyle changes to decrease one’s risk of cancer and heart disease. it is foolish to expect that a single nutrient can give the “green light” to continue lifestyle behavior that will cause disease.

Conclusion

Nutrition and lifestyle factors can profoundly reduce toxic side effects and improve the results of conventional treatments. In a recent study of 50 patients with early stage breast cancer, I evaluated the treatment side effects of radiation alone, or radiation combined with chemotherapy, while the patient took therapeutic doses of nutrients. Patients also followed the Simone Ten Point Plan (see Table 1). The patients were asked to evaluate their own response to the treatment in terms of impacts of treatment on their quality of life. The major rationale behind our nutritional plan is that it contains a well-rounded supply of antioxidants and immune enhancing nutrients. The results of the study were impressive:

1. More than 90% of both groups noted improvement in their physical symptoms, cognitive ability, performance, sexual dysfunction, general well-being, and life satisfaction.
2. Not one subject in either group reported a worsening of symptoms. Patients who follow the Ten Point Plan and use certain vitamins andminerals report few side effects from chemotherapy and radiation therapy. Twenty studies with more than 2,700 patients that investigated lifestyle modification that includes dietary changes, nutrient supplementation, and other lifestyle changes demonstrated a lower recurrence rate and an increase in survival. The patients in these studies had the following cancers: breast, ovarian, cervical, uterine, head and neck, lung, pancreatic, prostate, and bladder.

Cancer patients should modify their lifestyles using the Ten Point Plan, which includes modifying nutritional factors and taking certain vitamins and minerals, especially if they are receiving chemotherapy and/or radiation. The studies indicate that it is important to take the correct nutrients to reduce side effects, enhance conventional therapies, and increase outcomes (table 2).

Table 1
The Simone Ten Point Plan:


NUTRITION. Maintain an ideal weight-lose even 5 or 7 pounds if needed. Follow a low-fat (about 20%), high-fiber (25 gm) diet. Take specific nutrients (see table 2). Eliminate salt, food additives and preservatives, and caffeine.
TOBACCO. Do not smoke, chew, snuff, or inhale other's smoke.
ALCOHOL. Avoid alcohol.
RADIATION. Avoid unnecessary X-rays and use sunscreens when in the sun. Avoid electromagnetic fields.
ENVIRONMENT. Keep air, water, and work place clean.
HORMONES/DRUGS. Avoid all estrogens and unnecessary drugs.
KNOW THE SEVEN WARNING SIGNS OF CANCER. Lump in breast, non-healing sore, change in wart/mole, change in bowel or bladder habits, persistent cough or hoarseness, indigestion or trouble swallowing, unusual bleeding.
EXERCISE.
STRESS MODIFICATION, SPIRITUALITY, AND SEXUALITY.
HAVE AN EXECUTIVE PHYSICAL ANNUALLY.

Table 2
Dr. Simone's recommended nutrients/dosages:

Beta carotene = 20 to 30 mg per day
Lutein = 10 TO 25 mcg per day
Lycopene = 10 TO 25 mcg per day
Vitamin E = 400 to 600 IU per day
Vitamin C = 350 to 6,000 mg per day
Bioflavonoids = 10 to 20 mg per day
Selenium = 200 to 300 mcg per day
Zinc = 15 to 20 mg per day
Copper = 3 to 5 mg per day
Cysteine = 20 to 500 mg per day
Vitamin A = 5,000 to 7,500 IU per day
Vitamin D = 400 to 600 IU per day
Vitamin B1 = 10 mg per day
Vitamin B2 = 10 mg per day
Vitamin B6 = 10 mg per day
Vitamin B12 = 18 mcg per day
Niacinamide = 40 mg per day
Biotin = 150 mcg per day
Pantothenic acid = 20 mg per day
Folic acid = 400 mcg per day
Iodine = 150 mcg per day
Chromium = 125 mcg per day

Until we meet again,
Dr. Judi

Sunday, September 5, 2010

The Perfect 10 Diet

This is taken from Bottom Line Secrets and I thought it was worth reading:

The Perfect 10 Diet

Michael Aziz, MD
American Academy of Anti-Aging Medicine

Like most physicians, I used to advise overweight patients to follow the American Heart Association’s low-fat guidelines, but most of these patients continued to gain. After years of research, I discovered that most diets fail because they don’t take into account the hormones that regulate appetite and control weight.

The body contains more than 100 hormones, substances that regulate bodily functions. People who maintain an optimal hormonal balance are more likely to maintain a healthy weight than those who count calories.

Overall, I have found that the diet that is best for hormone optimization has 40% carbohydrates (vegetables, fruits, legumes and whole grains)... 40% fat (saturated fats from dairy products, coconut and palm oils, and monounsaturated fats in olive oil, avocados and nuts)... and 20% protein (eggs, fish, shellfish and poultry, plus red meat in moderation).

Many people are surprised that I recommend eating saturated fats. Probably the single greatest nutritional myth of past decades has been that saturated fat is unhealthful. Eating foods rich in saturated fat boosts the production of anti-aging hormones, including estrogen, progesterone and testosterone.

The important hormones* for weight control and how to regulate them...

Insulin

Up to 75% of American adults produce too much insulin. This increases appetite and leads to obesity as well as diabetes.

What happens: A low-fat diet with excess carbohydrates causes the pancreas to overproduce insulin. Excess insulin increases fat storage and makes it extremely difficult to lose weight.
Solution: A diet high in natural foods (whole grains, vegetables, fish, etc.) with a minimum of processed carbohydrates.
Also helpful: One to two tablespoons of brewer’s yeast daily. It’s high in chromium, a trace mineral that reduces blood sugar and improves glucose tolerance. Better glucose tolerance reduces the amount of insulin that is produced by the pancreas.

Glucagon

Levels of glucagon (glu-ca-gon) rise when insulin is low. Unlike insulin, which transports the sugar in blood into the body’s cells, glucagon pulls sugars out of storage to provide energy. It melts away fat in the process.

What happens: Glucagon and insulin can’t be present in large amounts simultaneously, because they have opposing actions. If your insulin levels are high, your levels of glucagon will always be low.
Solution: Limit yourself to three meals a day. It was once thought that "grazing" (having frequent small meals) would help people lose weight. This style of eating promotes weight gain because it elevates insulin and depresses glucagon.

Leptin

The hormone leptin is secreted by fat cells and is the main hormone that controls satiety, the feeling of fullness after eating.

What happens: People who produce too little leptin -- or, paradoxically, too much -- tend to gain weight because they’re hungry all the time. A diet high in processed foods, particularly those that contain trans fatty acids or high-fructose corn syrup, causes the body to burn fewer calories and store fat even in the presence of leptin.
Solution: A diet high in natural fats, such as the omega-3 fatty acids in fish, along with whole grains, vegetables and fruits.

Thyroid

About 25 million Americans suffer from hypothyroidism, an underactive thyroid gland. This lowers the body’s metabolism and can lead to obesity -- even in people who don’t eat very much.

Hypothyroidism is an autoimmune disease that requires medical care, but it can be exacerbated by a poor diet.

What happens:
People who follow a low-fat or low-carbohydrate diet often develop low thyroid hormone levels. So do people who eat mainly processed foods. Iodine from excess salt blocks enzymes that produce thyroid hormones.
Solution: Use sea salt instead of regular salt. It contains less iodine. Eat sea vegetables (such as wakame and nori) at least twice a week. They contain just enough iodine to help you maintain optimal thyroid function. Eat plenty of fruits and vegetables -- they enhance the body’s production of thyroxine, the active form of thyroid hormone.

Human Growth Hormone (HGH)

HGH is produced by the pituitary gland to promote the growth and repair of muscle tissue.

What happens: People who don’t produce enough HGH tend to have less muscle and more body fat. Excess body fat further depresses HGH.
Solution: As with glucagon, HGH rises when people eat less frequently. Eat just three meals a day.
Also helpful: Eat eggs, poultry or fish most days. These foods increase HGH. Get a good night’s sleep. Most of the body’s HGH is produced during sleep.

Cortisol

Cortisol is a stress hormone because it rises during times of stress. In our high-stress society, virtually everyone has elevated levels of cortisol.

What happens: It promotes the storage of fat, particularly the dangerous visceral (belly) fat.
Solution: Maintain your emotional equilibrium with activities such as yoga and meditation. Also, people who eat natural foods and avoid processed foods tend to have healthier cortisol levels.

Sex Hormones

Men start producing less testosterone at about age 20, while women have a sharp drop in estrogen and progesterone as they approach menopause. It’s not a coincidence that most people start to gain weight when levels of these hormones decline.

What happens: Declines in sex hormones are a natural, age-related phenomenon. But excessive drops in these hormones usually are caused by too much sugar in the diet and lack of natural fats, such as butter, along with lifestyle factors, such as smoking and alcohol consumption.
Solutions: Men and women can improve their hormonal profiles by exercising regularly... not smoking... and drinking alcohol only in moderation (no more than two drinks daily for men and one for women).
Also important: Drink less coffee. Caffeine lowers testosterone.
Women can maintain a healthier estrogen/progesterone balance by eating high-quality proteins and fats (from eggs, butter, whole milk and poultry) at least once a day. The same foods will help increase testosterone in men.

DHEA

DHEA is the "precursor" hormone produced by the adrenal gland that the body uses to manufacture other hormones, including estrogen and testosterone.

What happens: People who drink too much coffee or eat margarine or other foods that contain trans fats tend to have lower levels of DHEA. Processed carbohydrates, including white bread, also can cause DHEA to decline.
Solution: Avoid processed foods, and eat some saturated fat most days of the week. This will help increase the body’s production of DHEA.

10 Steps to The Perfect 10

To optimize your hormones and lose weight...

40% carbohydrates: Vegetables, fruits, legumes and whole grains.
40% fat: Saturated fats from dairy products, coconut and palm oils and monounsaturated fats in olive oil, avocados and nuts.
20% protein: Eggs, fish, shellfish, poultry and red meat, in moderation.

Also...
Limit yourself to three meals a day (avoid snacking).
Have one to two tablespoons of brewer’s yeast daily.
If you have low thyroid, eat sea vegetables twice a week and choose sea salt over regular iodized salt.
Reduce stress with yoga and meditation.
Get regular exercise.
Limit alcohol and caffeine, and don’t smoke.
Get a good night’s sleep.

*Few physicians routinely test all of these hormones in overweight patients. To find a specialist in your area who uses this approach, go to the Web site of the American Academy of Anti-Aging Medicine at www.WorldHealth.net.

Bottom Line/Personal interviewed Michael Aziz, MD, founder and director of Midtown Integrative Medicine, which blends traditional and complementary therapies. He is an internist and attending physician at St. Vincent’s Hospital in New York City, where he also maintains a private practice. He is author of The Perfect 10 Diet (Cumberland House). www.Perfect10Diet.com.

This is Dr. Judi again: If a person is able to eat a palm size piece of protein, including red meat and eggs, along with plenty of vegetables and some fruit at their meals, their blood sugars will maintain between meals. However, if the diet isn't quite that healthy, eating a healthy snack between meals is important to keep the blood sugar up and maintain brain function until the blood sugar/insulin/glucagon levels begin to stabilize.

Until we meet again,
Dr. Judi

Wednesday, August 25, 2010

Thyroid Answer


I haven't written for quite some time because I have received the blessing of physical custody of four of my dear grandchildren. They have taken most of my extra time, so these blogs may be less often for a while. However, I received a question that I thought may be useful for everyone to read the answer to:

"I have some concerns about my low temperature in the AM and my tiredness, foggy brain, joint and pain muscles, my swollen body and the fact that no matter what I do I do not loose weight. My symptoms point to hypothyroidism...

I am curious to learn what is your approach to this health challenge, some of your recommendations and the best supplements and strategies to use to mnage/cure this situation. Thanks in advance."

First I would recommend getting tested. I have a much more narrow range than most doctors for test results, based on both studies and my own experience with patient symptoms.

Get the following tests: TSH, Free T3, Free T4, and thyroid antibodies.

My range for normal TSH is between 0.5 and 1.5. If it is between 1.0 and 2.0 and there are symptoms I normally recommend a trial of iodine. Over 2.0 I usually treat, most commonly with Armour Thyroid, though a small number of patients do better with Synthroid, or levothyroxine.

If any of the thyroid antibodies are positive, this is a diagnosis of Hashimoto's autoimmune thyroiditis. About 60% of people with Hashimoto's have a gluten intolerance, so I would encourage anyone with this diagnosis to do a three month trial of a gluten free diet.

For further comments on thyroid imbalances, see my blog of Nov. 30, 2008.

Until we meet again,
Dr. Judi

Sunday, May 23, 2010

A Simple Exercise for Diabetics (and anyone wanting to lose weight!)



There is no doubt that exercise improves glucose levels, increases insulin sensitivity, improves glucose utilization by the muscles, reduces the vascular and neurological damage caused by high glucose, and improves weight control. However, time and energy are at a premium for many people with diabetes. Although any exercise is better than no exercise, I recommend the following exercise regimen for my patients:

Individualized Interval Training

FOR 12 TO 15 MINUTES ONLY:

1. Do a vigorous aerobic activity as fast and as hard as you are able in your current state of health. This may be running, going up and down stairs, doing jumping jacks, dancing vigorously, bicycling, or any aerobic gym machine.

2. When you are breathing hard and your heart is pounding, STOP! This may be after ten seconds or five minutes, depending on your state of health and your exercise capacity.

3. Rest until your breathing and your heartbeat normalize.

4. Do the aerobic activity vigorously again.

5. When you are breathing hard and your heart is pounding, STOP!

6. Rest until your breathing and your heartbeat normalize.

7. Repeat this until 12 to 15 minutes is up.

This type of exercise breaks down fat over the next twenty-four to forty-eight hours, improves the strength of the heart muscle, lowers blood sugar and cholesterol, builds muscle, reduces vascular inflammation and increases the feel-good chemicals in the brain.

This exercise is tailored to fit your individual needs. You do not go beyond your limit because your breathing and heartbeat tell you when to stop. Over time the amount of time you can exercise increases, and the amount of time you rest decreases. Your body improves at its own individual rate and ability. Be patient with it. It knows what it’s doing!

Conclusion to these blogs on Diabetes (yes, we're finally coming to an end!!)
This information was designed to inform the person diagnosed with diabetes or pre-diabetes about the nature of the disease process, the effect of medications, and ways to improve and at times even stop the disease process.

When each person takes individual responsibility for their own health, rather than depending completely on the health system to tell them what to do, they will find the ability to change their life and change their health.

In my experience, many who follow the Sugar Stabilization Program, along with supplementation and exercise, can reduce, and in many cases for Type 2 Diabetes, come off of their diabetic medications under the supervision of a physician. The less medication needed, whether insulin or oral medications, the less long term side effects of those medications. And the more balanced the glucose and insulin levels become, the less long-term complications from the disease process occur.

The earlier a person starts a program like this the more effective it is. Someone who has been dealing with diabetes for many years has more damage to clean up, so it takes longer to balance the blood sugars. But be patient, because the more you do for yourself, the better you will be in the long run. If it took you a long time to come to this state of health, it may take one or two years to improve. But it will be worth it!!

Best wishes to you all in your pursuit of health!

My next few blogs will be on the effects of hypoglycemia, or low blood sugar. Did you know that people who have low blood sugar have less self control? Stay tuned!

Until we meet again,
Dr. Judi

Wednesday, May 19, 2010

Supplements for Diabetes


The following supplements have been shown through scientific studies to have a positive effect on blood glucose and/or insulin levels, and some are protective for the body and blood vessels when the blood sugar goes to high:

1. Glucose tolerating factors—chromium and biotin have been shown in studies to help optimize glycemic control by increasing insulin sensitivity, and are needed to burn protein, carbs and fat.

2. Vanadium—mimics the effect of insulin in the body.

3. Alpha Lipoic Acid—recirculates anti-oxidants to reduce free radical damage, is necessary for converting glucose to energy, and can protect brain and nerve tissue from elevated glucose levels.

4. Gymnema Sylvestre—slows the transport of sugar into the blood stream.

5. MHCP from Cinnamon bark—acts as a natural insulin, increases insulin receptivity of the cells, and helps maintain good triglyceride and LDL levels.

6. Benfotiamine—a form of Thiamine (Vitamin B-1) that protects the vessels from the complications of diabetes, reducing retinopathy, nephropathy and neuropathy.

7. N-acetyl-L-cysteine—prevents or delays beta cell dysfunction in the pancreas and improves glutathione production for better detoxification of the body.

8. Acetyl-L-carnitine—prevents and reduces pain associated with neuropathy, and may improve glucose balance.

9. Banaba leaf—has been shown to lower blood sugar with insulin-like properties.

10. Nopal (Prickly Pear Cactus)—normalizes blood sugar, whether too low or too high, increases insulin sensitivity and reduces inflammation.

11. Karela (Bitter Melon)—lowers blood sugar, increases insulin sensitivity, and stimulates digestion.

12. Agaricus Blazei—mushroom that increases adiponectin levels, a protein hormone that is produced by adipocytes (fat cells), which regulates the body’s metabolism of lipids and glucose, influences the body’s response to insulin, and reduces inflammation in the vessel walls.

I developed a supplement, Glucose Balance by SpringTree Nutrition (www.springtreehealth.com), which contains all of these ingredients listed above. Used in combination with SuperMulti Plus, which contains all the vitamins, minerals, bioflavinoids and anti-oxidants necessary to provide for what becomes depleted in the diabetic body, blood sugar levels frequently improve, energy and health improve, and often medication can be reduced under a physician’s supervision.

Other supplements that I would recommend for people with diabetes:

• A good soluble fiber supplement to reduce glucose absorption and assist digestion.

• Betaine HCL, taken at the beginning of a meal, to improve stomach acid, which is often low in those with diabetes. Low stomach acid reduces stomach emptying, reduces digestion and absorption of calcium and other minerals, B-vitamins, and proteins. It also increases acid reflux.

• Digestive enzymes, taken at the end of a meal, to assist digestion.

• An adrenal support supplement, such as Adrenal Stress Relief by SpringTree Nutrition, as stress increases blood sugar and makes the disease process worse. Diabetes itself is also very stressful to the body and a good adrenal support will assist the body in better dealing with that stress.

• If overweight, a healthy supplement to assist with weight loss such as Appetite and Carb Control, which will be soon released by SpringTree Nutrition.

GI Health, coming soon from SpringTree Nutrition, is an excellent support for digestive health, containing soluble fiber, pre-biotics and pro-biotics, and other excellent ingredients to support the digestive health of a patient with diabetes who struggles with gastro-intestinal problems.


Next blog will be on a simple exercise that does wonders for weight loss and blood sugar control for people with diabetes.

Until we meet again,
Dr. Judi

Saturday, May 8, 2010

What Can I Eat When I Have Diabetes?


I'm going to discuss two diets here: the diet proposed by the American Diabetes Association (ADA) and the diet I have found works best for the diabetic patients that come to my office.

The ADA recommends the following:

•Grains and starches 6-11 servings a day
•Vegetables 3-5 servings a day
•Fruit 2-4 servings a day
•Milk and dairy 2-3 servings a day
•Meat and meat substitutes 4-6 oz. divided between meals
•Fats, sweets and alcohol keep small servings for a special treat

A serving of grains or starches includes 1 slice of bread, ¼ bagel, 1/3 cup rice, ½ cup potatoes, yams, peas, corn, beans.

A serving of vegetables is 1 cup raw or ½ cup cooked.

A serving of fruit is ½ cup canned fruit, 1 small fresh fruit, or 1 cup melon or berries.

A serving of mild and dairy is 1 cup non-fat or low-fat milk or 1 cup of yogurt.

Four ounces of meat is a quarter pound. 1 oz. of meat is equal to ¼ cup cottage cheese, 1 egg, 1 tablespoon peanut butter, and ½ cup tofu.

A typical serving of sweets includes ½ cup ice cream, 1 small cupcake or muffin, or 2 small cookies.


The problem I see in my patients on this diet, even though basically healthy, is that their blood glucose and insulin levels are still not controlled. And I believe the greatest source of that problem is in the grains and the starches, which are given the highest priority in this diet.


Sugar Stabilization Program

The following is the program I put my patients on which has very positive effects in balancing their blood glucose and insulin levels. This can be used for both type 1 and type 2 diabetics, and often both the amount of insulin and/or oral medication can be reduced (under the direction of a physician) when the diet is used in combination with the supplements.

1. Avoid refined sugar: sucrose, fructose, maltodextrose, etc. No honey, syrup, turbinado sugar, etc. Avoid artificial sweeteners: aspartame (Nutrasweet, Equal), saccharin (Sweet'N Low, SugarTwin), acesulfame K (Sunett, Sweet One), Sucralose (Splenda). Limited amounts of xylitol, stevia and agave nectar are acceptable.

2. Eat a palm size piece of protein (meat, fish, egg, tofu) at each of the three major meals a day.

3. Eat as many vegetables as possible—preferable five servings a day, especially green leafy and non-starchy vegetables. Eat potatoes sparingly.

4. Eat three fruits a day, preferably as a dessert after a normal meal. Eat bananas sparingly. Avoid fruit juice.

5. Eat a healthy (protein, vegetable, nuts or seeds, cheese) snack between meals.

6. Avoid products made with flour: bread, crackers, tortillas; use pasta sparingly. Whole grains: whole wheat berries, brown rice, whole barley, oatmeal are acceptable in limited amounts, unless you are gluten sensitive. Bread made from sprouted grains rather than flour are acceptable in limited amounts. DO NOT USE GRAINS IF YOUR BLOOD GLUCOSE REMAINS HIGH ON THIS DIET.

7. Legumes, nuts and seeds are acceptable.

8. Dairy is acceptable if there is no allergy to it.

9. Use healthy fats and oils: olive, sunflower, safflower, grape seed, walnut, etc.

10. Drink 6-8 cups of water a day.

11. Glucose Balance supplement daily.

12. Interval exercising 12 minutes a day.

This way of eating combined with the supplements and exercise program described in a future blog often reduces blood sugar enough to reduce or even come off of medication (under a doctor’s supervision) for Type 2 Diabetes, and often reduce the level of insulin necessary in Type 1 Diabetes, which reduces long-term complications.

Before you start this program, it is important to take your blood sugars four times a day: before each meal and at bedtime, to get a baseline of where your blood sugars are normally, and then continue for the first couple of weeks on the program to see how you are responding to it. Once a month it is useful to take your blood sugars four times a day, if you are not already doing it, to be sure that your regimen is working for you. If your blood sugars start going too low, talk to your doctor about reducing your medication.

After you get used to the basics of this program, having been on it for more than a month, if your glucose readings are still too high, you can modify it in the following steps as needed, one at a time, step by step, until your readings, along with supplements and/or medication, are between 80 and 110 (the majority of diabetics will not have to go beyond the first one to two steps):

1. Using an online carbohydrate counter and reading labels, count the number of grams of carbohydrates you are eating and reduce to 75 grams a day.

2. Use an online glycemic index table, and only eat foods that are given the value of 50 or below.

3. Cut out all gluten (wheat, oatmeal, rye and barley). Some people are sensitive to gluten and it causes an unusual rise in insulin levels.

4. Reduce the number of grams of carbohydrates you eat to 50 grams a day.
5. Reduce the number of grams of carbohydrates to 25 grams a day.


Studies have shown that people who don’t eat gluten (in wheat, oatmeal, rye and barley), lose weight, lower glucose levels, and increase their HDL and ApoA1 levels.

The low number of carbohydrates seems restrictive, but blindness and kidney dialysis and amputations are much more restrictive. Often, when the blood sugars are under control for a year, the body can handle more carbohydrates without a rise in blood sugar.

The next blog will be about supplements that have been shown to assist in lowering and stabilizing glucose and insulin levels.

Until we meet again,
Dr. Judi

Wednesday, May 5, 2010

About the Medicines Used for Diabetes



The information in this blog is rather technical and probably boring for someone who doesn't have diabetes. However, if you are on any type of medication for diabetes I recommend that you at least read about the medicines you are taking. It is important to be knowledgable about what you are taking into your body, so that you can be aware of what is helping and what may be causing a problem.

Type 1 diabetes is always treated with insulin. Without insulin, a person with type 1 will develop hyperglycemia that progresses to ketoacidosis, and eventually death. They are usually given a long acting insulin that is given in shots once or twice a day, depending on the type, and then supplement it with short acting insulin at mealtime to cover the amount of carbohydrates they eat. There are various brands and types of long-acting and short-acting insulin, and sometimes they are put together in one shot. The combination shot may work for some people with type 2 diabetes, but I don't recommend it for type 1.

Type 1 diabetics now have the option of using an insulin pump, which keeps a more steady flow of insulin. However, they often still may need to give extra short acting insulin to cover their meals.

Often I have heard doctors tell type 1 diabetics that they can eat what they want; just cover the amount of carbohydrates with adequate insulin. However, if type 1 diabetics eat high carbohydrate meals or eat too much so that they need large amounts of insulin, eventually their cells become resistant to insulin and they also develop type 2 diabetes. High levels of insulin also increase fat deposition and increase inflammation in the body, which increases hardening of the arteries, heart disease and stroke risk. I believe that it is very important for all diabetics to watch what they eat, and recommend the Sugar Stabilization Program given later in this book.

Type 2 diabetes is usually treated with oral medications, unless it advances to a level where they no longer work, and then insulin is given.

Please read the following carefully if you are taking oral medications for diabetes. Make sure the medication you are taking is not causing you serious side effects.

The various types of oral medications can be catagorized as follows:

Sulfonylureas. Sulfonylureas used to be the first medication to be prescribed for type 2 diabetes. However, with the newer drugs, they are usually now added after the other drugs are not giving enough control. Sulfonylureas lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent, have more side effects, and are shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c (HbA1c) of up to 1%-2%.

Sulfonylureas often induce hypoglycemia (low blood sugar) which often prevents a diabetic from achieving good glucose control; people usually keep their blood glucose elevated above optimal in order to reduce the frequency and severity of hypoglycemia, which can cause coma.

Like insulin, sulfonylureas can induce weight gain, which increases problems associated with diabetes. Other side-effects can be abdominal upset, headache and hypersensitivity reactions.

Sulfonylureas are potentially harmful to the fetus and should not be used in pregnancy or in patients who may become pregnant. Impairment of liver or kidney function increase the risk of hypoglycemia, and are contraindications.

The use of sulfonylurea agents has been reported, but not proven in all studies, to increase the risk of death from heart and blood vessel disease, probably because they cause an increase in insulin levels. Patients with diabetes are already more likely to have these problems, but they should be aware that many of these drugs make heart disease worse. However, glyburide (Micronase, Diabeta and Glynase) and gliclazide (Glipizide) have been shown in studies to have a positive effect on heart and blood vessel disease.

Biguanides. Metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza) is the most commonly used oral diabetic agent, and actually originates from the French lilac (Galega officinalis), a plant known for several centuries to reduce the symptoms of elevated blood sugar.
Metformin works by reducing glucose production by the liver (gluconeogenesis). The "average" person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third. Metformin also causes the cells to become more sensitive to insulin, increasing glucose uptake by the cells and therefore lowering blood sugar. Meformin can decrease the HbA1c 1%-2%. It also increases fatty acid oxidation, which reduced triglyceride and LDL cholesterol levels.

Unlike other diabetic medications, metformin does not cause low blood sugar, one of the most dangerous side effects of most medications. It has a lower side effect profile than the other drugs.

The most common side effect is gastrointestinal upset, including diarrhea, cramps, nausea, vomiting, and increased flatulence. GI upset happens most often at the beginning of use, or when the dose is increased. It is better to start low and slowly increase.

Metformin should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients, which can cause death.

Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Rosiglitazone (Avandia) and Pioglitazone (Actos) are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications.

These drugs may take a few weeks before they have an effect in lowering blood sugar.
The main side effect of all thiazolidinediones is water retention, leading to edema, generally a problem in less than 5% of individuals, but a big problem for some and potentially, with significant water retention, leading to congestive heart failure. Therefore, thiazolidinediones should be prescribed with both caution and patient warnings about the potential for water retention/weight gain, especially in patients with decreased ventricular function (NYHA grade III or IV heart failure).

Recent studies have shown there may be an increased risk of coronary heart disease and heart attacks with rosiglitazone.

Pioglitazone treatment, in contrast, has shown significant protection from both micro- and macro-vascular cardiovascular events and plaque progression.

Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.

Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.

However, these medications can still cause hypoglycemia to some degree. They can also cause weight gain because of the increased levels of insulin.

Dipeptidyl peptidase IV (DPP-IV) inhibitors, including sitagliptin (Januvia). Januvia works to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain, and often reduces appetite. The medication may be taken alone or with other medications such as metformin.

Side effects include headache, nausea, diarrhea or constipation, sore throat and respiratory tract infections. More rare but serious side effects include fever and a headache with a severe blistering, peeling red rash. Many report an increase in joint pain. The FDA has warned of serious pancreatitis that can lead to death.

Incretin mimetics. Exanitide (Byetta) is a new class of medication approved in 2005. Byetta is administered as a subcutaneous injection (under the skin) of the abdomen, thigh, or arm, 30 to 60 minutes before the first and last meal of the day. It is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster. It enhances the glucose-dependent secretion of insulin, suppresses glucagon secretion, and slows gastric emptying. It supposedly reduces appetite and assists with weight loss.
The main side effects of Byetta use are gastrointestinal in nature, including acid or sour stomach, belching, diarrhea, heartburn, indigestion, nausea, and vomiting. Other side effects include dizziness, headache, and feeling jittery. The FDA has issued a warning about severe pancreatitis that can lead to death associated with Byetta.

Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.

When blood sugars are not able to be controlled with oral medication, a person with type 2 diabetes may also be placed on insulin.

The next blog will be about diets used for diabetes, including my Sugar Stabilization Program.

Until we meet again,
Dr. Judi

Monday, May 3, 2010

How is Diabetes Diagnosed?


The medical guidelines for diagnosing diabetes is as follows:

Fasting plasma glucose (a blood test after at least 8 hours of fasting):
•80-99 normal
•100-125 pre-diabetes (impaired glucose tolerance)
•126 or over diabetes

2-hour glucose tolerance test (blood test 2 hours after fasting and then drinking 75 grams of glucose):
•under 149 normal
•140-199 pre-diabetes (impaired glucose tolerance)
•over 200 diabetes

Hemoglobin A1C levels:
•under 6.0 normal
•6.0 to 6.4 pre-diabetes
•over 6.5 diabetes

The American Diabetic Association recommends that people aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors:
•being physically inactive
•having a parent, brother, or sister with diabetes
•having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
•giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes
•having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure
•having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 200 mg/dL
•having polycystic ovary syndrome, also called PCOS
•having IFG or IGT on previous testing
•having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits
•having a history of cardiovascular disease—disease affecting the heart and blood vessels

If results of testing are normal, testing should be repeated at least every 3 years. Doctors may recommend more frequent testing depending on initial results and risk status. The ADA states that people whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes.

I find that many people have a normal fasting blood glucose but still have pre-diabetes. My test of choice for testing for insulin resistence, glucose intolerance and diabetes, which used to be done commonly but is rare now, is a 4-hour Glucose Tolerance Test. The blood glucose level AND the insulin level is taken fasting, and then after a glucose drink it is taken at ½ hour, 1 hour, 2 hours, 3 hours and 4 hours, testing both glucose and insulin levels at each draw. This shows if the glucose and/or insulin goes too high, and often it will then drop too low at 3 or 4 hours, which increases stress on the body. THIS TEST SHOULD NOT BE USED TO DIAGNOSE TYPE 1 DIABETES.

Rather than advocating simply being re-tested in 1 to 2 years if there are any signs of pre-diabetes, we immediately change the diet and other risk factors, and start the patient on supplements that will reduce their risk of getting diabetes.

Type 1 diabetes is diagnosed through the same glucose level parameters. Most children diagnosed with diabetes have type 1, though that is changing. Most diagnoses of type 1 are made when the child presents to the emergency room extremely ill in ketoacidosis.

Most adults diagnosed with diabetes have type 2, but rarely it is type 1. Most of those with type 1 lose weight when their blood sugar rises. Most of those with type 2 fight obesity because of the elevated levels of insulin, which hold onto fat, though this isn't 100% true.

The differences between type 1 and type 2 in testing are:
•People with type 1 have ketones in their urine when their blood sugar is high. People with type 2 don't have ketones, unless they have been fasting or eating only protein.
•Extra testing to determine if diabetes is type 1 include a c-peptide test (which measures levels of this protein associated with insulin production) or tests for islet cell antibodies (ICA), insulin auto-antibodies (IAA), and/or glutamic acid decarboxylase (a beta cell protein known as GAD).

If you suspect the possibility that you may have diabetes or pre-diabetes, please ask your doctor to test you. Early treatment with diet and supplements before medication is needed may keep you from ever needing medication.

The next blog will be on the medications that are used to treat diabetes.

Until we meet again,
Dr. Judi

Thursday, April 22, 2010

What Causes Diabetes?


Type 1 diabetes usually develops due to an autoimmune disorder. This is when the body's immune system behaves inappropriately and starts seeing one of its own tissues as foreign. In the case of type 1 diabetes, the islet cells of the pancreas that produce insulin are seen as the "enemy" by mistake. The body then creates antibodies to fight the "foreign" tissue and destroys the islet cells' ability to produce insulin. The lack of sufficient insulin thereby results in diabetes.

It is unknown why this autoimmune diabetes develops. Sometimes it is a genetic tendency. Sometimes it follows a viral infection such as mumps, rubella, cytomegalovirus, measles, influenza, encephalitis, polio, or Epstein-Barr virus. It has been shown through studies that children who develop DM 1 have a higher number of life stress events than controls. Cow's milk has been implicated. Other less common (very rare) causes of type 1 diabetes include injury to the pancreas from toxins, trauma, or after the surgical removal of the majority (or all) of the pancreas.

The medical community still does not know the cause of DM 2, or what makes one person's cells become resistant to insulin and not another person. However, there are various factors that have been shown to increase the risk of getting DM 2.

The first risk factor is genetics. About 5 to 11% of people who have DM 2 have a family history of it. People who have DM 2 in their family history are 25% more prone to getting it than those who don't.

The medical community claims that eating sweets does not cause diabetes. They do admit, however, that if eating sweets leads to obesity, then eating sweets may be related to diabetes because there is a much increased risk of DM 2 when a person is obese.

Increasing age is another risk factor, as is smoking and drinking caffeine. Interestingly, using artificial sweeteners has also been shown to increase the risk of DM 2.

Race is also a risk factor. Native Americans, Eskimos, African-Americans, Hispanics, Asian-Americans and those of Pacific Island descent are at increased risk of DM 2.

High emotional stress has also been shown to be a risk factor, because elevated levels of cortisol which comes from chronic stress increase the insulin levels. Also, adrenaline from anxiety causes a rapid release of glucose into the bloodstream, causing chronic elevation of blood glucose.

My personal theory is that diet DOES play a very important role in creating the disease process of DM 2. The two problems in diet are 1) eating too much, and 2) eating too many refined carbohydrates. If a person has a family history or other risk factors, a poor diet can often “turn the switch” and start the disease process. It can also affect those without a family history.

Eating too much puts a strain on the pancreas in both digestive enzyme production and in insulin production. It increases fat cells which also cause impaired glucose uptake.

Eating too many refined carbohydrates (sugar, sugar sweets, processed foods with a lot of sugar and flour, eating a lot of bread—flour is a refined carbohydrate) causes a rapid rise in blood glucose. This causes an excess of insulin to be secreted.

Too much insulin drives the blood glucose down so quickly that often low blood sugar (hypoglycemia) results. When a person has low blood sugar they crave more refined carbohydrates, and there is a yo-yo effect of blood sugar and insulin levels bouncing up and down.

The brain doesn't like low blood sugar. The rest of the body has ways to make energy when glucose isn't available, but the brain doesn't. That's why we often feel tired and can't think straight when our blood sugar is low. If it goes too low, the brain shuts down and we can go into a coma (a diabetic coma is not caused by the blood sugar being too high, but by being too low because of medication or insulin usage).

Symptoms of low blood sugar can include (most people don’t have all of these but they do have some): anxious feelings, unusual tiredness or weakness, difficulty in concentrating, drowsiness, excessive hunger or cravings, headache, shakiness, nausea, anxiety and nervousness, blurred vision, cold sweats, confusion, cool pale skin, fast heartbeat, nightmares, restless sleep, slurred speech, and behavior change similar to being drunk. Blood sugar that drops too low can lead to complete unresponsiveness (coma).

So the body tries to compensate for the problem of low blood sugar by becoming resistant to the elevated levels of insulin. If the cells don't respond to the higher levels of insulin so easily, then the blood sugar doesn't drop as rapidly, saving the brain from problems.

However, the insulin resistance keeps the higher levels of glucose (from eating too much or from eating too many refined carbohydrates) in the bloodstream. This causes hyperglycemia, and leads to DM 2.

This theory explains the rapid rise in cases of DM 2 in the last fifty years, and why it is still rising. Up to 75 years ago, sugar was not as easily available. There were few processed foods with sugars and refined carbohydrates. People ate whole foods and cooked from scratch. Desserts were a treat, not a diet. The amount of high fructose corn syrup in sodas, drinks and other treats has dramatically increased in the last ten years. High fructose corn syrup has been shown to cause obesity, diabetes and heart disease even above table sugar.

Since that time, with an increase in sugar and processed food and drinks, children are eating sugar cereal (both the sugar and the cereal are refined carbs) for breakfast, sandwiches and chips and chocolate milk and desserts for lunch (bread and chips are refined carbs, and a hamburger, fries and a sugary or artificially sweetened caffeine soda for dinner (fries are also considered a refined carbohydrate). Even so-called “healthy” snacks like fruit snacks and granola bars are usually made with high-fructose corn syrup and other refined carbohydrates.

The diet of the modern first-world countries with an ever increasing amount of refined carbohydrate processed foods, high-fructose corn syrup drinks, chemicals and sweeteners is predisposing our population to a dramatically increased risk of insulin and blood sugar problems. Add to that the chronic, increased stress of our modern society and we have an excellent recipe for the creation of diabetes.


My next blog will be on how diabetes is diagnosed.

Until we meet again,
Dr. Judi

Saturday, April 17, 2010

What is diabetes?



We all like sugar. Our bodies are programmed to love the sweet taste because we need sugar in the form of glucose. Glucose is the sugar that the body uses to make energy. When we eat the body breaks down the food into glucose, which then enters the bloodstream to be taken to all of the cells in the body.

As the level of glucose rises in the blood, insulin, a hormone, is released from the pancreas, which is a gland that sits behind the stomach and also helps digestion. The insulin attaches to the body’s cells, which opens channels in the cell walls for glucose to enter. The cell then uses the glucose to make energy in the form of ATP in little organelles called mitochondria. The body needs this energy to be able to function.

Therefore, insulin lowers the glucose in the bloodstream by opening the cells so that the glucose can leave the bloodstream and enter into and help feed the cells. If we didn't have insulin, the glucose in the blood would remain high and the cells would starve.

Diabetes Mellitus (diabetes, or DM), is a group of metabolic diseases which is characterized by hyperglycemia (too much glucose in the blood). This happens when there either isn’t enough insulin (Diabetes type 1), or the cells become resistant to allowing the insulin to open the glucose channels (Diabetes type 2). When glucose can’t get into the cells, the levels in the blood increase, and the cells starve, being unable to make adequate energy for the body’s needs. The elevated levels in the blood vessels can then cause damage to those vessels.

Symptoms of high blood sugar can include: blurred vision; drowsiness; dry mouth; flushed and dry skin; fruit-like breath odor; increased urination; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); and unusual thirst.

When insulin levels are too low and glucose levels too high, there is weight loss because the glucose can't enter the cells (type 1 diabetes). When the cells are resistant to insulin, the insulin levels rise. Insulin causes the body to hold onto fat, and there is weight gain (type 2 diabetes).

When the glucose is too high in the bloodstream, the glucose begins to “glycosylate,” or attach, to proteins in the blood and blood vessels, causing damage to the vessels. This is what causes the damage in the body related to diabetes. Over time, this glycosylation can lead to blindness, kidney failure and nerve damage (neuropathy). These types of damage are the result of damage to small vessels, referred to as micro-vascular disease.

Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to not enough blood to the legs and feet, strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macro-vascular disease.

There are two main types of diabetes, simply named as type 1 and type 2. Diabetes Mellitus type 1 (DM 1) is generally a disease that starts in childhood, though more rarely it can start in adulthood as well. No one knows the absolute cause of DM 1, but it is characterized by a destruction of the beta cells in the pancreas that make insulin. There seems to be an autoimmune problem in which the body starts to destroy its own cells. Therefore, in DM 1 there is not enough insulin, and insulin shots are necessary for the patient to survive. If the patient does not have enough insulin, he/she will go into a condition called ketoacidosis, and will die without help. This is a very serious condition.

Symptoms of ketoacidosis that need immediate hospitalization include: flushed dry skin, fruit-like breath odor, ketones in urine, passing out, troubled breathing (rapid and deep) and possibly fever.

Diabetes Mellitus type 2 (DM 2) is much more prevalent. About 90% of the diabetes in the United States is DM 2. DM 2 is a condition in which the cells become resistant to the insulin, so that the glucose cannot get into the cell even when the insulin attaches to the cell receptor. Often the body makes more insulin to try and get the cells to open, so most people with DM 2 will have higher than normal levels of insulin. These patients will not develop ketoacidosis, and so do not die quickly if their blood sugars rise, but usually die from the long-term complications of glycosylation. The medicines for DM 2 are designed to either increase insulin or assist the cells to be more receptive to the insulin.

DM 2 has been considered a genetic disease, but recently many people have been diagnosed that do not have a family history. I believe that this disease is a disease of our modern lifestyle, and comes on much easier if there is a genetic tendency towards it.

In my next blog we will discuss the possible causes of diabetes.

Until we meet again,
Dr. Judi

Tuesday, April 13, 2010

Dealing with Diabetes


Blindness, amputations, kidney dialysis, chronic pain from neuropathy, heart attacks, depression and mental decline...no disease is more debilitating to so many people as is diabetes.

Two of my grandparents died of complications of Diabetes Mellitus type 2. Many of my aunts and uncles have suffered from the disease. I have a grandson who has Diabetes Mellitus type 1. A few years ago, my blood sugars were in the diabetic range, though they are now normal.

The next series of blogs are going to be on diabetes. They will be taken from my new microbook, "Diabetes: Don't Depend on the Medical System to Keep you Healthy." This e-book will be available on this site soon.

I learned about diabetes in medical school, but what we learned was, in my experience, inadequate. We were taught about medicines to help with the disease, and how to do bypass surgery and amputations when the arteries in the legs were blocked, and dialysis when the kidneys shut down, and do laser surgery for the eye complications, and how to treat the heart attacks that resulted.

But we were told that the disease was chronic and the patients would eventually die from the complications of diabetes. The only hope we had was to preserve their ability to function a little longer through medication, surgery and other interventions. We were not taught much about diet or any of the other major things that can have a tremendous impact on diabetes. There is a belief that the patient won’t stick to a diet, anyway. There was also a belief that there was nothing that could prevent the disease.

In 2007 the American Diabetic Association estimated that there were 17.5 million people in the United States that had been diagnosed with diabetes, and an additional 5.8 million that have not yet been diagnosed but still have the disease (for a total of about 8% of the population, or 10% of those 20 and older). The numbers are rising rapidly, and the age of onset is becoming younger. Almost 200 thousand teenagers are now suffering with Diabetes type 2, which used to be a disease of older adults.

From an economic perspective, the total annual cost of diabetes in 2007 was estimated to be over $174 billion dollars in the United States, a per capita cost of $17,750.00. 2.7 million days of hospital stay a year, and 28.6 million physician office visits were attributed to diabetes. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering and growing rapidly.

Diabetes is the sixth leading cause of death in the United States; however, the first leading cause of death, heart disease, is often related to diabetes. Clearly, the medical mainstream has not found the answers to this rapidly growing and enormously expensive and deadly problem. The medications help lower blood sugar but often do not reduce the problems associated with diabetes. The medical community does very little to prevent diabetes and claims to not know the cause except for genetics. However, most people being diagnosed with diabetes today have not had it in their families.

Because this disease has personal implications to me, I have taken up a study of diabetes. I have learned a lot more than what I learned in medical school and I would like to share what I have learned with you: what diabetes is, what it does to your body, how to prevent it, and the many ways to treat it, some better than others.

I feel that it is tremendously important for people with diabetes, or who have diabetes in their families, to understand their bodies and to understand the disease, so they can take control of their own prevention and treatment, assisting the doctors who are treating them, rather than completely depending on the doctors to do it for them. I am not advocating that people with diabetes stop seeing their doctors. Medical care is important. But I am advocating that patients take a greater role in their own care, bringing things to their doctors’ attention so that their care can be improved.

My next blog will answer, "What is Diabetes?"

Until we meet again,
Dr. Judi

Saturday, January 9, 2010

Government Protection?


Many of us don't like the government interfering in our lives, but we often expect the government to protect us. Police, firemen, etc. are government employees. We expect the Food and Drug Administration (FDA) to keep our food safe and tell us which medications are safe and effective. We expect the Environmental Protection Agency (EPA)to keep us safe from toxic chemicals in our food, water and environment.

I've written in recent blogs about the effect of heavy metals on the body, and how heavy metals and chemicals are ubiquitous in our food, water and environment. The following statement by Lisa Jackson, Administrator of the EPA, shows us how ineffective the EPA really is. She states that the EPA has the authority to control only around 200 chemicals out of the 80,000 currently being manufactured.

We really have no idea how these chemicals are affecting our health. With dramatic increases in autoimmune diseases, mental illness, autism, ADHD, etc., could there be a correlation? Wouldn't it be good to find out? Again, I am a proponent of less government intrusion, but as I've studied this, the businesses really have no concern whether these chemicals are affecting our health or not. They are concerned with the financial bottom line.

Please read the following and form your own conclusions. Comments are welcome.

Legislative Hearing on the Toxic Substances Control Act (TSCA)

CONTACT:
EPA Press Office
press@epa.gov
202-564-4355
FOR IMMEDIATE RELEASE
December 2, 2009

Statement of Lisa P. Jackson
Administrator, U.S. Environmental Protection Agency
Legislative Hearing on the Toxic Substances Control Act (TSCA)
Senate Committee on Environment and Public Works
December 2, 2009

WASHINGTON – Chairman Lautenberg, Chairman Boxer, Ranking Member Inhofe and other members of the committee, thank you for the opportunity to speak about how we can improve our framework for assessing and managing chemical risks.

Understandably, the public is turning to government for assurance that chemicals that are ubiquitous in our economy, our environment and our bodies have been assessed using the best available science, and that unacceptable risks have been eliminated.

But, under existing law, we cannot give that assurance. Restoring confidence in our chemical management system is a top priority for me, and a top environmental priority for the Obama Administration.

EPA is the agency tasked with ensuring that the chemicals used in the American economy are safe. But, Mr. Chairman, the current law that gives EPA that authority is outdated, and does not provide the tools to adequately protect human health and the environment as the American people expect, demand and deserve.

Chairman Lautenberg, I commend you for your long standing leadership on this issue and look forward to working with you, Chairman Boxer and other Members of this committee as you consider ways to improve the safety of chemicals.

The Toxic Substances Control Act (TSCA) was signed into law in 1976 and was intended to provide protection of health and the environment against risks posed by chemicals in commerce. However, when TSCA was enacted, it authorized manufacture and use, without any evaluation, of all chemicals that were produced for commercial purposes in 1976 or earlier years. Thus, manufacturers of these “grandfathered” chemicals weren’t required to develop and produce the data on toxicity and exposure that are needed to properly and fully assess potential risks. Further compounding this problem, the statute never provided adequate authority for EPA to reevaluate existing chemicals as new concerns arose or as new scientific information became available.

TSCA does provide some authority to EPA to mandate industry to conduct testing, but even in these cases it has taken years to obtain data and information. As a result, there are large, troubling gaps in the available data and state of knowledge on many widely used chemicals in commerce.

TSCA also doesn’t place any legal obligation on producers to conduct testing on new chemicals being introduced into commerce. They are required only to supply existing data to EPA and are not required to provide all the data necessary to fully assess a chemical’s risks.

In the rare cases where EPA has adequate data on a chemical, and wants to protect the public against well-known, unreasonable risks to human health and the environment, there are too many legal hurdles to take quick and effective regulatory action

For example, in 1989, after years of study, EPA issued a rule phasing out most uses of asbestos – a chemical whose health effects had been exhaustively studied and demonstrated to cause lung cancer, mesothelioma and asbestosis in humans. Yet, a federal court overturned the rule because EPA failed to clear the many hurdles imposed under TSCA before existing chemical risks can be controlled

Due to these legal and procedural hurdles in the law over the last 30 years, EPA has only been able to require testing on around 200 chemicals produced and used in the United States, and it has only issued regulations to control five existing chemicals determined to present an unreasonable risk under Section 6 of TSCA. Five from a total universe of more than 80,000 existing chemicals listed on the TSCA Inventory. Though many of these chemicals likely pose little or no risk, the story is clear---we’ve only been able to effectively regulate a handful of chemicals and we know very little about the rest.

TSCA must be updated and strengthened.

Earlier this fall, I announced the Obama Administration’s legislative principles for how this law should be revised and modernized. Let me highlight the Obama Administration’s principles:

First, chemicals should be reviewed against safety standards that are based on sound science and reflect risk-based criteria protective of human health and the environment. Safety standards should be driven solely by scientific evidence of risks. EPA should have the clear authority to establish safety standards that reflect the best available science while recognizing the need to assess and manage risk in the face of uncertainty.

Second, the responsibility for providing adequate health and safety information should rest on industry. Manufacturers must develop and submit the hazard, use, and exposure data demonstrating that new and existing chemicals under review are safe. If industry doesn’t provide the information, EPA should have the necessary tools to quickly and efficiently require testing, or obtain other information from manufacturers that are relevant to determining the safety of chemicals, without the delays and obstacles currently in place, or excessive claims of confidential business information.

Third, EPA should have clear authority to take risk management actions when chemicals do not meet the safety standard, with flexibility to take into account a range of considerations, including children’s health, economic costs, social benefits, and equity concerns. EPA and industry must include special consideration for exposures and effects on groups with higher vulnerabilities – particularly children. For example, children ingest chemicals at a higher ratio to their body weight than adults, and are more susceptible to long-term damage and developmental problems. Our new principles offer them much stronger protections.

Fourth, EPA should have clear authority to set priorities for conducting safety reviews. In all cases, EPA and chemical producers must act on priority chemicals in a timely manner, with firm deadlines to maintain accountability. This will not only assure prompt protection of health and the environment, but provide business with the certainly that it needs for planning and investment.

Fifth, we must encourage innovation in green chemistry, and support research, education, recognition, and other strategies that will lead us down the road to safer and more sustainable chemicals and processes. All of this must happen with transparency and concern for the public’s right to know.

Finally, implementation of the law should be adequately and consistently funded, in order to meet the goal of assuring the safety of chemicals, and to maintain public confidence that EPA is meeting that goal. To that end, manufacturers of chemicals should support the costs of Agency implementation, including the review of information provided by manufacturers.

I know that legislative reform may take time. Consequently, I have directed my Assistant Administrator of Pollution Prevention and Toxic Substances, Steve Owens, to utilize our current authority under TSCA to the fullest extent possible, including Section 6 authority to label, restrict, or ban a chemical, to ensure that we do everything we can to protect the American people and the global environment from dangerous chemicals. While fundamental reform is needed to fully protect against chemical risks, this is a step forward.

Specifically, EPA is currently evaluating an initial set of chemicals based on available hazard, exposure, and use information, for potential action. We will complete and make public “action plans” for the chemicals which will outline the risks that the use of these chemicals may present and what steps we may take to address those concerns. Following this, we aim to complete and make publicly available a group of chemical action plans every four months. EPA intends to engage stakeholders and dialogue with other federal partners, as well as the public, in the discussion about prioritizing chemicals for future risk management action over the coming months through public notices and public meetings.

But let me be clear – this is no substitute for meaningful reform of the underlying law. The need for fundamental TSCA reform has been recognized by industry groups, including the American Chemistry Council, environmental groups, public health groups, several States and cities, and many other groups who have all called on Congress to Act. I too call on Congress to act on this issue and give EPA the tools to adequately protect human health and the environment.

The time has come to bring TSCA into the 21st Century. EPA looks forward to working with this committee on this very important issue.


Until we meet again,
Dr. Judi