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From the Townsend Letter
May 2016

Head-On Collision Kills Millions Yearly
by John Parks Trowbridge, MD
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Individual opinions are just like individual driving styles – some people dart in and out, some go speeding by, others leisurely meander along (those are the ones that get in my way!). Small scientific studies can have the same kind of limitation – they might see "rush hour congestion" and they might miss it. Larger studies, however, can give important clues to what's really happening "out there." One such investigation reviewed 136,905 patients admitted to hospital with coronary artery disease and found that the mean LDL level was 104.9 +/−39.8, HDL 39.7 +/−13.2 mg/dL. They showed less than ideal mean HDL levels (39.7 +/−13.2 mg/dL) and elevated triglycerides (161 +/−128 mg/dL). Almost half of patients admitted with coronary artery disease had admission LDL levels <100 mg/dL – touted in 2009 as an optimal goal of antilipid therapy – even though only 21% of all patients were on drug treatment. High-density lipoprotein cholesterol was <40 mg/dL in 54.6% of patients. So … the conclusion offered by the authors is, "These findings may provide further support for recent guideline revisions with even lower LDL goals and for developing effective treatments to raise HDL" (emphasis added).45 Is that what you saw in the data – we must lower the LDL levels even more? Are we fully aware of the potential health risks of dramatically lowering a physiologic molecule?

If you choice is to continue advising use of the (Lipitor/Mevacor/Zocor/Crestor/others) "Nevermore" drugs, at least you can see a saving grace. Researchers at the Purdue biochemistry lab of associate professor Scott Briggs has shown that yeast with impaired histone methylation pathways have lower levels of ergosterol (a provitamin form of vitamin D2, fungal and protozoal equivalent of cholesterol) and are more sensitive to inhibition by statin-type drugs.46 The stronger the cholesterol-lowering effect, the stronger the antifungal activity.47 Antifungal drug amphotericin B targets ergosterol within the fungal membrane, creating a polar pore. The popular "azole" class of antifungal agents inhibit the demethylation enzyme in the biosynthetic pathway to ergosterol. Any needed treatment for highly elevated cholesterol levels might be entering an exciting new era.

Grab a Candy Bar and a Coke
Feeling sleepy while driving? Maybe you skipped a meal? Or you've really worked hard today? Don't want to veer into oncoming traffic, do you? Just get a snack to eat on the road. Sadly, that is almost the equivalent of the diet recommended by the American Diabetic Association (ADA) for those with sugar-handling problems. For some inexplicable reason – certainly not found in the "owner's manual" for the human body – they teach how you can eat "borderline" foods by an "exchange" program. One commentator noted that, before insulin and diabetes medications, the recommendation was for a diet with carbohydrates no more than 20%, also very low in calories. Then the ADA began to offer dietary recommendations in the 1950s: 43% carb, 19% protein, 37% fat. The sugar/starch content gradually increased until 1994, when the advice was 55% to 70% carbohydrate, 10% to 20% protein, remainder of calories from fat. As of 2011, no concrete changes were offered since 1994.48

Many conventional physicians and surgeons have casually recommended the ADA diet for years, thinking that it's better than "Just eat anything you want." Well, maybe. A number of very effective dietary programs have been advised over the years by alternative practitioners. In many cases, customization is essential for success of an individual patient. My personal preference has worked well for a majority of patients for over 30 years.49 Find what works best for your patients – it won't come from a dietitian!

Smoking Keeps Me Focused On the Road
Happily, this is one area where conventional and alternative practitioners agree on the stop signs! Many doctors caution that smoking eventually causes lung cancer, a good reason to detour from a life of misery. Few, however, counsel patients that a profound medical study some 25 years ago reviewed all the "hi-de-hoes" – high blood pressure, high blood sugar, high cholesterol (and triglycerides), high weight, and so on – to determine which factor sped you faster down the road to fly off the curve with a heart attack.
Take a guess. Which do you stress the most in your counseling? Patients can slow their headlong approach to a dead end by reducing and then stopping smoking. The total number of cigarettes smoked in a lifetime is the prime factor in choosing the route to heart attack.50 Enough said.

So why mention this agreement between the conventional and alternative camps at all? Simply because the rest of the study reported a startling finding: the second most reliable predictor of life-threatening coronary heart disease is not one of "hi-de-hoes." Few physicians realize that ferritin – a different way of transporting iron than transferrin – is a major risk factor for an often deadly head-on collision with coronary occlusion (infarction).

In a landmark study of 1931 adult men without a history of heart disease, Salonen's group in eastern Finland performed a wide variety of tests before and after the 3-year observation.51 Fifty-one of them suffered heart attacks. They found that the total number of cigarettes smoked in a lifetime is the No. 1 best predictor of a heart crash-and-burn. But to the surprise of the investigators, the key laboratory measurement that would have predicted this group was elevation of serum ferritin. Above 100 mcg/L, the higher the ferritin level, the greater the risk of infarction, regardless of other factors. The numbers were startling: ferritin of (200 mcg/L) or double "normal" showed a more than double risk (2.2). The effect was more pronounced in patients with elevated LDL cholesterol levels.

Strangely, this predictive measure is largely ignored by conventional physicians, whose test reports often list "up to 300" as a "normal" result! (According to the Mayo Clinic, the normal range is 24 to 336 mcg/L in men, slightly lower in women.52) Only rarely do patients with values above 100 have a classical iron-storage disease, such as hemosiderosis. But like 2% of all highway collisions that are head on and total over 10% of the deaths, ferritin above 500 mcg/L can kill you five times more likely than the a normal level of about 100 mcg/L. Chronic inflammatory changes are more likely the explanation.

Why is ferritin such a reliable indicator? Possibly because aging and biochemical stresses, especially in the common setting of dietary deficiencies of antioxidants, induce a progressive and persistent acidotic change, a condition in which iron transport is diverted to ferritin, from which prooxidant iron might be more readily made available. Certainly it is a marker; the contribution to pathology is unclear. What interests alternative practitioners are the underlying stressors (including toxic chemicals and heavy metals) and the corrections needed for more optimal nutritional status.

Driving at Night … with Sunglasses?
Some readers will wonder, why didn't he mention the extraordinary value of chelation therapy in these various cardiovascular conditions – is he blind? No, I just reserved that for a special mention here, as we conclude this review. Toxic heavy metals clearly impair virtually all metabolic processes. Along with toxic chemicals permeating ever more insidiously throughout our environment, toxic metals steal our comfort and health and, eventually, our lives.53,54 Due to their stealthy attack, these impairments go unsuspected, untested, undiagnosed, and untreated – by a conventional doctor. An alternative physician has his head "on a swivel," looking for problems from every which direction.

Chelation, of course, is the solution for so many problems because toxic metals strike at a fundamental level of metabolism.55 Clinical training and practice are essential, as is detailed study of "nutritional medicine." Conventional doctors simply have no idea and don't stop to ask for directions. Some alternative practitioners have experience with sweating out organic chemicals using the Hubbard method, and this needs to be carefully managed with nutritional support and to minimize reexposure as these molecules are being mobilized for excretion.56

Another area that might seem surprising for cardiovascular conditions is treatment for the Yeast Syndrome.57 Guaranteed: conventional physicians know nothing about this and strongly dispute that it exists. But what has been known for over 30 years matters: Canditoxins interfere profoundly with critical junctures in metabolism, eventually resulting in lowered levels of magnesium, pyridoxine (vitamin B6), essential fatty acids conversions, among others. As such, they can aggravate various conditions such as cardiomyopathies, hypertension, degenerative chemistry in the blood and endothelium, and more. This unsuspected comorbidity that deserves careful attention and proper treatment, no "quickie programs"!

Slow – Construction Zone
The challenge has been to give sufficient detail to current issues while mapping out emerging patient care strategies. Several novel technologies will enhance our effectiveness with chelation therapy by targeted intervention at "biochemical intersections," which I call pinch-points. A key is to identify those discrete reactions where a small alteration can dramatically enhance results down the road, often quickly.
Frequency specific microcurrent (FSM) devices are becoming more affordable and simple enough for home use. The healing thus stimulated can be quite amazing, even unpredictable. In effect, the electrical biomodulation can restore biochemical and electrophysiological processes that have not even been identified as suffering. A stunning example is the consistently rapid vision improvement in 85% of patients with macular degeneration with the Kondrot Eye and Vision Program.58 But don't stop there – other eye pathologies including glaucoma can improve as well, also brain and other functions … all over the body.
Another therapy hiding in the shadows (behind the billboard, like a motorcycle cop) is the precise introduction of stem cells into tissues. Harvesting cells from various sources, research into this nascent tissue transformation is, literally, all over the map since first announced in 1998. Cost and availability are roadblocks to widespread utilization – and insurance carriers can be suppressive of any novel technology. Very likely, willing cash investments in "beauty medicine" procedures will pave the way to understanding how best to drive forward this astounding regenerative product to reversing cardiovascular and other pathologies.59
Since 1993, I have pioneered the home use of nocturnal and exercise supplemental oxygenation to enhance mitochondrial efficiency, using a portable concentrator. Remember: the oxygen we breathe isn't "magic" – it's essential biochemistry. Inhaled oxygen captures and removes electrons deriving from production of high-energy phosphate bonds (ATP) and contributes to balancing of pH in various tissue compartments. Conventional teaching assumes (almost insists on!) an insufficient flow rate of 2 L/min. Thoughtful alternative physicians achieve impressive healing results in suitable patients with nocturnal 3 to 4 L/min via nasal cannula, even higher flow rates for exercise with a modified nonrebreather mask (made by removing one of the one-way flap-valves).

Hyperbaric oxygen is technical and expensive; home oxygen concentrator results are "almost" equally impressive but available to a vastly larger number of patients. This one technology is "the tiger in our tank" for congestive heart failure, coronary heart disease, cardiomyopathies, gangrene, kidney failure, macular degeneration – virtually all cardiovascular pathologies. Conventional physicians (even "sleep lab specialists") accept that 88% saturation qualifies for Medicare reimbursement "for life." Then they inexplicably assure patients with saturations in the mid- or low-90s that they are "OK" and do not need home oxygen support. How many nonobstructive (centrally mediated) sleep apnea patients have "awakened dead" due to fatal ventricular arrhythmias associated with unexpected hypoxemia?60 In my casual office research, I have found that toxic organic chemicals and/or heavy metals and/or head injuries are related to central sleep apnea, but the mechanism is speculative. Significant nutritional deficiencies or occult infections might play a role as well. And remember, at the scene of the accident, emergency medical technicians slap on oxygen as a first step.

One final approach deserves to be taken out for a spin: effective treatment of unsuspected/undetected parasite infections. Conventional physicians (over)use antibiotics for infections presumed to be with free-living and intracellular bacteria but rarely properly advise probiotic replacement, if at all. Prescriptions for viral infections still leave much to be desired – but alternative practitioners have a full toolbox of options to enhance immune performance in general. Still, other than veterinarians, who else stumbles along the bumpy road to investigating and treating parasites?

Diagnostic techniques for these stealthy organisms are evolving, especially with regard to biofilm matrices, even those that are (non-device-related) intravascular.61 These advances have helped us appreciate the unique contributions of oral pathology – caries, gingivitis, root canals, osteonecrotic cavitations, and other biological dentistry complications – to cardiovascular (and other system) diseases. Innovative PCR (polymerase chain reaction) nucleic acid sequencing for identification has opened a high-speed lane to new horizons. A new organism, Protomyxzoa rheumatica, was discovered by Stephen E. Fry, MS, MD. Related to the "malaria family," which includes babesia and other intracellular parasites, this "bug" might be responsible for many so-called chronic fatigue syndromes wherein etiologies have not been clear. Treatment approaches for a wide variety of organ pathologies has been pioneered by integrative internist Simon Yu, MD.62

An overwhelming amount of research looms down the road ahead. Detours right now result from the meager awareness among physicians that parasitic invasion could be causative/contributing factors in many puzzling "idiopathic" diseases. The drugs are expensive, the bugs are tricky, and the physician has to firmly steer the complex treatment program. Alternative practitioners also turn to an assortment of immune support and herbal products that contribute to spectacular results in carefully selected patients.

Sorry I Cut Across Your Lane
Any comparative/contrasting article must make broad generalizations, not all of which apply to any one group or a specific practitioner. So, my apologies to all the good doctors – I don't intend to malign your viewpoints, your efforts, your commitment to excellent patient care. Who are the good doctors? You know who you are. You master the knowledge and skills to produce wonderful results for patients – and you have an open mind to encourage them to discover "whatever works" for their health concerns.

And my apologies for those integrative/alternative physicians who have a shallow belief that merely doing things "differently" is somehow "better." Divergent procedures are not the issue – results for patients are all that matter: safe and effective, customized, hopefully comfortable, cost sensitive, and doable. Helping patients to feel remarkably better should not be a long or frustrating road. Find it now – fix it right!
Drugs can be dangerous – and wonderful. Operations can be dangerous – and wonderful. Needlessly delaying treatments of any kind can be foolhardy – and dangerous. Alternative treatments can appear to be miraculous, because they rely upon the sacred healing power of the life-force within each of us. So we seek the right drugs, the right operations, the right alternatives, and the right information that we need to make these choices.
The same narrow alleyway approach for which I chide inflexible conventional physicians and surgeons is sometimes arrogantly apparent in alternative practitioners, whether they are "one-trick ponies" or they claim mastery across a gamut of specialties. Attendance at weekend seminars does not an expert make. Attendance at the bedside, summoning all necessary skills in tending to the ills of patients and restoring more robust health and vitality – that is good, that matters.
Good doctors across the entire spectrum of practices – I salute you.

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