The Theory AND the Calculator are FLAWED… imho…

by Morley Robbins | Nov 18, 2013 | General

NY Times November 17, 2013

Risk Calculator for Cholesterol Appears Flawed

By GINA KOLATA

Available at http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?hp&_r=1&pagewanted=all&
Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.
The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.
“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”
The controversy set off turmoil at the annual meeting of the American Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.
Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”
The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review. Both reported back that the calculator was not working among the populations it was tested on by the guideline makers.
That was unfortunate because the committee thought the researchers had been given the professors’ responses, said Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University.
Drs. Ridker and Cook saw the final guidelines and risk calculator on Tuesday at 4 p.m., when a news embargo was lifted, and saw that the problems remained.
On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.
Other experts said there has not been a real appreciation of the difficulties with this and other risk calculators. “I don’t think people have a good idea of what needs to be done,” said Dr. Michael Blaha, director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University, who was not associated with forming the new guidelines.
Dr. Blaha said the problem might have stemmed from the fact that the calculator uses as reference points data collected more than a decade ago, when more people smoked and had strokes and heart attacks earlier in life. For example, the guideline makers used data from studies in the 1990s to determine how various risk factors like cholesterol levels and blood pressure led to actual heart attacks and strokes over a decade of observation.
But people have changed in the past few decades, Dr. Blaha said. Among other things, there is no longer such a big gap between women’s risks and those of men at a given age. And people get heart attacks and strokes at older ages.
“The cohorts were from a different era,” Dr. Blaha said.
This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.
The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.
“Miscalibration to this extent should be reconciled and addressed before these new prediction models are widely implemented,” Dr. Ridker and Dr. Cook wrote in The Lancet. “If real, such systematic overestimation of risk will lead to considerable overprescription.”
In a response on Sunday, Dr. Smith of the guidelines committee said the concerns raised by Dr. Cook and Dr. Ridker “merit attention.”
But, he continued, “a lot of people put a lot of thought into how can we identify people who can benefit from therapy.” Further, said Dr. Smith, who is also a professor of medicine at the University of North Carolina and a past president of the American Heart Association, “What we have come forward with represents the best efforts of people who have been working for five years.”
The chairmen of the guidelines panel said they believed the three populations Dr. Ridker and Dr. Cook examined were unusually healthy and so their heart attack and stroke rates might be lower than expected.
Asked to comment on the situation on Sunday, some doctors said they worried that, with many people already leery of statins, the public would lose its trust in the guidelines or the heart associations.
“We’re surrounded by a real disaster in terms of credibility,” said Dr. Peter Libby, the chairman of the department of cardiovascular medicine at Brigham and Women’s Hospital.
What are patients and doctors to do? On Sunday, there seemed to be no firm answers, except that those at the highest risk, like people who have had a heart attack or have diabetes, should take statins.
The guideline developers said they were not totally surprised by the problems with the calculator.
“We recognize a potential for overestimates, especially at the high end of risk,” said Dr. David Goff, the dean of the University of Colorado School of Public Health and the co-chairman of the guidelines’ risk assessment working group.
Last year, not long after it received the assessments from Dr. Ridker and Dr. Cook, the National Heart, Lung and Blood Institute removed itself from the development of the guidelines, saying that was not its mission. The institute handed responsibility to the American Heart Association and the American College of Cardiology.
Dr. Michael Lauer, the director of the division of cardiovascular sciences at the institute, said on Sunday that it had received many reviews and sent them to the other groups, together with the responses of the guidelines’ authors.
Some doctors who tested the calculator with hypothetical patients wondered if they should trust the results.
Dr. Nissen entered the figures for a 60-year-old African-American man with no risk factors — total cholesterol of 150, HDL (the good cholesterol) of 45, systolic blood pressure of 125 — who was not a diabetic or a smoker. He ended up with a 10-year risk of 7.5 percent, meaning he should be taking cholesterol-lowering statins despite being in a seemingly low-risk group.
Dr. Nissen also calculated the figures for a healthy white man, age 60, and also got a risk factor of 7.5 percent.
“Something is terribly wrong,” Dr. Nissen said. Using the calculator’s results, he said, “your average healthy Joe gets treated, virtually every African-American man over 65 gets treated.”

Is the Hair Tissue Mineral Analysis Inside or Outside the Cell?

by Morley Robbins | Nov 8, 2013 | General

Recently one of the MAG-pies (Louise from Ireland…) posed a question about what the HTMA reveals, particularly in contrast to a Red Blood Cell test of the mineral. The starting point is to know what the HTMA test is showing in the way of minerals: specifically, are they intracellular elements, or are they extracellular elements? The standard answer is that
the HTMA is a tissue biopsy and therefore, the mineral results are actually total tissue concentrations. However, I realize that this needed further explanation as many other practitioners may have the same question and I sought the input
of David L. Watts, DC, PhD, the founder and CEO of Trace Elements, Inc. Here’s his response to that critical question:
Formation of the Hair Shaft
“The development of the hair follicle begins at about the twentieth week of
gestation. Hair growth and location of hair formation is influenced by sex,
age, race, and hormones. It is also affected by illness, medications and
even the immune system. Hair formation begins at the base of the hair
follicle in the area known as the papilla. There is a blood supply to the
papilla that provides nutrients to the matrix cells surrounding the papilla.
The matrix is derived from stem cells, contains several types of cells and
are the most dynamic and active cells in the body and is responsible for the
formation and growth of hair. Via the papilla the cells that make up the
matrix receive a blood supply that provide nutrients to these cells and
carry waste products away. These continually dividing cells form the
medulla, cortex and cuticle of the hair shaft. As production continues
ultimately, the hair shaft formed from the matrix cells is pushed upward
from below the skin and grows above the dermis. Constituents that were
present in the circulating blood, during development of the hair are
contained and preserved in the hair shaft itself, providing a record of
those events.
“Therefore, the answer to the question, Does the concentrations of
minerals in the hair shaft represent intracellular or extracellular
minerals? We can say that in the strictest sense that it does represent
intracellular minerals incorporated into the constantly dividing matrix
cells that form the hair shaft.
“However, in a broader sense the hair shaft itself is also exposed to lymph,
extracellular fluids, sebaceous glands, sweat gland and surrounding tissue
of the dermis and epidermis. The hair shaft may contain constituents or
minerals from these sources as well. So in the broadest sense the minerals
incorporated into and on the hair shaft in total contain both intracellular
and extracellular minerals. Therefore, the answer to the question would be
that the hair represents not only intracellular constituents but
extracellular constituents as well. Thereby, the hair test could be
considered a representation of the tissue mineral levels that are present
from these sources. Presence of minerals in the hair shaft cannot be devoid
of contact from these sources nor eliminated in any practical manner.”
So the mineral and heavy metal information from the HTMA is, in actuality, both inside and outside the cell. In contrast, as the name would imply,the RBC is purely an intracellular assessment. In that sense, it is more “pure,” but that doesn’t necessarily tip the scales completely to the RBC, despite its focus. It is a far more expensive test and beyond that, what I don’t know is how to properly interpret the RBC results to gain the same level of insight from the HTMA re the mineral ratios, which is the true value of any form of mineral/heavy metal testing.
If I had a choice, I’d do both which would be cost prohibitive. But in effect, that’s exactly what we do that when we order both an HTMA and a Mag RBC — we’re getting the best of both worlds at a far more reasonable cost.
So, Louise, I hope that answers your question, maybe not as decisively as you were hoping, but this is the best that is available at the present time… And thank you for being so patient so that I could incorporate the input of Dr. Watts, as well…
A votre sante!

Magnesium supports the Adrenals & Thyroid…

by Morley Robbins | Aug 27, 2013 | General

“ATP is synonymous with life…” — Andrew Kim

I love this picture!
And we’ve all been there, right?… Unfortunately.
OK, so many moons ago I promised an article on the Adrenals & Thyroid. I could say that I was too tired to write it, but then the MAG-pies would vote me off the Island — quite deservedly. So this is the first in what will clearly be a series on these pervasively dysfunctional parts of our anatomy.
Actually, as those with any sort of Adrenal and/or Thyroid dysfunction know, these critical Endocrine (energy-producing) glands are really complicated, and based on my Mg-centric research, are really misunderstood. And I hope that this article begins to shed some new light on this vital topic. And please know, I in no way seek to compete with the outstanding information available on STTM (http://www.stopthethyroidmadness.com/) I’m just offering some added information that is missing in this energy equation…
Truth be known, I was challenged to find an article that was penetrating enough to bring new insights to this issue, that is until I read Chris Kresser, LAc’s recent article on 5 Ways Stress Causes Hypothyroidism. Chris should take a bow for this one… it’s that good, and I encourage all to take a few minutes to read and review it closely.
That said, I want to build on Chris’s excellent post and shed added insight from a Magnesium perspective. (Did you think I forgot our favorite mineral?!?… 😉 ) What this article on Stress and low Thyroid function does is open the door for what I think are some compelling reasons why 100 million Americans are taking Synthroid and not feeling any better for it. Btw, does it strike anyone else as “odd” that 1/3 of our fellow citizens are taking this Rx medication, and are not seeing any metabolic benefit?…
OK, enough intro, let me share the 5 Ways from Chris’s article: (I will offer commentary in between…)

1) Adrenal stress disrupts the HPA axis

Just so we’re clear on this, “Stress!” causes Mg loss. And when it’s chronic enough, it becomes quite severe and disrupts the entire HPA Axis. Here’s an amazing article that sheds penetrating insight on how a lack of a lowly mineral can wreak havoc on our HPA Axis. “Magnesium deficiency induces anxiety and HPA axis dysregulation: Modulation by therapeutic drug treatment.”
So yes, technically, “Adrenal stress disrupts the HPA axis,” but it’s the breadth of relentless “Stressors!” that preceded that CAUSED the chronic, severe, and unrecovered Mg loss that created the Adrenal stress… Given that the Adrenal glands are ruled by the ratio of Sodium/Magnesium. Loss of Mg causes an initial rise of Sodium, and then an eventual collapse of both Sodium and Mg — the classic case of “Adrenal burnout” that so many are subject to.

2) Adrenal stress reduces conversion of T4 to T3

Many are aware that the enzyme 5′-deiodinase is a Selenium-dependent peptide, but it also “Mg-driven,” as it takes Mg-ATP to make this transaction complete, and very often what blocks it is not just a lack of Mg-ATP, but the presence of excess, unbound Copper, which is “lack of Mg-ATP on Steroids!” In fact, Copper must be bound to its target protein, Ceruloplasmin, to be effective, and it takes three separate metabolic transactions that call for Mg-ATP to make that happen. There are many articles on Copper toxicity that point out the effect that excess, unbound Copper has on the Thyroid, but no one shares the Mg robbing effect that this metallo-mineral has.

3) Adrenal stress promotes autoimmunity by weakening immune barriers

It is well established that our gut represents 80+% of our immune system. Huh?… What exactly do they mean when they say that?… Well, the more diversified the gut flora, the more effective your body can respond to external threats. (Given that, does it make any sense that we confront all infections with increasingly potent anti-biotics?… topic for another post!) In any event, recent research has shed keen light on the metabolic origin of “Leaky Gut:” “Changes in intestinal bifidobacteria levels are associated with the inflammatory response in magnesium-deficient mice.”
It’s hard to stress just how important this finding is. That coupled with the fact that WBCs (White Blood Cells) — our 1st responders to threat — are most potent when they have optimal levels of Glutathione, a Mg-dependent and Mg-ATP energized chief anti-oxidant that is critical to our health and environmental well-being.
If our “Stress!” is on overdrive, our Mg is missing, and it leads to weakened intestinal immune barriers and WBCs. Again, it’s the precursor to Adrenals that ushered in the auto-immunity. This stuff is NOT from Mars, it’s comes from within, especially when we have lost our innate “Stress!” response due to a chronic loss of Maggie…

4) Adrenal stress causes thyroid hormone resistance

I’m sure that many of you have heard of Insulin Resistance, Leptin Resistance and Vitamin-D Resistance. What they ALL have in common is that invariably, a key Mg-dependent enzyme keeps the receptor sites clear and operating optimally. And when Maggie is missing, these hormone receptors do NOT work as well, if at all.
For an excellent overview of this topic, please go to Danny Roddy’s blog entitled: “Is Supplemental Magnesium a Surrogate for Thyroid Hormone?”

Danny really lays it out with this blog, and explains the critical role that Mg plays in proper Thyroid function. Trust me, it’s rare for any kind of practitioner to ever use the words “Magnesium” and “Thyroid” together in the same sentence. Given their totally symbiotic relationship inside the cell, it’s a wonderment to me that this is the case. And for those seeking a more erudite examination of this relationship, please read Dr. Vitale’s classic from 1957. This relationship is apparently no longer being taught in Medical Schools across the country.

5) Adrenal stress causes hormonal imbalances

Again, what apparently has gone unnoticed in much of the clinical training across the country is the fact that Cholesterol is the source of all Steroid, Sex and Stress Hormones. What’s even more fascinating is that the enzyme family, Cytochrome P-450, is activated by Mg. Hmmmmm… You mean the hormonal dysfunction might be a result of my “Stress!” level?… Yup!
And furthermore, you’ll note the presence of Cortisol at the bottom of that chart. Yes, Cortisol, the ultimate “Stress!” hormone. And what’s it’s relationship with Maggie? Cortisol eats Mg for lunch. So when we’re “Stressed Out!”, we have less Magnesium and therefore less Mg to recycle the Cortisol back to its storage form, Cortisone, where it can do less harm. And even more important to our mission of increasing energy (Mg-ATP), the ultimate T4>>T3 buster is Cortisol. Imagine that. “Stress!” is at the very root of our Thyroid and Adrenal problems, in large part due to our inability to properly restore Magnesium status in our body and in our cells.
What to do? For starters, I would take a spin through how to restore Maggie.

In subsequent posts, I’ll take a closer look at additional ways to ward off the impact of Mg loss on our Adrenals and Thyroid glands. And I’ll also provide additional recommendations for steps to rebuild and restore function to these essential energizers in our body.
A votre sante!

Magnesium deficiency causes Epigenetic Stress!

by Morley Robbins | Aug 6, 2013 | General

In a recent FB thread, several MAG-pies were commenting on the notable rise of missing enzymes, esp. those that are key to methylation and sulphation (i.e. MTHFR and CBS)

It’s a timely and important topic… Here’s a summary of some of my Mg-oriented observations that are worth understanding as it relates to this cultural metabolic shift that is sweeping the nation…
Please note the following:
o “Stress!” causes an automatic depletion of 3 key nutrients: Zinc, Magnesium & B-Vitamins…
o The Perception of “Stress!” (whether a tiger or a toxin) is ENLARGED by a Magnesium deficiency and it’s impact on the Hypothalamus — it is the Master of Perception in our body… Everything is perceived BIGGER & BADDER when Mg is low…
o Genes are circuit breakers — just like the one’s in your basement… They flip on/off. They are NOT in concrete. They are mutable and they are changeable, under the right conditions, and circumstances.
o The job of genes is to make proteins, which then get made into enzymes when vitamin(s) & mineral(s) gets added…
o Given my “Magnesium-myopia,” I have only researched the impact of Mg deficiency on the performance of genes, as follows:
   1) ALL 3 DNA Ligase enzymes (I, II, & III) are activated by Mg and address “nicks” (I), “single strand breaks” (II) & “double strand breaks” (III)
   2) Riboflavin (B2) plays an ongoing role in the maintenance, repair and overall health of DNA –> B2 is activated by Mg
   3) The entire process of mitosis and DNA replication is regulated by Mg-activated enzymes
   4) Riboflavin (B2) is the backbone of RNA (Ribonucleic Acid)
   5) The energy needed to perform genetic tasks is provided by Mg-ATP…
   6) The Adenine (B4) is the back-bone of ATP. Adenine (B4) is activated by Mg. Also, there are 5 components to make ATP, 4 of them are Mg-dependent
   7) At the genetic level, Heat Stress Proteins (HSP 30, 60, 70, 90, etc.) surface when Mg deficiency reaches a critical threshold.
o When “Stress!” overwhelms the genes, they flip the epigenetic switch and don’t work effectively and stop making the right proteins => enzymes, apparently due to a lack of Zinc, Mg, & B-Vitamins, among other factors…

ALL THAT SAID, THE PROCESS “BACK” IS NOT SIMPLY “TAKE MO’ MAGGIE!”
I KNOW THAT, AND FIRMLY BELIEVE “IT TAKES A VILLAGE.” MY POINT IS THAT I DON’T THINK ENOUGH ATTENTION IS BEING GIVEN TO RESTORING Mg STATUS TO RESTORE THE => BODY >> ORGAN >> CELLULAR >>GENETIC “STRESS RESPONSE…”

Given the metabolic facts above, it’s seems central to the process of recovery.
Thoughts?…

Randy Travis suffers from Magnesium deficiency…

by Morley Robbins | Jul 9, 2013 | General

In less than a week, another global celebrity, Randy Travis, is challenged by “heart disease…”

What another supreme tragedy, and had it not been for one of our regular MAG-pie posters, I would never have known about it, nor fully understood how “Viral Cardiomyopathy” (VC) is related to Magnesium deficiency… Huh?… You’ve got to be pulling my leg!
C’mon, Magnesium Man, you’ve linked a lot of chronic conditions to low Mg status, but this seems waaaaay outside Maggie’s wheelhouse… And truth be known, that’s exactly what I thought — until today… And that’s why I love MAG FB group, as they are always challenging me to reach new levels of understanding about the impact of Mg deficiency in our daily lives, as well as in the illnesses that are an increasing part of our lives.
But before I delve into VC any deeper, let me take you on a slight bunny trail to highlight the importance of Mg and Mg-ATP to our blood, esp. our Red Blood Cells (RBCs).

(I’ll let you figure out above which are the “red” and which are the “white” blood cells, the latter of which will become far more important in just a minute…)
So, it turns out that RBCs are totally dependent on Maggie (Mg-ATP — the energy currency of the cell) for their unique donut-like (bi-concave) shape. In fact, it is this design that allows them to hold more Hemoglobin, which then allows them to hold more Oxygen, which we would all agree is important for life. And when the RBCs have plenty of Maggie, it also allows them to be more flexible, so that they can get into the nooks and crannies of our micro-capillaries — a very important dimension of their design and metabolic function. (I could write a book about just the aspects of RBCs that are Mg-dependent, but then you’d think me mad, or MAG or some such deserving appellation…)
OK, enough of that… So, what’s the Mg angle on Viral Cardiomyopathy?
Well, until today, I figured it was pretty remote. Until I read this key article. I was totally blown away, as it very clearly indicates the importance of Glutathione to the function of the White Blood Cells (WBCs), aka monocytes. Without activated Glutathione, WBCs cannot marshal an effective immune response. (Know anyone in your circle that’s dealing with any immune issues?…)
In any event, many savvy nutrition types know that Selenium is key for the proper activation of Glutathione. It turns out, the Master Anti-oxidant Chemical in our body will NOT work without that key mineral. But the part that most don’t know is that you cannot make the Glutathione molecule without Magnesium (Mg-ATP), and the Glutathione Detox Pathway (known as the GSH Pathway) MUST also be energized by Mg-ATP. What I did not know until today was how central Glutathione was to the function of the WBCs… (see picture below)

Now, while this article is “silent,” as virtually most scientific & clinical articles are, on Magnesium’s ubiquitous metabolic and regulatory role throughout our body, know that an “activated” WBC is just as dependent on Mg status as an “activated” RBC. And while I should have known that, or even suspected that, it wasn’t until I was digging deeper today into Randy Travis’ heart condition, “Viral Cardiomyopathy” that this nuance jumped out at me.
So what’s my theory? Randy Travis is an internationally-known celebrity operating in a highly competitive field called the “Music Industry.” My guess, it’s a pressure-cooker that few of us can imagine, complete with many “Stressors!” that regularly crank his Magnesium Burn Rate (MBR). Over time, he hit a threshold low for his Mg status, and as a result, his “Immune System” was unable to mobilize enough “Activated” WBCs that were insufficiently armed with Glutathione. As you certainly can imagine, one of the most “Stressed!” out dimensions of our body is our Hearts… Therefore, it’s an organ that is highly dependent on Mg, more so than you’ve been led to believe.
This Mg deficiency then made Randy more susceptible to a viral infection, given his likely weakened immune response. And with his likely “Stressed-out!” Mg status, which is rarely, if ever, measured with a Mag RBC blood test by conventional Cardiologists, his heart function became weaker and further compromised due to its inability to create adequate energy (spelled Mg-ATP inside our cells and especially inside heart muscle cells) to perform its 24/7 function of keeping his “electo-magnetic nuclear reactor” (aka, the Heart) working at optimal levels.
Now granted, that’s just a theory. And a disruptive one, at that. But given the fact that “heart disease” has been our Nation’s #1 cause of death — for the last 100 years — I think it’s time for some new answers.
After 3 years of meticulous research of more than a 1,000 scientific and clinical articles, I’ve come to a sterling conclusion: “heart disease” is little more than a dynamic manifestation of Magnesium deficiency. Could it really be that simple? Time will tell. But know that this “theory” has been the focus of scores of Mg-focused researchers, around the world, for the last 80+ years. So why hasn’t it caught on?
Occam’s Razor! (Magnesium’s waaaaay too simple, among other “unsavory” characteristics…)
To be continued…
A votre sante!