Thursday, January 28, 2010

Tyramine, Migraines, and Hypertension

Two common complaints in the ER are headache and elevated blood pressure. After dealing with the symptoms only to see the same patients return again and again with the same problems, I did some reading into some of the causes for these issues.

For migraine, it turns out that certain foods are significant triggers. Foods that contain high levels of a mono-amino acid called tyramine can cause migraines. This is the same substance that patients on the anti-depressants MAOIs are told to avoid so as to not develop seretonin syndrome. Well it turns out that many aged and processed products contain high amounts of tyramine. Here is a list:

Wine, Hard Cheese (Sharp Chedder, Swiss), Pickles, Sauerkraut, and nearly all processed meats like bologna, hot dog, sausage, bacon, corned beef, pastrami, SPAM, vienna sausages, pepperoni, soy sauce, teriaki sauce, tofu, and chocolate, etc). Pretty much all the good stuff. Cured ham is okay.

But it turns out that tyramine releases large amounts of seretonin, norepinephrine, and dopamine. That may be why these foods are so addicting because they make us feel good. But for people who suffer from migraines they can trigger one. knowing that tyramine releases seretonin and dopamine, it makes sense that the treatment for migraine is to block both seretonin and dopamine. Triptan medicines like Imitrex and Relpax are seretonin blockers, while Compazine and Reglan used in the Emergency Department limit Dopamine.

So, what about elevated blood pressure. Well, in addition to all these foods being very salty, the release of norepinephrine will cause increased blood pressure. A routine treatment for HTN is what we call a "water pill" or diuretic. Medicines like HCTZ and Lasix lower blood pressure by dehydrating the patient and stimulating the kidneys to get rid of excess water. But just so you realize how these medicines work. They really are not water pills but anti-sodium pills. The medicines really stimulate the kidneys to get rid of sodium and the water follows the sodium by osmosis. So, realize and remember, if you are eating more sodium then your kidneys and the medicines are able to get rid of, you will retain water, gain weight, have increased blood pressure, bloat, have worse circulation, swell, and slowly damage your kidneys, heart, brain, and eyes. You could even develop a fatal bleeding-type stoke if your blood pressure gets high enough. And the tryamine-norepi BP effects just go on top of the salt effects of eating these foods.

So, the message of the day kids is eat fresh.

Iron Chelation, Cystic Fibrosis, COPD and Ventilators

Cystic Fibrosis is a terrible disease that involves a mutation in a gene that encodes for a chloride channel. The result of having a defective Chloride channel is that children with CF do not produce secretions well. Everything is too thick. CF patients sweat is too salty and respiratory mucous is too thick. It also negatively affects seamen production, and can be a reason for over-thick muconium in a neonate. The consequence of all this is that because the respiratory secretions in the lungs are so thick, the cilia in the airway cannot get rid of them well and consequently, bacteria set up shop in the lungs. Bacterial biofims of antibiotic-resistant gram negative bacteria usually get entrenched in the lungs causing recurrent pneumonias and an eventual early death. That is unless the patient can get a lung transplant. But that is just trading one problem for another (rejection) until we learn to genetically modify and grow organs.

After a while a typical CF patient will require more and more daily respiratory treatments to prevent pneumonia. These patients may spend up to 3 hours a day getting various antibiotic nebulization treatments and percussive treatments. Not long ago someone noticed that kids with CF who surfed had many less pneumonia infections and much better pulmonary function testing than CF kids who didn't surf. What researchers found was that the hypertonic saline in ocean water was working to kill some of the biofilms in the CF kids airway. Using hypertonic saline nebulization is now routine for CF.

Very new research has come out that another strategy is very effective at almost totally eliminating biofilms in the lungs of CF patients. Even nasty resistant B-lactimase producers like pseudomonas and burkholderia cepacia are no match. CF patients regularly receive nebulized aminoglycoside antibiotics and Polymixin B. If you add a safe iron chelator deferoxamine to the mix, the antibiotic tobramycin and deferoxamine work senergistically together to eliminate biofilms more that 90%.

Now this just isn't good new for CF patients, because CF patients are not the only ones with impaired ciliary motility and biofilm problems. COPD patients as well as all Ventilated patients could theoretically benefit from routine treatments with these cheap medicines. Vent patients are almost guaranteed 100% to contract what is called "ventilator-associated pneumonia" after being intubated for 7 days or more. And the bacterias that are responsible are usually the same nasty resistant gram negative pseudomonas and acenitobacter species that plague CF patients. The consequence of this is that if a patient is intubated for a week, they will likely be intubated for 2 weeks until they get over their VAP. And then there are a significant number of these patients who get a VAP that can't get off the vent unless they are trached. And then there is a number of trached patients who become permanently ventilator dependent.

I have done some research in the past involved with iron regulation, ferritin, and even worked with Deferoxamine, etc. I remember discussing the bacterio-static potential of deferoxamine with Dr. Watt and others, but I didn't know medicine at that time, so although we realized that limiting iron metabolism would limit bacterial growth, we didn't know how to apply it.

Vitamin D

There have been many studies on vitamins such as A, E, and C which show very little benefit and even some increased harm in the case of vitamin E when taken as a supplement. Of course we need these vitamins in the food we eat, but some nutritionist comment that if you are paying a lot for a daily vitamin, you are just creating expensive urine. However, when pressed, these nutritionists usually will say, If you are taking a daily vitamin, keep it up.

There are several exceptions to this pessimistic view on vitamin supplementation. One is fluoride for children while their teeth are developing. Another is folate for all women of child-baring age who could possibly get pregnant. Folate supplementation has proven to decrease the rate of spina bifita, neural tube defects, and anencephaly in newborns. The reason you need to take it before you are pregnant is because by the time you know you are pregnant, the benefit of taking folate is gone. The important stuff is already done. Now, the focus and attention has turned to vitamin D.

It turns out that Vitamin D is not just a vitamin but also a hormone. Vitamin D is produced in the skin upon exposure to UV light. Vitamin D then must be converted into its active form by traveling to the lungs and kidneys, becoming 1,25-dihydroxycalciferol. Thats the good stuff. However, people with kidney or lung disease may not be able to convert calciferol into the active form and may be deficient.

It has been assumed for decades that all that Vit D was good for was bone formation. It turns out that Vit D does way more that that. Some of which we are only now discovering. Now we are discovering that Vit D is way important for the development of fetal brains and future IQ, as well as brain health and volume throughout life. Scientists have found that seniors with significant brain atrophy and Alzheimer's have low vitamin D levels. Genes linked with the development of Alzheimer's disease are associates with how the brain metabolizes Vit D.

Also, science is finding out that there is a link between Vitamin D and autoimmune disease. Patients who receive high does of Vit D supplementation have significantly less MS relapses. Also, patients with Inflammatory Bowel Disease have less symptoms after taking Vit D. Vitamin D is also being said to prevent Rheumatoid arthritis.

Doctors have known for decades that the bone disease called rickets is the consequence of low Vit D. The issue here is that when doctors set normal values for Vit D levels, the levels were set based on the point at which rickets and osteoporosis set in. But, at that time, doctors didn't know that the vitamin served so many other purposes for the immune system as well as the brain. The consequence of this is that even if your have had your Vit D level checked and it came back normal, it may not be normal if its low normal.

As far as MS is concerned. This is a disease that people only get in the higher latitudes. No one in the tropics gets MS. So, we have known all along that this probably had something to do with the sun. In fact, African Americans who never get MS, are at increased risk to contract MS if they move to nothern latitudes. The leading theory is that there is a gene that has been identified on Chrom 6 which is influenced by Vit D while the fetus in in the womb. the children of women with this gene mutations and who have mothers with low sun exposure and low vit D levels are at much greater risk of developing MS.

But before all pregnant women get out in the sun, UV light isn't all good. Too much UV light destroys folate. And low folate causes those terrible spina bifita defects. Vit D has been in our milk by as we get older we tend to become lactose intolerant and therefore stop drinking it. Another issue is the color of our skin. People in northern latitudes developed lighter skin so that they can produce more Vit D. But the trade off is less folate. People with darker skin actually have a more difficult time producing vit D because the high melanin in their skin absorbs the UV light before it can reach the cells that make Vit D. This especially becomes even more of an issue for people with dark skin who live at the equator who then move to extreme northern or southern latitudes.

When it comes to preventing osteoporosis, I would add that getting vit D is much more important than taking Calcium. There is usually plenty of calcium around, but its the vit D that is the problem. If you are going to take a calcium supplement, be aware that most calcium is not absorbed well at all. Citrical is a formulation that is absorbed better than typical Calcium salts like in Tums. Ester-C wasn't that much better than Tums.

Wednesday, January 27, 2010

The Dark Universe

When I was growing up, my best friend's grandfather was a physicist. One day we were visiting his home on the East Bench in Salt Lake City, and while we were swimming in his pool on a hot summer day, my friend's older brother yelled out to their grandfather who was sitting in a at patio table quietly engrossed in something, "whatcha doing grandpa?" Their grandfather coyly replied, "I am calculating the amount of dark matter in the universe." If I remember, that had to occur sometime in the late 80's before my friend''s father left Utah to serve as a mission presidents in Fort Lauderdale. Hurricane Hugo hit while they were there which would make it before 1989. Anyways, That's how a few of the conversations went over at their house.

Even before Einstein, many scientists conceived of some kind of ether throughout the universe. This kind of thinking fell out of vogue until more recently astronomers just couldn't make the numbers add up when it came to galaxies. After calculating the masses of galaxies based on the number and weight of all their stars, the combined mass just didn't account for the high speed of galactic rotation. That is when scientists began looking for what is known as "Dark Matter" which is currently believed to make up nearly 90% of the mass of the Universe. Dark Matter cannot be observed directly, but is inferred based on its effect on regular matter. We are not just talking about dark clouds of hydrogen or other elements. When clouds of gases pass in front of other stars, the gas absorbs certain light and emits certain other wavelengths of light. It is this kind of astro-spectroscopy that allows scientists to directly measure regular matter in space. On the other hand, Dark matter does not interact with light the way regular matter does.

There is another problem with the universe. It turns out that as we build larger and higher resolution telescopes that can look further and further into the past. Observations of galaxies by gravitational lensing and other observations of super-massive gamma ray bursts have been calculated to be about 13 billion light years away. The universe is only calculated to be about 14 billion years old. In looking out at the universe, scientists have observed by red-shift observations that the universe appears not to just be expanding away, but also accelerating. To provide the energy necessary to explain the acceleration, scientists have proposed the existence of "dark energy" which would comprise 74% of the total mass-energy of the universe. Together with dark matter which comprises an additional 22% of the mass-energy of the universe, this means that man has no idea what is going on with 96% of the universe. And even the 4 % we can see we can't explain well.

The visible universe that we see is comprised of stars, gases, and planets. As I said above, we really can't explain very well how the stuff we can see works let alone the stuff we can't see. One example of the mystery of stars centers around our own sun. Our sun is theorized to be a gigantic fusion reactor. However, the combining of hydrogen to produce helium should give off a certain number of neutrinos. The problem is that when scientists go to measure neutrinos, 2/3rds of them are missing. Now some theorize that there can be 3 types of neutrinos and they are constantly fluctuating between neutrino flavors. But again, that is the current theory.

Back when I was a boy, I remember by friend's father saying that maybe electromagnetism and gravity were the same thing. The equations for gravitational bodies compared to charge carrying particles do look similar. Also, he said that the reason for the missing neutrinos was because the sun was absorbing dark matter coming from outside the solar system. This dark matter possibly coming from a binary star was generating the intense heat of the corona and a majority of the energy of the sun.

Now scientists are claiming something similar. is featuring an article that claims the sun might be generating dark matter. Theoretic particles called Axions may be forming inside the sun. As the axions travel outward and are subjected to a gravitational field, they turn into photons of light. The scientists claim that these axion conversions may be the reason why the corona of the sun is hotter than the sun's surface. Scientists are currently trying to detect axions by pointing large cold superconducting magnets at the sun and x-ray detectors at the magnet hoping that they will observe the conversion of an escaped solar axion into an x-ray as it passes through their magnetic field. If my friend's father is correct, the axions would be coming from outside the solar system and attracted by the sun. As the axions interact with the sun's powerful magnetic field they then convert into photons in the photosphere. The sun's magnetic field is only 1 Gauss and 4000 Gauss at sun spots. A 1 Telsa magnet equals 10,000 Gauss. Neutron stars and magnetars can generate a magnetic field of 10^12 -10^17 Gauss. I'll have to ask is the xray film is being exposed if it sits next door to the MRI room. WIMPS are theoretic supersymmetry particles that are also being proposed as a candidate for dark energy.

Tuesday, January 26, 2010

No Bailouts

Government bailouts have several outcomes, none of them good. #1. Knowing that mom and dad will bail you out leads to excessive risk taking by companies. #2. Bailouts just continue to inflate the balloon. #3. Bailouts delay businesses from reorganizing, trimming and improving things.

If a Company is too big to fail, the system has 2 mechanisms to deal with the problem; neither of which involves a bailout. 1. Anti-trust legislation: prevent a business from becoming too big to fail by dividing it up regionally or into subsidiaries. 2. Chapter 11 Bankruptcy: allows a business to reorganize and trim off unprofitable parts of the business, refinance loans, and rehabilitate until it becomes profitable again.

Kruschev Prophecy

I remember reading a story told by Ezra T. Benson, who served as the Secretary of Agriculture during the Eisenhower administration. The leader of the Soviet Union, Nikita Kruschev (who followed Stalin) was going to visit the U.S. and Benson was ordered by Eisenhower to give Kruschev a tour of some of our agricultural facilities. With great reluctance, Benson agreed to do as requested by the President.

During the tour Kruschev remarked to Secretary Benson that communism would eventually consume democracy. Benson replied that Americans would never accept such a drastic change in their form of government as communism. Kruschev then told Benson that it was already beginning to happen.

He said that Americans were being fed one small bite of communism at a time, and that over the course of several years, Americans will have accepted so many communistic ideals, including a massive and uncontrollable federal government, that one day we would wake up to discover that we are a democracy only in name - that our policies and methods of government will be communist in nature. Kruschev concluded that it will be the slow injection of socialist/communist principles into America - not nuclear missiles - that would destroy our nation.

Wednesday, January 13, 2010

How to Fix America

1. End the Federal Reserve
2. Balance national budget
3. Print money and pay off national debt
4. End fractional reserve lending to prevent inflation caused by printing money to pay off debt
5. End banking practice of charging interest to Americans
6. Non-profit community safety societies (CSS) would make home and business loans by purchasing asset on your behalf. The borrower would retain rights to control the property. The bank would charge a fee and down payment and future payments would go towards the borrower becoming a larger shareholder of the asset. All profits are distributed to depositors who are all part owners in the bank(CSS).
7. Government would invest and incentivize business that result in greater self-sufficiency. For example, the government should have invested in natural gas instead of oil and gasoline.
8. Government should get out of the business of administering socialist programs and buying votes using other peoples money.
9. Shift responsibility of social programs to state and local level.
10. Make fornication socially unacceptable again as illegitimacy is the number one contributer to poverty. Maybe the days of the "Scarlet Letter" weren't so bad in spite of what your High School English teacher would have you believe. But I think it more just to make the guy wear it.
11. Use tariffs to prevent a trade deficit.
12. Put currency back on gold, silver, and copper standard.
13. Charge interest to foreign governments who exchange dollars for gold only.
14. States should encourage local self-sufficiency. Georgia and South Carolina should encourage cultivation of pecans, figs, and blueberries, and pine trees. They should also encourage shrimping and protect this industry from cheaper overseas pond shrimp. If local farms didn't have to pay huge interest on their farms, I believe that food could be produced cheaper than it can be shipped from overseas. The same thing would apply to technology production.

Monday, January 04, 2010

Stimulus, Banking and Bubbles

Thomas Woods, author of "meltdown" was speaking on the C-Span 2 Book Club discussing why government stimulus doesn't work. Up to this point, I have failed to hear any expert economists explain in a coherent manner what caused the latest economic downturn until this interview.

The first thing that Woods criticized is Keynesian Economics. Keynesian economics says that sometimes the free market can act irrationally and emotionally and cause instability in the markets especially in response to a natural disaster. Keynesian says that a government and central bank can stabilize irrational market fluctuations through stimulus and injecting capital into the system until the markets become rational again. The traditional example in support of this economic theory is the government investment in US manufacturing and US highways during and just after WWII which are seen as contributing to the post-war boom in the US during the Eisenhower's presidency.

Thomas Woods on the other hand favors the theories of Nobel Laureate Friedrich von Hayek of the Austrian School of Economics who observed that government stimulus during a market downturn is the worst possible thing a government could do. Woods gives the example of a brickmason building a structure out of bricks but not knowing that he doesn't have enough bricks to finish the job. At some point the brick mason will discover the shortfall and the sooner the better. If the mason discovers that he will be short early, then he can alter the plans and make the best out of the situation. If he finds out late, then the consequences are much worse.

Woods explains that the reason there are ups and downs in the markets is because we have a difficult time predicting what consumers will be doing next. Therefore, then a particular market sector is hot, businesses tend to invest a lot of money in hopes of earning future profits. But if that market falls off for whatever reason, then the business is left having invested all this money for nothing.

What has happened in the US, is that the US central banks have come in and bailed businesses out using billions of taxpayers dollars. Therefore, the consequences of all the risk taking by these businesses gets transferred the US tax payer. Government bailouts have several outcomes, none of them good. #1. Knowing that mom and dad will bail you out leads to excessive risk taking by companies. #2. Bailouts just continue to inflate the balloon. #3. Bailouts delay businesses from reorganizing, trimming and improving things.

According to Woods and Hayek, the government should never bail companies out. What should happen when the market turns south is that the Federal Governments should cut back on spending, and encourage saving by raising interest rates. Increased saving would cause deflation and an increase in wealth assuming US currency was still on the gold standard like it was in 1920. Companies during an economic downturn should cut back on spending as well. Some could use existing bankruptcy laws to reorganize their debt and trim off unprofitable parts of their business and come out of bankruptcy trim and more efficient. Woods laments that now because the US dollar has no backing and has lost considerable value due to continual inflation, the average American is forced to become a stock market speculator when saving money and now is subject to losing money either through inflation or with each market crash.

The current problems began with the Dot.Com bubble. The Internet stimulated all sorts of wild speculation and investment in companies with no hopes of profit. The Federal Reserve under Alan Greenspan offered low interest rates and people were borrowing money to invest in the stock market. Money was so cheap, individuals were taking out 10 billion dollar loans and buyout huge companies like HCA and Linen and Things. But, the party had to end eventually. Beginning in 1999 and 2000 the Fed raised interest rates 6 times and the over-inflated bubble burst. Instead of cutting back, The US Government and US companies believed they could spend their way out of a recession. So, the Fed reduced interest rates again and poured stimulus money into housing. In stead of housing prices and the housing market cooling with the rest of the market, housing prices continued to rise while wages were stagnant and US manufacturing jobs went overseas. Again, even the manufacturing boom was really a balloon which has been slowly and painfully deflating as well.

The continued growth in the US housing market gave the illusion that the US home mortgage market was recession proof. But no one recognized it was the government that was over-inflating the market and creating the next bubble. The illusion of stability led to banks issuing mortgage backed securities and assigning them AAA ratings. But it wasn't long before, like the bubble, the housing bubble burst as well. Because of inflation, and the devaluation of the dollar, wages could not keep up with the increase in housing costs. As I have said in other posts, it wasn't just the sub-prime borrowers who are to blame. There were just as many wealthy Americans who defaulted on their second homes as there were sub-primes who defaulted.

As I have explained previously, Banks who were leveraging their fractional reserves by owning toxic derivative mortgage backed securities were hurt by the meltdown because they lost their reserves which they needed to lend. No reserves, no lending. No reserves, no ability to pay withdrawals. AIG was hurt because they had been selling mortgage insurance to sub-prime borrowers and couldn't pay when so many defaulted at once. But AIG did end up paying the banks using US Taxpayer money.

Fed Chair Ben Bernanke then got Congress to also put up money to buy all the toxic assets or these worthless derivative mortgage backed securities. This money for toxic assets is what is known as TARP (troubled assets relief program). Astonishingly, not one dollar of TARP money so far has gone to buy any of these toxic derivatives. Instead, the 700 billion dollars went directly to the banks as a zero interest loans to replace their lost fractional reserves. It appears the banks are holding onto the MBS. Why? Because not only is the taxpayer bailing them out by giving them free money to lend back to us, but eventually the volatile MBS will regain value and I bet you the banks are planning to sell those assets later at a profit to the banks and at an additional lose to the US taxpayer. And we are supposed to think Bernie Madoff is a swindler.

American Economic Empire
As a side note, I also listened to an interview by John Perkins who wrote "Confessions of an Economic Hitman." Perkins discusses how the US in conjunction with US businesses strong armed developing countries to accept huge loans from the World Bank which were used by US businesses to steal their resources and then left the country with the unpaid debt. After getting these countries deep into debt, the US manipulates these countries to sell their natural resources to the US for cheap in exchange for assistance in helping them pay the debt. For those government leaders who refused to play ball, the CIA sends "Jackals" who have been responsible for several assassinations.

Swiss Banks and Tax Evasion
60-Minutes ran a story this week about Bradley Birkenfeld who was a mid-level banker for UBS, the largest Swiss bank. Birkenfeld suffered intense guilt while working at UBS and eventually went to the US government as a "whistleblower" confessing that he was an accomplice to assisting thousands of rich Americans shelter money and evade taxes using secret Swiss Bank accounts. The US demanded UBS turn over the names of some American account holders. According to the 60-min interview, the US is not investigating all account holders but only the big ones. When I hear this, what I hear is, the US is conveniently picking and choosing who they are investigating based on politics. Also, the US is currently offering amnesty to all American's with overseas bank accounts to pay back taxes without penalty while Birkenfeld is being prosecuted and going to jail. Birkenfeld was initially offered complete immunity, but he failed to disclose his #1 client and is going to jail. Birkenfeld lawyers are trying to see if he is entitled to millions which according to recent "whistleblower" legislation he may receive.

Bursting of the Manufacturing Bubble
During WWII, the US invested billions of dollars in manufacturing. The government built huge factories for the production of tanks and bombers only to turn these facilities over to private companies following the war. Emerging from the war, the US became the most powerful country of the free world. But the US had a considerable debt burden which peaked at 120% GDP. Currently our national debt is approaching 80% GDP. Nearly 50% of this debt is owned by the Federal Reserve whose shareholders are private banks and ultra-wealthy investors. An increasing amount of our US Treasury Bonds are now owned by foreign countries (30%) like China, Japan, and the United Kingdom. As the US debt is transferred over to emerging countries like China, India, and Brazil, the private investors and banks are cashing out on T-Bills and moving their money to take advantage of the capital needs of the emerging economies and their emerging middle classes. The US has large trade deficits with other countries like China. This means we buy much more of their stuff then they buy of ours. If we were still on the gold standard, those countries would have been draining our gold reserves by trading in those extra dollars sitting around. Instead, they have nothing to do but buy our T-Bills and stock in US companies. Now the value of our currency and the value of Chinese wealth in US dollars is increasingly dependent upon China continuing to purchase our T-Bills to fund our national debt instead of allowing our government to print money which would cause inflation and devalue those dollar. This pressure is allowing the Fed Private investors and Banks the leverage they need to cash out, which they have been doing steadily.

My View on Stimulus
First, I consider the collection of interest an act of war, and modern day slavery. Second, I agree with Woods that government stimulus which encourages companies to keep on doing more of the same in the face of a downturn is wrong. However, I don't think that all government stimulus and incentives are wrong. I believe that the United States government, as part of its primary role to protect this country, should have focused on our countries self-reliance instead of blackmailing and economically enslaving other countries into selling us their resources cheaper. What we should have done is build our nation based on our local natural resources. Our countries' economy is petroleum based, but we have been blessed with huge coal and natural gas reserves. Why do we depend upon gasoline and oil when electricity can be generated using coal and nuclear and cars can run on natural gas? I don't know. But our dependence on foreign resources makes our country vulnerable. And it should have been the duty of our government to use the power of tariffs to protect American jobs, manufacturing, steel production, and farms as well as the value of our currency which should have remained on the gold and silver standard. The last 100 years has seen the homogenization of America and there are forces that would like to have McDonald's and Walmart in everywhere. But I live in Georgia, and figs and pecans grow well here, coastal fishing produces shrimp, but each year I see less and less local commodities and more and more imports. Our just-in-time, and homogenized society is more vulnerable than ever and all it would take is another World War, or Pandemic, Natural Disaster causing a transportation interruption and the people of the US are gonna be in a world of hurt. A lose of self-reliance is what sets an Empire up for the big fall.