2018-2019 Flu Vaccine, Prevention and Treatment

November 14, 2018 Philip Miller Comments 2 comments

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

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

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

There is no universal flu vaccine

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

Flu Strains

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

A/Michigan/H1N1

A/Singapore/H3N2

B/Colorado 2017 B/Victoria 87

B/Phuket 2013 B/Yamagata 88

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

Vaccine Effectiveness Rates

CDC Seasonal Flu Vaccine effectiveness — Seasonal Influenza Vaccine Effectiveness, 2004-2018

Last year it was said that the flu vaccine was only 10% effective. In retrospect, the CDC published an average for all age groups of 40%. Here are the reported rates of effectiveness for the last 14 years [link is no longer available]. A more detailed breakdown by age for 2016-2017 shows even more variability. All these statistics are somewhat irrelevant. What is more relevant is the flu vaccination most often less than 40% effective. So the recommendation is based on, “well, it’s better than nothing.” I can’t think of hardly any other medication in use today were the rationale is, “well, it’s better than nothing.” Surely there must be a stronger argument and rationale to the widespread public campaign to “get your flu shot now.”

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

Anti-Virals now available

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

My recommendation for a natural approach

Miller Anti-Viral Regimen ™

Vitamin D 50,000 daily x 5 days

Astragalus 1000 mg daily x 5 days

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

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

Now let me know your thoughts and experiences.

Philip Lee Miller, MD
Carmel, CA 93923
Nov 2018

Vitamin D and Osteoporosis Prevention

October 8, 2018 Philip Miller Comments 1 comment

Vitamin D is back in the news again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reader beware.

Philip Lee Miller, MD

Carmel CA

How CEOs respond to a cancer diagnosis

July 27, 2018 Philip Miller Comments 2 comments

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

Cancer Risk Benefit Management

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

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

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

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

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

Tell me what you think.

Treat and Prevent Iron Deficiency Anemia

May 24, 2018 Philip Miller Comments 0 Comment

This is the last in our series on Iron Deficiency and Iron Deficiency Anemia. In parts I, II, III, and IV, I talked about all aspects of the essentiality of iron. How to diagnose iron deficiency anemia. Various controversies surrounding iron supplementation. And the relationship of iron to various inflammatory states including cancer. Let’s recap this series with specific treatment routines. I encourage you to read this final wrap-up containing new and revolutionary medical paradigms.

[If you want the nitty gritty, scroll down to “treatment.”]

Enter Functional Medicine

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

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

Binary vs. Optimal Choices

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

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

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

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

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

Challenging Standard Definitions

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

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

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

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

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

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

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

Treatment Options

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

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

Heme vs non-heme iron sources in food.

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

Iron Salts

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

Iron chelates

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

Iron Infusions

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

Philip Lee Miller, MD
Carmel, CA
May 24, 2018

Iron metabolism and iron supplementation in cancer patients: Wien Klin Wochenschr (2015) 127:907–919 DOI 10.1007/s00508-015-0842-3
Ludwig H, Müldür E, Endler G, et al. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24:1886–92.
Iron Dosing for Optimal Absorption: NEJM Journal Watch Oct 30 2015.
Iron deficiency Anemia NEJM May 8, 2015

Five Quick Health Tips

April 28, 2018 Philip Miller Comments 0 Comment

Five Vital Health Tips

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Facebook and Privacy

March 24, 2018 Philip Miller Comments 0 Comment

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

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

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

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

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

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

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

Safeway

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

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

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

Free Email?

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

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

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

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

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

Credit Cards

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

HIPAA

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

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

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

Happy safe computing

My Daily Personal Nutrition Routine

March 14, 2018 Philip Miller Comments 4 comments

People ask me what is your personal nutrition routine? What do you take on a daily basis? What supplements and micronutrient do you take yourself for optimal nutrition? To achieve optimal health and well being in a high stress world today.

Personal Goal

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

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

” you are as old as your arteries.”

Arterial health is a major goal. This is why we strongly advocate CIMT imaging of your carotid arteries here in our office.

My daily routine starts upon arising (on an empty stomach) with fat soluble nutrients. This includes:

1 tbl of fish oil
Vitamin E 1200 units
Vitamin K2 15,000 mcg
Vitamin D3 10,000 units
Thyroid
Phosphatidylserine 300 mg and
Nattokinase 100 mg to prevent heart attacks and strokes.

These fat soluble nutrients are more efficiently absorbed with fish oil. They are taken on an empty stomach so they do not interfere with oatmeal for breakfast.

There is a 45 to 50 minute hiatus. Read my morning emails. A morning shower after which I apply my first dose of testosterone cream.

Breakfast

Breakfast starts with Bob’s Red Mill gluten-free oatmeal. Cooked to a creamy consistency over a gas stove. Now my first highly fortified protein shake of the day.

2 scoops of whey-based protein
1 tsp (3 grams) of carnitine tartrate
1 tbl phosphatidylcholine
1 scoop of d-ribose
l-deprenyl for cognitive enhancement

This is the most efficient and richest source of high quality protein. The protein shake can be mixed with Odwalla orange juice or your favorite base.

Breakfast is fortified with an array of vitamins and micronutrients.

Selenomax 200 mcg
OptiZinc 30 mg
Nutrient 950 multivitamin
DHEA 50 mg
Diaxinol
4Sight
Vitamin B2
Methyl folate 1600 mcg
B12 10,000 mcg
Alpha lipoic acid 300 mg
Ginkgo Biloba 60 mg
ProBiotic 100
Vitamin C as ascorbyl palmitate
“Reacted” chelated Iron 58 mg (read my previous series on iron)

It’s quite a handful, but each of these is designed to improve immune function, cardiovascular function, energy and cognitive vigor.

Lunch

Lunch is a very sparse affair with my second protein shake of the day.

2 scoops of whey-based protein
1 tsp ( 3 grams) carnitine tartrate
Gluco-shield.

It is a quick and efficient source of energy. This carries me through the day until 5:00 or 6:00 pm.

Dinner

Dinner is a rich source of protein including fish, chicken or organic beef with some vegetables, most especially broccoli and carrots. My preference at night is a combination of chocolate Rice Dream and chocolate Hemp Milk.

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

Ketogenic diets do promote weight loss. I am still concerned about the quality of fats being advocated in ketogenic diets. Usually including large amounts of butter, cheese, bacon, sausage and other sources of potentially inflammatory Omega-6 oils. Omega-6 fats potentially increase arachidonic acid which promotes a cascade of inflammatory metabolites.

This is the source of another blog soon.

Dinner is also supplemented with:

Nutrient 950 multivitamin 3 caps
Diaxinol 1 cap
4Sight 1 cap
Ginkgo biloba 60 mg
Magnesium 400 mg
Alpha lipoic acid (a stellar antioxidant) 300 mg

Bedtime

Just before retiring at night I take

Magnesium 200 mg
Nattokinase 100 mg

Coda – Ask Jack

Jack LaLanne at age 60. Original fitness guru — Jack age 60

Does that sound like too much? We could have asked Jack LaLanne. Our supreme nutrition and exercise experiment. He took all known supplements and micronutrients for well over 70 years.

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

I can remember Coach Dees in high school. He was our cross country coach. On the first day he said, “Now I want all of you to go out and start drinking wheat germ oil.” This was 1960 when you went into a tiny proto health-food store with an old guy sitting at the bar drinking carrot juice. Wheat germ oil was supplied in plain unattractive brown bottles. It was my first source of concentrated Vitamin E.

In Medical School at UCSD a group of us would read Adele Davis. Then Linus Pauling started writing about OrthoMolecular Medicine. He was advocating therapeutic, supra-physiologic doses of vitamins, minerals and selected micronutrients.

It’s been a life-long quest.

We all want healthy and robust longevity in a chaotic world. The ultimate goal of the preventive medicine physician is to set an example and show the way.

Thank you for reading. Now what are you taking? Drop me a line. Don’t forget your Fullscript source of all supplements and micro-nutrients. Then read (or re-read) my bestselling book. The Life Extension Revolution.

Philip Lee Miller, M.D.

Carmel California

Looking for Prescription Drug Medication information

March 8, 2018 Philip Miller Comments 0 Comment

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

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

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

Historical Precedents

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

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

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

Current Sources

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

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

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

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

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

Help us increase our readership.

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

Not So Random Thoughts on Aging

March 4, 2018 Philip Miller Comments 6 comments

Why Are Baby Boomers Dying Prematurely?

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

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

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

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

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

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

Generational Age Categories

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

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

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

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

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

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

The Challenge for You

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

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

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

Epilogue

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

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

Iron Deficiency Signs and Symptoms -Part IV

February 18, 2018 Philip Miller Comments 2 comments

Symptoms of Iron Deficiency Anemia:

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

Mental Fatigue and Cognitive Impairment.

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

Pale (pallid) or Yellow (sallow) Skin.

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

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

Unexplained Fatigue or Lack of Energy

Heart Failure in Susceptible Individuals with Heart Disease

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

Pagophagia – Craving for Ice or Clay

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

Sore or smooth tongue and cheilitis

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

Brittle nails or hair loss

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

Restless Legs Syndrome

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

Additional Symptoms:

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

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

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