Maternal thyroid deficiency during pregnancy increases risk for schizophrenia


Hypothyroxinemia during early to mid-gestation was associated with increased risk for schizophrenia in offspring, according to recent findings.

“Clinical hypothyroidism during pregnancy is an established risk factor for cognitive dysfunction of offspring and neuroanatomic abnormalities including reduced hippocampal volume,” David Gyllenberg, MD, PhD, of the University of Turku, Finland, and colleagues wrote. “An emerging literature has yielded intriguing evidence that hypothyroxinemia is also associated with delayed cognitive, motor, and speech development in offspring.”

To determine associations between maternal thyroid deficiency during early to mid-gestation and schizophrenia in offspring, researchers conducted a nested case-control study of maternal sera from a national Finnish birth cohort of all pregnancies since 1983. Maternal sera of 1,010 case-control pairs were evaluated for free thyroxine and sera of 948 case-control pairs were evaluated for thyroid-stimulating hormone.

Alan S. Brown

Maternal hypothyroxinemia was associated with an increased risk for schizophrenia (OR = 1.75; 95% CI, 1.22-2.5; P = .002).

When adjusting for maternal psychiatric history, province of birth and maternal smoking during pregnancy, the association remained significant (OR = 1.7; 95% CI, 1.13-2.55; P = .01).

“This work adds to a body of literature suggesting that maternal influences, both environmental and genetic, contribute to the risk of schizophrenia. Although replication in independent studies is required before firm conclusions can be drawn, the study was based on a national birth cohort with a large sample size, increasing the plausibility of the findings,” study researcher Alan S. Brown, MD, MPH, of the Mailman School of Public Health, Columbia University Medical Center and New York State Psychiatric Institute, said in a press release. – by Amanda Oldt

HbA1c testing in ED targets undiagnosed diabetes, prediabetes


People with undiagnosed diabetes and prediabetes may be identified with routine HbA1c testing in the ED, according to findings of a pilot study in Australia.

Routine HbA1c testing may provide opportunities for these patients to improve their care, according to the researchers.

“Diabetes case finding in the ED is justified as there is a significant population with known and undiagnosed diabetes,” the researchers wrote. “Following the findings of this pilot, it is intended that routine HbA1c testing will be the norm in the ED at Blacktown Hospital.”

Tien-Ming Hng, MBBS, PhD, FRACP, of Western Sydney University and Blacktown Hospital in Australia, and colleagues evaluated all patients undergoing blood sampling in the ED and random blood glucose measuresover 6 weeks. HbA1c was measured on the same sample if blood glucose was at least 5.5 mmol/L. Diabetes was defined as HbA1c levels of at least 6.5%, and prediabetes was defined as HbA1c levels of 5.7% to 6.4%. Researchers identified patients with previously undiagnosed diabetes by reviewing hospital records.

Tien-Ming Hng

Tien-Ming Hng

Overall, there were 4,580 presentations to the ED and 1,267HbA1c measurements (47.3% women); 38% of participants were identified as having diabetes. Of those with diabetes, 45% were women and 32.2% were newly diagnosed.

Of participants with newly diagnosed diabetes, 61.8% had mild diabetes. Twenty-seven percent of participants with HbA1c sampled had evidence of prediabetes. The diagnosis of diabetes was not coded in 28% of participants who were known to have diabetes; 11% were previously known to have diabetes, 81% were newly diagnosed and 8% were coded as impaired glucose regulation.

“In areas of high diabetes prevalence, HbA1c screening is an effective means of findings cases of diabetes and prediabetes,” Hng told Endocrine Today. “The findings of this study provides a better understanding of the diabetes burden in our local population and its potential impact on our health resources. This allows us to plan service delivery within our local health district and the wider community; to identify individuals at risk for diabetes thus providing an opportunity for intervention to prevent them from progressing to diabetes; to identify undiagnosed patients thus resulting in earlier intervention; to recognize the population and improve management of diabetes within the hospital; and to ensure that patients admitted to the hospital are appropriately coded for the complexity of their admission.” – by Amber Cox

Flu Vaccine Effective Until It’s Not


Many Americans rely on information provided by the U.S. Centers for Disease Control and Prevention (CDC) — which is supposed to be the nation’s leading health protection agency — to make important health decisions.

Taking Flu Vaccine

Story at-a-glance

  • A U.S. Centers for Disease Control and Prevention (CDC) advisory committee recommended against the use of FluMist live attenuated nasal spray vaccine
  • Data showed the nasal spray vaccine to be less effective than the inactivated vaccine, and in some cases showed it had zero effectiveness against certain flu virus strains
  • The CDC has claimed the nasal spray vaccine to be safe and effective for years and has heavily promoted its use to children and adults

So when the agency suddenly flip-flops on a key health message, it’s not only disconcerting but also dangerous.

For years the CDC has been making general and often misleading categorical statements that in order to stay healthy during the flu season, “the most important thing is for all people 6 months and older to get a flu vaccine every year.”1

Although this is stated as fact, it’s easily debatable, as a strong immune system — the result of leading a healthy lifestyle — is actually among your best defenses against getting sick or experiencing complications from viral infections like influenza.

Taking a closer look at the CDC’s authoritative message to Americans, public health officials have also stated, as recently as the 2015 to 2016 flu season, that “both the nasal spray vaccine and the flu shot have been shown to be effective in children and adults.2

You’d be wise to take such statements with a grain of salt, as now a CDC advisory committee has recommended the widely used nasal spray influenza vaccine not be used during the upcoming flu season.3

CDC Reverses Their Advice, Says No to Nasal Flu Vaccine for 2016 to 2017 Flu Season

About one-third of flu vaccinations given to children in the U.S. are the nasal spray, which is often preferred by pediatricians because it’s needle-free.

In recent years, both the CDC and the American Academy of Pediatrics (AAP) went so far as to say the live virus nasal spray version was the preferred vaccine for healthy children ages 2 to 8 because research showed it worked a little better for them than the inactivated injected vaccine.

Children were given two doses to inhale initially, so theoretically, they could quickly build immunity.4 But it turned out the nasal spray flu vaccine was a bigger failure than injectable flu shots. During the 2014 to 2015 flu season, for instance, the nasal spray flu vaccine showed potentially no benefit for young children.5

Despite the failure, during the 2015 to 2016 flu season the CDC again stated that the nasal spray vaccine was effective in children and adults, and that “either vaccine is appropriate” (referring to either the nasal spray or inactivated flu shot) for people aged 2 through 49 years.6

This is in direct contrast to this year’s advice, with the CDC panel now recommending against the nasal spray vaccine (brand name FluMist). The decision, which still has to be approved by CDC Director Tom Frieden, was based on recent data showing continued poor performance. As CNN reported:7

“During the [CDC advisory committee] hearing, Dr. Chris Ambrose of MedImmune [FluMist’s maker] shared results from the company’s 2015 to 2016 influenza vaccine effectiveness study, which found the FluMist quadrivalent vaccine to be 46 percent effective, compared with the flu shot’s 65 percent effectiveness.

However, Dr. Brendan Flannery of the CDC presented data indicating that FluMist had zero effectiveness against one strain of flu.”

Can Live Virus Vaccines Transmit Disease?

While the CDC’s decision against FluMist was based on lack of effectiveness, there are other important considerations when considering use of a live-virus vaccine.

The flu shot is an inactivated vaccine while the nasal spray contains live, albeit weakened (or attenuated), virus that is intended to stimulate the immune system to fight disease without causing clinical symptoms of illness.

However, when you get a live attenuated viral vaccine, you shed live vaccine-strain virus in your body fluids — just like when you get a viral infection and shed virus in your body fluids.

After getting a live-virus vaccine, you can shed and transmit vaccine-strain virus to other people, in whom it might cause serious complications.

Live attenuated viral vaccines also have the potential to affect the evolution of viruses, which are constantly recombining with each other, because vaccine-strain live viruses are released into the environment where further mutations can occur.8

How Accurate Are Vaccine Effectiveness Studies?

When health agencies state a vaccine’s effectiveness rate, it’s important to be aware that this may be incredibly difficult to gauge in the real world. Some researchers may rely on data from population-based electronic immunization registries to conduct vaccine effectiveness studies, for instance.

Yet, researchers found that what was stated in the registry often did not match up with records at doctors’ offices, even when data was electronically transferred. There were discrepancies in the number of vaccinations received, the formulations given, the manufacturer and lot number of the vaccines and more.9

Challenges have also been identified when evaluating vaccine effectiveness using large cohort studies, which rely on data from a large group of people with a defining characteristic, such as being within a certain age range.

“No single set of definitions or analytical approach can address all possible biases,” researchers explained.10

Studies on vaccine reactions may be equally flawed or at least misleading. In one CDC study, for instance, it was claimed that life-threatening anaphylaxis occurred in 33 confirmed cases out of more than 25 million vaccine doses.11

While the media touted the results as proof vaccines rarely cause serious reactions, this study only looked into one serious reaction. Rates of other serious side effects, such as encephalitis, meningitis, febrile seizures, brain damage, coma and death, for instance, were not discussed.

Meanwhile, the CDC study used electronic health data to determine rates of anaphylaxis following vaccination — data that, as mentioned, is often wrong.

Getting a Flu Shot Every Year May Increase Children’s Likelihood of Getting the Flu

There are more questions than answers when it comes to manipulating the human immune system and attempting to stimulate artificial immunity using highly variable, rapidly mutating viruses like influenza.

While health officials continue to promote annual flu vaccination for virtually every man, woman and child, researchers have quietly released results showing that children who received an annual flu shot for a number of years were more likely to get the flu than children who had received a flu shot during the present season only.12

Previous research has also shown annual vaccination against influenza hampers the development of certain types of immunity in children.13 In other words, the seasonal flu vaccine may weaken children’s immune systems and increase their chances of getting sick from influenza viruses not included in the vaccine.

If the flu shot being so highly promoted by the CDC might inadvertently be increasing children’s risk of illness, you might think it would be a top area of research, but not in the U.S.

Since flu shots are already being recommended annually, health officials maintain that it would be “unethical” for researchers to conduct a study in the U.S. and not offer the shots to all (whether or not they may be having serious unknown adverse health consequences).14

CDC’s Plan: If the Flu Shot Doesn’t Work, Take Antiviral Flu Drugs

During flu seasons when the influenza vaccine turns out to be a poor match because it doesn’t contain the type A or B influenza strains that are circulating and causing most cases of influenza, which happens quite often, the CDC has another trick up its sleeve: anti-viral flu drugs.

It sounds good in theory to take a medication that might stop influenza in its tracks, but the reality is much less convincing — the drugs are ineffective and potentially dangerous. The Cochrane Collaboration conducted a review of Tamiflu (oseltamivir) and another anti-viral drug Relenza (zanamivir) that revealed:15

  • Both drugs shorten the duration of flu symptoms by less than a day (specifically, by just 16.8 hours)
  • Tamiflu did not affect the number of hospitalizations; Relenza trials did not record this data
  • The effects of the drugs on pneumonia and other flu complications were unreliably reported and included limitations in diagnostic criteria and problems with missing follow-ups on participants
  • Tamiflu was associated with nausea, vomiting, headaches, kidney problems and psychiatric events and may induce serious heart rhythm problems

Tamiflu and Relenza are part of a group of anti-influenza drugs called neuraminidase inhibitors, which work by blocking a viral enzyme that helps the influenza virus to invade cells in your respiratory tract.

The problem is that your nervous system also contains neuraminidase enzymes essential for proper brain functioning, and when blocked with these dangerous drugs, severe neurotoxicity may ensue (especially in the infants and children whose blood-brain barrier has not yet developed sufficiently).

Again, despite their questionable effectiveness and risks, the CDC heavily promotes their use, and even released a health alert in 2014 warning that drifted influenza viruses may result in diminished vaccine effectiveness.

So, in addition to still recommending the likely ineffective influenza vaccine, public health officials have also recommended starting anti-viral medication as soon as possible after illness onset — which would likely be before you’ve even received laboratory confirmation that you have an influenza infection!16

How to Stay Well During Flu Season

If you live in the U.S., flu season may be the last thing on your mind, but it’s not too early to start making healthy changes to resist influenza and other viral or bacterial infections.. A healthy immune system is the key to avoiding complications from infections like influenza. If you have a healthy immune system and take commonsense approaches to healing if you do get sick, you should feel better again quickly and, in some cases, may not even know you were “sick.”

Toward that end, if your diet contains a lot of refined sugars, grains and processed foods, you’re not doing your body any favors. Instead of giving your body the fuel it needs to function optimally, which means being healthy enough to fight off infectious viruses, you’re giving it more toxic elements that it must overcome.

For instance, too many carbohydrates in the form of sugar and grains are damaging to your gut flora. Sugar is “fertilizer” for pathogenic bacteria, yeast and fungi that can set your immune system up for an easy assault by a respiratory virus. Most people don’t realize that 80 percent of your immune system actually lies in your gastrointestinal tract. That’s why controlling your sugar intake is crucial for optimizing your immune system.

Additionally, making sure you’re ingesting plenty of beneficial bacteria in the foods you eat (specifically fermented foods) is also crucial, as is optimizing and having your vitamin D level monitored to confirm your levels are at a therapeutic 50 to 70 nanograms per milliliter year-round.

I believe optimizing your vitamin D levels is one of the most potent preventive strategies available, followed by diet (including fermented foods to optimize your gut flora), stress relief, exercise and sleep. There are other factors that can come into play too, of course. The following guidelines will also act in concert to support your immune system and help you avoid getting sick and heal more quickly if you do get sick. You can also read my complete guide to fight the flu naturally here.

Take a High-Quality Source of Animal-Based Omega-3 Fats: increase your intake of essential fats omega-3s which are crucial for maintaining health. It is also vitally important to avoid damaged omega-6 oils (think vegetable oils), as seriously damage your immune response.

Wash Your Hands: washing your hands will decrease your likelihood of spreading a virus to your nose, mouth or other people. Be sure you don’t use antibacterial soap using synthetic chemicals for this — conventional antibacterial soaps are completely unnecessary, and they cause far more harm than good.

Instead, identify a simple mild soap that you can switch your family to. Avoid overwashing your hands, however, as this can lead to tiny cuts that allow an entryway for pathogens.

Tried-and-True Hygiene Measures: in addition to washing your hands regularly, cover your mouth and nose when you cough or sneeze, ideally with the crook of your elbow (to avoid contaminating your hands). If possible, avoid close contact with those who are sick and, if you are sick, avoid close contact with those who are well.

Use Natural Immune Boosters: examples include oil of oregano and garlic, both of which offer effective protection against a broad spectrum of bacteria, viruses and protozoa in your body. And unlike pharmaceutical antibiotics, they do not appear to lead to resistance and the development of super germs.

Avoid Hospitals: I’d recommend you stay away from hospitals unless you’re having an emergency and need immediate medical care, as hospitals are prime breeding grounds for infections of all kinds. The best place to recover from illness that is not life-threatening is usually in the comfort of your own home.

Low-Dose Naltrexone and Dietary Changes for the Treatment of Autoimmune Diseases


Most people are aware that drugs are not an ideal solution to their health problems, but there are some exceptions to this rule.

Dr. Thomas Cowan, a family physician and founding board member of the Weston A. Price Foundation (WAPF), is a strong proponent of using low-dose naltrexone (LDN) for autoimmune diseases.

Story at-a-glance

  • Naltrexone is an opiate antagonist, originally developed in the early 1960s for the treatment of opioid addiction. When taken at very low doses (LDN), it triggers endorphin production, which can boost your immune function
  • Gluteomorphins (from gluten) and caseomorphins (from casein) act as exogenous opioids that suppress immune function. Hence an autoimmune diet needs to be free of gluten and dairy
  • LDN is most effective when combined with an autoimmune diet, free of gluten and dairy, rich in fresh and fermented vegetables, with low to modest amounts of high-quality protein

What Is Naltrexone?

Naltrexone is an opiate antagonist, originally developed in the early 1960s for the treatment of opioid addiction (such as heroin), which was prevalent at that time. It blocks the effects of the narcotic by attaching to opioid receptors in your body.

“Naltrexone is a pure opiate antagonist; meaning it has no agonist. Agonist means it has a positive effect. It has no agonist effect. It has no analgesic effect. There’s no euphoria. There’s no high. It simply blocks the opiates,”Cowan explains.

For heroin overdoses, a dose of about 30 to 50 milligrams (mg) of naltrexone was, and still is, used to prevent the fatal respiratory depression from a narcotic overdose.

However, the drug not only blocks exogenous narcotic opiates. Many drug users refused to take naltrexone because it made them feel terrible, and this led to the discovery of endorphins.

Endorphins are endogenous opiates, meaning they’re not introduced from the outside. They’re naturally produced by your body. This was why people suffered dysphoria (the opposite of euphoria) when taking naltrexone, as the drug blocked the natural opioids (endorphins) as well.

The Discovery of Low-Dose Naltrexone and Its Benefits

Dr. Bernard Bihari1 began taking an interest in naltrexone in the late 1980s, as many of his addicted patients also had immunological problems. Many of them had AIDS, which is a cell-mediated immune collapse.

He observed that virtually the only patients dying from HIV infection were those using opiates. He wondered whether endogenous opiates might have something to do with immunological function, which has since been shown to be the case in thousands of studies.

“He decided that maybe these people with immunological problems have endorphin deficiencies,” Cowan says. “That led him to try to figure out a way to stimulate endorphin production.

He [discovered that] if you use a very low dose of naltrexone, you block the opiate receptors for maybe an hour or so, and then your body responds by upregulating its synthesis of opiates.

You end up with a hundred or a thousand times more endorphins and a better-functioning immune system.”

Essentially, when using a very LOW dose, about one-tenth of the dose you’d use for opioid addiction, or less, naltrexone works like a form of hormesis, which is when a compound that is toxic at high doses ends up having the converse effect in small or minute doses.

“LDN is probably the only pharmaceutical medicine I routinely use,” Cowan says. “I have seen more people get better with that medicine than any other medicine I’ve ever used.

When you look at natural medicine, for instance: ginseng stimulates adrenal cortical function. It doesn’t actually do anything itself; it just stimulates your adrenal gland to make something. That’s typically how natural medicines work. That’s the whole philosophy of homeopathy.

Similarly, even though it’s not actually a ‘natural medicine,’ LDN stimulates endorphin production. It doesn’t actually do anything positive itself. The patient has to respond.

If they don’t respond, you don’t get an effect. If they do respond and they make more endorphins, like they would have had with a natural medicine, then you get a positive effect from a normal amount of endorphin production.”

LDN Dosing Recommendations

The normal range for LDN is between 1.5 and 4.5 mg per day, taken about an hour before bedtime (not in the morning). There are a couple of reasons for this timing.

First, since you’re blocking endorphins, doing it in the middle of the night prevents you from noticing that you feel lousy. Second, the endorphin response is greater at nighttime. As for side effects, LDN has an enviable safety profile. The most common side effect is unusual and sometimes more vivid dreams.

Cowan typically starts patients out at 1.5 mg for two weeks. Sensitive people, such as those with thyroid problems, may start as low as 1 mg per day, but as a general rule, doses lower than 1.5 mg/day tend to be ineffective for most adults.

If there’s a positive effect, the patient will stay on that dose. If there’s no effect, the dose is increased to 3 mg per day. If there’s a negative effect, the dose is decreased.

If there’s a positive effect at 3 mg, stay on that dose. If there’s still no effect, raise it to 4.5 mg, and if there’s a negative effect, decrease the dose. That said, the key to LDN is the low dose. So many times you may actually need to lower the dose if you don’t notice a beneficial effect.

“If you gave somebody 2.5 mg and it didn’t work, lower the dose. You gave him 1.5 mg and it didn’t work, give it every other day,” Cowan says. “Because the principle is it’s the rebound that’s the positive effect, not the drug. With normal drugs, if it doesn’t work you give more, but here, it’s the opposite.”

Opiates Are Potent Immunosuppressive Drugs

A famous study called the European Prostitute Study showed the primary risk factor for HIV and AIDS was not sexual exposure, not IV exposure, but opiate exposure.

According to Cowan, you see a similar pattern in cancer patients. As soon as they start taking opiates for chronic pain, their health rapidly declines as their immune system falters.

“Opiates are highly immunosuppressive medicines,” he explains. “What I mean by opiates is exogenous opiates; opiates from the outside. Bihari saw that. He saw that the people that were getting AIDS were opiate addicts. And not just that, but that was a certain subset.

Since endorphins are essentially the flipside of exogenous opiates, meaning endogenous opiates, what you’re doing is substituting the good guys for the bad guys.

… In the late ’90s, I had a very good friend who was diagnosed with terminal lymphoma. He actually knew Bihari. Bihari put him on 4.5 mg of LDN. He did IV vitamin C, and he went into remission. I went to Hawaii on vacation with them about three years ago. That’s something like 15 years later. That was a situation that got my attention big time.”

Cowan’s Autoimmune Diet

Aside from opiate drugs like heroin and prescription painkillers, your diet can be a source of exogenous opiates. Many natural health physicians recommend removing wheat and dairy from the diet, as these foods tend to trigger complications in a large number of people.

What many don’t realize is that part of the problem stems from the fact that gluteomorphins (from gluten) and caseomorphins (from casein) act as exogenous opioids.

“Basically, when you’re doing this diet … you’re getting rid of exogenous opiates. It’s really about getting rid of exogenous opiates (the ones that downregulate and cause dysfunction of your immune system) and then upregulating the endogenous or healthy endorphins,” Cowan says.

Virtually anyone suffering with an autoimmune problem, be it multiple sclerosis (MS), inflammatory bowel disease (IBD), or Hashimoto’s (autoimmune thyroid disease), just to name a few, would be wise to try a gluten- and dairy-free diet to help optimize immune function. (Grass-fed ghee can be used, as it’s very low in casein.)

In Cowan’s experience, and he’s prescribed LDN for at least 1,000 patients, the autoimmune diet or LDN alone are typically not nearly as effective as the two combined. Besides avoiding or eliminating gluten and dairy, his dietary recommendations are very similar to the Gut and Psychology Syndrome (GAPS) Diet.

“It’s basically getting rid of the exogenous opiates and repairing the gut flora [with] fermented foods,” Cowan says. “The Cowan Autoimmune Diet is animal foods that are low to modest in protein; seeds, but no grains for a while, and a diversity of vegetables and fermented foods.”

Consider Eating a Wider Variety of Vegetables

Fresh vegetables, which are high in fiber, also help heal your gut by nourishing healthy microbes. Some bacteria also create short-chain fatty acids from the fiber, which are important for your health. One key is variety and diversity. Most Americans eat perhaps a dozen different kinds of vegetables in any given year, whereas our ancestors ate hundreds of different varieties.

Part of the problem is that most people only have access to seasonal vegetables sold in the grocery store. To amend this situation, Cowan grows his own. He has a large garden with about 60 different vegetable varieties, some of which are perennial, such as tree collards (collard greens that grow on trees).

“They’re sort of deep green, deep purple vegetables. They live for about 12 to 15 years and withstand even down to about 10 degrees Fahrenheit. They’ll withstand frost.

There’s the perennial chard, which is the genetic precursor of beets and Swiss chard. There’s Ashitaba. There’s Gynura, which is Okinawa spinach. That’s the spinach that is supposedly reputed to be why the Okinawans live so long. It has a chemical in it that has an effect similar to metformin. It’s an anti-diabetic, essentially nutrient-rich food.”

I believe anyone fully committed to health will inevitably and invariably come to the conclusion that they have to grow their own food, and pay attention to the soil quality. Aside from being hard to find commercially, perennial vegetables have the distinct advantage of growing and producing year-round.

“I recently read a statistic from the Food and Drug Administration (FDA): People who eat three to four different parts of the plant per day — we’re talking about the root part, the leaf part, and the flower or fruit part; those are fundamental parts — have 40 percent less chronic disease than people who don’t do that. I believe that.

We don’t need vegetables for calories, fats and proteins. That’s the role of the other foods in the diet. We eat them for phytonutrients, fiber to feed the microbiome, vitamins, minerals, things known and unknown.

Therefore, to eat a huge bowl of Romaine lettuce is sort of a waste of vegetable power. You want to have a salad with as many colors as you can get, as many parts of the plant as you can get, as much diversity as you can get. That’s the role of vegetables in the traditional diet,” Cowan says.

“I would absolutely encourage everybody to grow their own vegetables. [My book even contains] the science of when vegetables are the most nutritious.

For example, zucchini should be eaten within a couple of hours after picking it, because the sugars degrade and the nutrients degrade, whereas lettuce actually likes it to be injured a little bit and then sit around for about 12 hours, so it actually makes more reactive chemicals to essentially heal itself. It’s better eaten after about 12 hours.”

The Relationship Between Vitamin D and Insulin Resistance


Vitamin D is a steroid hormone that influences virtually every cell in your body, which is why maintaining a healthy level is so important. Low vitamin D levels are widely known to harm your bones, leading them to become thin, brittle, soft or misshapen.

Vitamin D and Diabetes

Story at-a-glance

  • Vitamin D is a steroid hormone that influences virtually every cell in your body. Low levels are linked to poor bone health, as well as heart, brain, immune and metabolic dysfunction
  • Animal studies have shown vitamin D is a foundational factor necessary for normal insulin secretion, and that vitamin D improves insulin sensitivity
  • Atypical antipsychotics such as quetiapine, a bipolar medication, can increase your risk of hyperglycemia and diabetes. Research suggests vitamin D3 may counteract these effects

But vitamin D is equally important for your heart, brain, immune function and much more. For example, there’s an important connection between insufficient vitamin D and insulin resistance and/or diabetes, both type 11 and type 2.

Vitamin D Deficiency May Influence Your Type 2 Diabetes Risk

According to recent research, vitamin D deficiency affects your glucose metabolism and may actually be more closely linked to diabetes than obesity. In a study of 118 people, those with low vitamin D levels were more likely to have type 2 diabetes, pre-diabetes or metabolic syndrome, regardless of their weight.

Among obese people, those without metabolic disorders had higher levels of vitamin D than those with such disorders, and among lean people, those with metabolic disorders were more likely to have low levels of vitamin D. According to one of the study’s authors:2

“The study suggests that vitamin D deficiency and obesity interact synergistically to heighten the risk of diabetes and other metabolic disorders. The average person may be able to reduce their risk by maintaining a healthy diet and getting enough outdoor activity.”

It’s not the first time vitamin D has been shown to play a role in diabetes. One Indian study found that vitamin D and calcium supplementation, in combination with exercise, can prevent pre-diabetes from progressing into full-blown diabetes.

For every unit increase in vitamin D levels, the risk of progression to diabetes in people with pre-diabetes went down by 8 percent.3

Another study4 published in 2013 found that type 2 diabetics given 50,000 IUs of oral vitamin D3 per week for eight weeks experienced “a meaningful reduction” in fasting plasma glucose and insulin. Other research showing this link includes but is not limited to the following:

  • Animal studies have shown vitamin D is a foundational factor necessary for normal insulin secretion5,6 and that vitamin D improves insulin sensitivity7,8
  • One study involving nearly 5,680 individuals with impaired glucose tolerance showed that vitamin D supplementation increased insulin sensitivity by 54 percent9
  • The mechanisms by which vitamin D reduces insulin resistance include its effect on calcium and phosphorus metabolism and by upregulating the insulin receptor gene10

Vitamin D May Lower Risk of Hyperglycemia in Those Taking Atypical Antipsychotics

Certain drugs can raise your risk of metabolic dysfunction. For example, statin drugs can trigger drug-induced diabetes. Atypical antipsychotics such as quetiapine, a bipolar medication, have also been linked to an increased risk of hyperglycemia and diabetes.

In the latter case, research suggests vitamin D3 may counteract these effects. As reported by The American Journal of Managed Care:11

“Atypical antipsychotics have long been associated with an increased risk of hyperglycemia — which can lead to new-onset diabetes, diabetic ketoacidosis, coma and even death.

Some proposed mechanisms for this effect include weight gain, decreased insulin secretion from pancreatic beta cells and insulin resistance.

To determine whether there were any medications that could decrease this likelihood of hyperglycemia, researchers analyzed the FDA’s Adverse Event Reporting (FAERS) system — a database that logs self-reported adverse effects or medication errors submitted by patients.

By cross-referencing atypical antipsychotics and hyperglycemia, the study authors found that patients who had been simultaneously prescribed to take vitamin D and quetiapine were somehow less likely to have hyperglycemia.”

Subsequent animal studies produced similar results. Mice given vitamin D and quetiapine had significantly lower blood sugar levels compared to mice given quetiapine alone. According to lead author Takuya Nagashima, vitamin D inhibits quetiapine from reducing an enzyme that causes hyperglycemia.

Based on these results, the authors suggest combining antipsychotics with vitamin D supplementation to “efficaciously safeguard against antipsychotic-induced hyperglycemia accompanied by insulin resistance.”

Other Benefits of Vitamin D

Researchers have pointed out that raising levels of vitamin D among the general population could prevent chronic diseases that claim nearly 1 million lives throughout the world each year.

Incidence of several types of cancer could also be slashed in half, or more. Recent research reveals raising your serum 25-hydroxyvitamin D to 40 ng/ml can slash your risk of invasive cancers by 67 percent!

In the interview above, Dr. Michael Holick — a well-known vitamin D researcher — expands on these and many other health benefits of vitamin D. For instance, optimizing your vitamin D levels can help protect against:

Cardiovascular disease

Vitamin D is very important for reducing hypertension, atherosclerotic heart disease, heart attack and stroke. According to Holick, one study showed that vitamin D deficiency increased the risk of heart attack by 50 percent.

 

Autoimmune diseases

Vitamin D is a potent immune modulator, making it very important for the prevention of autoimmune diseases, like multiple sclerosis (MS) and inflammatory bowel disease (IBD).

Infertility

Vitamin D may help stimulate the production of hormones including testosterone and progesterone, and has been shown to boost fertility in both men and women.

Vitamin D is also associated with semen quality in men and may improve menstrual frequency in women with polycystic ovary syndrome (PCOS).12

DNA repair and metabolic processes

One of Holick’s studies showed that healthy volunteers taking 2,000 international units (IUs) of vitamin D3 per day for a few months upregulated 291 different genes that control up to 80 different metabolic processes.

Some of these processes help improve DNA repair and boost immune function, while others affect autoxidation (oxidation that occurs in the presence of oxygen and /or UV radiation, which has implications for aging and cancer, for example).

Migraine

Recent research also suggests vitamin D can play a role in migraines. Researchers at Cincinnati Children’s Hospital Medical Center found that many who suffer from migraines have deficiencies in vitamin D, riboflavin (B2) and coenzyme Q10 (CoQ10).13

Girls and women who suffered migraines were particularly prone to having CoQ10 deficiency, while boys and men were more likely to be deficient in vitamin D. Those with chronic migraines were more likely to have CoQ10 and riboflavin deficiencies, compared to those with episodic migraines.

Neurological/psychological/mental disorders

Vitamin D also plays a major role in neurotransmission, and vitamin D deficiency has been associated with a number of neurological and brain disorders, including cognitive dysfunction and Alzheimer’s disease (in one study, those who were most vitamin D deficient had a 31 percent increased relative risk of suffering neurocognitive decline), schizophrenia, Parkinson’s disease, stroke, epilepsy and depression.

Cold and flu

Vitamin D has potent infection-fighting abilities, and can be beneficial for both the prevention and treatment of tuberculosis, pneumonia, colds and flu.

What’s the Best Way to Optimize Your Vitamin D Level?

There is no doubt that vitamin D is imperative for good health and disease prevention. It may even help counteract some of the deleterious metabolic effects caused of certain drugs. But there’s no lack of controversy when it comes to the issue of how to optimize your vitamin D. Most of the researchers specializing in vitamin D agree that sensible sun exposure is the ideal way though.

First of all, vitamin D3 supplements do not confer the identical effects as the vitamin D your skin generates in response to UV exposure. Secondly, sun exposure has additional health benefits that are unrelated to vitamin D production.

For example, UVA exposure produces nitric oxide (NO), which has a blood pressure-lowering effect. In fact, the entire solar spectrum is important for optimal health. We’re not dependent solely on the narrowband wavelength of about 295 nanometers (nm), which is where vitamin D is made.

However, unless you make a concerted effort, chances are you’re simply not getting enough sun exposure to raise your vitamin D level. As noted in a recent British study, adolescent Britons are not getting enough sun exposure even in the middle of summer to elevate their vitamin D to a healthy level, prompting the authors to suggest changes to the U.K.’s vitamin D guidelines.

As reported by Endocrine Today,14 “more than one-quarter of the adolescents in the study had inadequate vitamin D levels even during summer, the period when participants spent the most time outdoors.” According to the authors:

“Current U.K. national guidance on vitamin D acquisition assumes those aged 4 to 64 years gain their vitamin D requirements from sunlight alone, thus there is no recommended nutrient intake. Meanwhile, substantial proportions of the global population, including the U.K., are reported to have low vitamin D status, and rickets has returned as a clinical concern …

As U.K. current sun exposure patterns do not provide an adequate source of vitamin D, amendments are required to recommendations on vitamin D acquisition in this age group. While wider skin surface area exposure to sunlight might safely increase vitamin D status, oral vitamin D supplements may be beneficial during this critical time for bone development.”

When to Take a Vitamin D3 Supplement

Indeed, while sun exposure is the ideal route, it can be difficult for many to achieve an optimal vitamin D level this way. Your lifestyle, location, age, ethnicity, time of year, weather conditions and a number of other factors influence how much vitamin D your skin will make in response to sun exposure. The fact that vitamin D insufficiency and deficiency is widespread even in sundrenched areas like India attests to this difficulty.

In some cases, making changes to your routine in order to get more regular sun exposure may do the trick. Key points to remember is that you need to expose large areas of skin to the sun, and on a frequent basis (ideally daily). However, under ideal conditions you may not need more than a few minutes of exposure.

The worst thing you could do is to bake in the sun for hours on end on the weekends. You definitely want to avoid burning your skin, as this will only cause skin damage that could potentially increase your risk for skin cancer.

If sensible sun exposure is either not feasible or isn’t sufficient to raise your vitamin D to a healthy level, then taking an oral vitamin D3 supplement is a wise choice. If you decide to supplement with vitamin D please consider using one that also has vitamin K2, as it works synergistically with vitamin D to maximize the benefits.

The only way to know how your sun exposure is affecting your vitamin D level is to get your vitamin D tested. I recommend doing this twice a year, in January and June/July, to get a reading on your lowest and highest levels. This will tell you whether you might be in need of a supplement. It will also guide you in terms of dosage.

In short, your ideal dosage is one that will help you maintain a clinically relevant vitamin D level of 40 to 60 ng/ml year-round. For some this may be 2,000 IUs a day. For others, it could be 8,000 IUs a day or more.

The Role of Vitamin D in Disease Prevention

A growing body of evidence shows that vitamin D plays a crucial role in disease prevention and maintaining optimal health. There are about 30,000 genes in your body, and vitamin D affects nearly 3,000 of them, as well as vitamin D receptors located throughout your body.

According to one large-scale study, optimal Vitamin D levels can slash your risk of cancer by as much as 60 percent. Keeping your levels optimized can help prevent at least 16 different types of cancer, including pancreatic, lung, ovarian, prostate, and skin cancers.

Platelet and Stem Cell Therapy — Novel Approaches That Can Help Heal Orthopedic Injuries


Orthopedic injuries can be debilitating, and many who seek treatment frequently end up getting surgery. Unfortunately, the side effects from going under the knife are often irreversible. If a mistake is made, you can end up with a permanent, lifelong problem.

Story at-a-glance

  • Surgery is rarely the ideal choice for most orthopedic injuries. One alternative that can be helpful for a wide range of degenerative joint problems and sports injuries is platelet-rich plasma (PRP) and stem cell therapy
  • Stem cells precisely injected can be effective interventions, capable of regenerating damaged tissue. They can even transform destructive cells into helpful repair cells
  • PRP and stem cell therapy are ideally incorporated as part of a comprehensive treatment plan that includes a healthy anti-inflammatory diet, exercise, and other lifestyle factors that can influence inflammation, such as sleep

In my view, surgery is the last resort almost every single time. The practical question though is, what are the realistic alternatives?

James Leiber, a D.O., who is board certified in Neuromusculoskeletal Medicine and Pain Medicine as well as Family Medicine, has worked with the Air Force and was actually a personal physician to the former President Bush and Vice President Dick Cheney.

He’s currently an associate professor of family medicine and osteopathic principles and practice at the Lake Erie College of Osteopathic Medicine in Bradenton, Florida and runs his own practice, New reGeneration Orthopedics of Florida and is the first Florida affiliate of Regenexx.

He has a passion for interventional regenerative orthopedics — a field in which he has many years of experience. In his Florida practice, he uses a number of different stem cell products and techniques, which he discusses in this interview.

Many years ago he became interested in prolotherapy, which has been around since the 1930s, when orthopedists were trying to figure out how to strengthen ligaments without doing surgery.

They discovered that by injecting an irritant solution into damaged tissue, it will release growth factors that help heal and strengthen the area.

In the last decade, medical professionals have begun using platelet-rich plasma (PRP) or stem cells in the same way. Ultrasound is also used, along with other imaging techniques, which allows the doctor to “see” what’s going on inside the tissue. It’s also helpful for pinpointing the exact location for the injections.

The Benefits of Platelets and Stem Cell Therapy

Platelets are an important part of the healing cascade. They’re responsible for blood clotting and are among the “first responders” to any site of an injury. By forming a clot, they stop bleeding.

This process involves the platelets opening up and spilling out the growth factors held inside. These growth factors act as signaling molecules, issuing the instructions needed to call forth resources to repair the damaged tissue. This includes stem cells.

Stem cells are primitive precursors to your cells. They can be thought of as “baby cells,” and are found in high concentrations in your bone marrow and fat tissues. Some also float around in your blood, and in your joints. Dr. Leiber explains:

“When the (stem cells) come to the area, they can turn into the new tissue that’s trying to be repaired. They can also instruct all the other cells on what to do. They become like the foreman.

They can even take a cell that’s trying to destroy the knee, for example, and convert it into a cell that’s trying to repair.

Stem cells are very powerful in their ability to heal. That’s why we use them. We prefer to use someone’s own stem cells, and for many reasons we prefer to use the stem cells that come from the bone marrow rather than the fat.

There are other types of stem cells. You can get stem cells from someone else. Those could come from the fetus or from the fluid around the fetus [or] the umbilicus. All of those things are, first of all, not being done in the United States.

Secondly, we prefer to use someone’s own stem cells. We think that’s really the safest way to go. We like the idea of culture expanding, but we have some restrictions within the United States of being able to do that.”

Common Ailments That May Benefit From Stem Cell Therapy

When you’re young, you have high amounts of platelets and stem cells, which translate into a high level of self-regenerative ability. Children typically heal from injuries rather quickly.

With age, they become less effective, and the wear and tear on your body starts to outpace your body’s ability to repair itself. At some point, you begin to see chronic conditions from overuse, degeneration, and aging.

“We’re able to take the cells that that person has, isolate them, concentrate them, do a few little tricks with them to make them more effective, and then precisely place them in the areas that the tissue has damaged. We can get very good healing even for very advanced conditions.”

Most of Leiber’s patients are active seniors seeking to address age-related degeneration. Many are former competitive athletes. Over the past few years, awareness about PRP and stem cell therapy has also spread among professional athletes seeking treatment for sports injuries. Common complaints include:

  • Knee problems such as arthritis, knee or meniscus tears and anterior cruciate ligament (ACL) tears
  • Shoulder injuries like rotator cuff tears ,arthritis, and labral tears
  • Spine problems, such as disc herniations and spine arthritis
  • Hip, hands, feet, and elbow problems

Using Own Stem Cells Is a Safe Treatment Option

Stem cells can also be clinically indicated for other things, such as regeneration of peripheral nerves, organ damage, and even type 1 diabetes.

“There’s incredible potential for the use of stem cells from either bone marrow or fat for other types of problems, including heart and brain,” Leiber says.

“But we don’t claim to be as experts in that. I think there’s an issue when a doctor treats everything under the sun with stem cells. I think there’s a lack of expertise when that happens.”

One common concern with stem cell therapy is whether the injected stem cells might become malignant. According to Leiber, at least in orthopedic treatments (which is his specialty), stem cells have never turned into anything abnormal, and there’s more than a decade’s worth of patient data to support that claim.

Part of these safety concerns stem from the fact that when you inject another person’s stem cells, or ones from animals, the risk of malignant conversion does exist.

In fact, the veterinarian associated with my site, Dr. Karen Becker, has treated many animals using stem cells, and noticed that many dogs invariably develop cancer a few years down the line after being treated with another animal’s stem cells. This does not appear to be the case when you’re using your own stem cells though.

“We’ve been tracking that for sure,” Leiber says. “When you use someone else’s stem cells, there are other risks associated with it. There’s rejection risk. You’re obtaining the genetic material of someone else. I think that needs to be sorted out. I’m sure over time we can get that to be a safe therapy, but that needs a lot more research.”

What Stem Cell Therapy Is Not

While stem cell therapy has great healing potential, it would be inadvisable to approach it thinking it’s a one-shot magic bullet. On the contrary, it’s ideally incorporated as part of a comprehensive treatment plan that takes other lifestyle factors into account. Leiber explains:

“Stem cells have the capacity to repopulate and regenerate themselves. When we take bone marrow out, for example, they will repopulate themselves in six weeks. We give people about a six- to eight-week window, maybe a little bit longer depending on their situation.

We try and push them in the right direction with a lot of diet and food planning advice, supplement advice, exercise advice, discussions about sleep and environmental chemicals, and a whole bunch of different things to get them as healthy as possible.

Some people are facing a crossroads in their life where they’ve been told by multiple orthopedists that they need a spine fusion or they need a knee replacement, for example, and they really don’t want to go that route. They’re willing to make the changes necessary. I think it’s a real unique opportunity. I have been counseling people in this regard for many years, but the patients I’m seeing now are very, very motivated. We are able to sort of kick-start their life back in a lot of different ways.”

On the whole, your chances of success are radically improved if you eat real food, eliminate processed foods, and focus on high-quality fats while minimizing net carbohydrates (total carbs minus fiber), along with moderate protein. This kind of diet helps upregulate your body’s innate repair and regenerative systems. Most importantly, you radically downregulate inflammation, which is one of the core variables contributing to much of the pathology generating the damage.

“If you put stem cells into an area and you haven’t tried to change the terrain, inflammation will promote stem cells to turn more into scar tissue. That’s not really what we’re looking for, the fibrosis. We make a big deal about this,” Leiber says.

Recommended Supplements

Certain nutrients and supplements can help stem cells grow more efficiently. Regenexx, which specializes in developing stem cell therapies, conducted in vitro studies showing that when stem cells are placed in an environment mimicking an arthritic joint, their growth rate is significantly reduced. They then duplicated the test in various nutrient environments, to determine which nutrients could help the stem cells grow better.

Nutrients and combinations of nutrients that boost stem cell regeneration include vitamins C and D, glucosamine and chondroitin,curcumin, resveratrol, bitter melon, and the amino acid l-carnosine. Leiber recommends these to most of his patients. He also recommends taking a high-quality omega-3 supplement such as krill oil in higher amounts.

“Interestingly, melatonin, which most people are familiar with for sleep … helps stem cells preferentially turn into cartilage over a different kind of cell type. We don’t really know what the right dose is. But it’s safe, it’s cheap, and I think it’s worth taking just because of that information. Other people who I feel may have a need for detoxifying a little bit more, I may add N- acetylcysteine (NAC),” Leiber says.

“If I feel that they have quite a bit of inflammation or I have some testing that tells me they have inflammation, on top of that there’s a product I use that has a mixture of boswellia and willow bark and a whole bunch of different antioxidants, phytonutrients derived from fruits and vegetables. I’ll have them taking them in advance to the procedure as well. If they’re coming with a lot of gut issues, we may start exploring that a little bit and treating that in advance as well.”

On a side note, my latest passion is optimization of mitochondrial function with dietary intervention and supplementation, and many of these supplements are also very useful for improving mitochondrial biogenesis and mitophagy (mitochondrial autophagy). Resveratrol is a particularly intriguing one. It also stimulates SIRT 1, which activates both of those pathways, as does bitter melon and curcumin.

As for diet, you really need to restrict net carbs, which is total carbs minus fiber, to less than 50 grams a day, or maybe even as little as 30 or 40 grams if you’re trying to address chronic dysfunction. Replace those carbs with high-quality fats like butter,coconut oil, cocoa butter, and high-quality fat from pastured animals like tallow or lard.

These are strategies that will help you burn fat for fuel, which burns far cleaner and generates less free radicals, which in turn decreases inflammation. By optimizing your mitochondrial function, you optimize health and life in general. It’s a profoundly effective strategy to not only treat disease but improve longevity.

Anatomy of a Typical Stem Cell Treatment

Leiber specializes in platelet-based procedures and stem cell procedures, which include platelets and growth factors as well. The former are not as involved or expensive as a stem cell procedure. The stem cell protocol generally involves three parts, spread out over three separate treatments. A typical treatment protocol for advanced knee arthritis might go something like this:

1.Prior to your first appointment, or as part of your first appointment, you would get any necessary imaging tests done. Leiber also does a diagnostic ultrasound examination, which allows him to see the tissue structures of the area in question, in real time. The first treatment typically involves prolotherapy to strengthen the ligaments and tendons and create a more hospitable environment for the stem cells.

2.After three to five days, you go back in for a bone marrow aspiration. “I think there’s a lot of unnecessary fear associated with that,” Leiber says.

“I would say 95 percent of the time there’s really only mild discomfort or less associated with it. I numb the skin. I numb down to the bone in the back of the pelvis. Once I know the patient is comfortable, I take a separate tool, and go down to the bone.

There’s no sharp sensation. I let them know I’m about to enter the bone and that they’re going to feel a little bit of pressure … Then I start to draw out some of the bone marrow.”

Very small amounts of bone marrow are drawn at a time, at a slow pace, to prevent achiness. For most conditions, 60 to 100 milliliters of bone marrow will be drawn from four locations on each side of the pelvis. After eating a healthy lunch, you then come back for the injection, consisting of a mixture of stem cells, growth factors, and platelets. Leiber uses image guidance to select the best areas for the injections.

Unfortunately, a local anesthetic at the injection site cannot be used, as it’s been shown to kill the stem cells. But a small amount of local anesthetic in the skin and on the way to the target tissue can be used or a nerve block can be administered (like for a dental procedure), and most patients tolerate these injections very well. You’ll have limited mobility for about three to five days as you have to minimize pressure on the joint. You may also need pain medication during this time.

3.Three to five days later, another blood draw is done, from which platelets and growth factors are separated and extracted and then reinjected into the trouble area. This acts as “fertilizer” for the stem cells that were put in earlier. A brace may be used to protect the area. After that, you’ll need to see a physical therapist for about six weeks.

“In very advanced conditions, in very advanced knee arthritis or hip arthritis, we’ll go ahead and do a concentrated platelet booster at about the six-week mark,” Leiber says.

“When you’re talking about something that’s bone on bone, this is not a cure. For lesser conditions — for tears in ligaments and tendons — this can be a cure; for very advanced arthritis, I think of this more of as a treatment strategy. You may need periodic platelet boosters to maintain the benefits you get from the original stem cell treatment.”

Money And Doctors, Shame Or Pride


Born to three generations of government employees, I was so full of ideology when I finished my medical school. I wouldn’t practice, I said. I would only serve the poor, I proclaimed; a good teacher would I become, I yearned. And so was it, over the next few years. I wasn’t unhappy at all. I had very few needs and no serious financial commitments. Life was good, and little things kept me happy. But over time, I started feeling uncomfortable. Was I doing enough? I fancied myself a good surgeon-to-be, and as and otolaryngologist, I needed technology to go a step higher. But that needed money. I decided to work for it, but also balefully remembered my classmate in school, a perpetual cynic, who told me once, without mercy- “soon, you will be just the same as everyone else- do things only for money, and rot inside”.

I so badly wanted to prove him wrong. Then, as if by sheer chance, I happened to watch a TV interview of the well-known psephologist. He said, and I felt it strike a chord inside me – “the middle class are often bought up thinking that making money is bad- we need to get out of it and understand that to make money well is actually satisfying and benefits a lot of people”. Voila, I thought- I can actually relate to that. Lets now fast forward thirty years. I now am a surgeon with considerable repute, have a really good, well equipped hospital, employ over a hundred people. No, I didn’t have any inherited wealth, I didn’t marry for money, neither did I have wealthy friends who would pitch in for me. I also didn’t, much to my childhood friend’s surprise, make money the wrong way. All of us here work to protocol, never prescribe a drug, or order a test unnecessarily, refuse more surgeries than we do and there’s a strict no-no to pharma funding of any kind. How was this possible?

There’s no magic here, no providential hand. Just a formula that can just as easily be adapted by anyone else with reasonable skill and a little bit of guts. Let me try and enumerate what made me do well. We must remember that for most of us, our only earning comes from the patient. This money is never given thankfully- illness is a burden and the expense related to it’s alleviation is given grudgingly. Understanding this basic equation must make us strive to make each rupee of that money count for the patient. So, the first recommendation from my side to an aspiring entrepreneur is to make sure that you give value. We have long been caught in a vortex of trying to undercut our charges to gain practice. It is a losing game. We have to add value, albeit slowly, for everything we do. A better waiting room, more efficient patient management, transparency and education, everything counts for the patient, and they would actually like paying for it. It is simple economics. If you intend to spend an x amount of money to increase the facility in your clinic/hospital, you need to spread it over the patients that you see now, and look at the increase in patient flow due to the better system to make your profits. You just can’t work the other way, it is foolish to invest heavily and think they would come pouring it just because the waiting room rivals a luxury suite.

The increase in your professional worth is what should give you profits. Let us take an imaginary scenario. There are often patients who present with a symptom that could be because of two different conditions. Doctor A, is cautious, ill trained and afraid of failure. He would investigate heavily, and when that too doesn’t give him enough clues, gives the patient medications for both conditions. The patient gets better, yes, but the doctor would never know which medicine has made him so. The spiral begins, and patients get investigated more and more, medicated more and more, side effects of treatment spirals and skill acquisition is minimal. Let us look now a doctor B. He is shrewd, well trained and is not afraid to experiment. He starts with the same uncertainty. He, by using an analytical, but yet unskilled brain, thinks in favor of one. He doesn’t investigate much because he trusts his instincts. If the patient gets better, he is elated- he is proven right. If he doesn’t, there’s always option 2. To prevent the discomfiture of an irate patient irked by the delay in treatment, he uses kind words and counseling to reassure the patient that he is only trying to avoid unnecessary medications and investigations. Over time, doctor B gets more and more skilled. He now has acquired that sixth sense which tells him what the patient might be having instead of over investigating. If the doctor B has entrepreneurial skills, he will now increase his charges. What the lab gets and what the pharmacy gets is now his. Money, now flows into the coffers, and a beaming patient praises the doctor. Doctor A is, unfortunately, still despondent.   The same goes for investing in surgical equipment.

If you think that a particular instrument would greatly add to your results, buy it, but do not look at charging for it every time you use it to repay your loans. It creates stress and stress reduces your results. You would buy a Laser, simply because the salesman would pitch in with a formula “Sir, you might have ten laser cases a month, so x times ten times twelve, your loans are over in so many years” It is a gambit we fall for. I would buy a Laser only if it significantly improves my results. I would never even advertise or boast about it. I would use that in my counseling for a surgery if I think its absolutely necessary. But I would increase charges over my entire operation list for the month to make sure I am not pressurized to use it when I don’t really need it. Thereby I have only marginally increased charges; I have no stress if I don’t have any laser cases for a month, and if I do get one, I do a pretty damn good job. And this creates more patients, while shouting from the rooftop that I have an expensive laser would only have created suspicion, and sometimes, jealousy. We have to prioritize our investments- I would rather buy a good equipment than say, a fancy car or a palatial house that I can very well do without. If my choice of the purchase was founded on good grounds, it is often that the house and the car would follow, even if you can’t really count on it! Similarly, we must understand that a well run professional medical establishment offers far greater returns that those fancy stock market juggle.

I was once told about this by some one who I consider my mentor and hold that close to my heart. My only real investment is my hospital- and if I retire, that should give me returns in decent terms for as long as I live. Another important lesson I received early on in life is from a senior neurosurgeon colleague. He once told me that it was a dangerous ploy to keep referral patients over 10%. It surprised me then, but the logic was irrefutable. Referrals are fickle. A doctor who refers to you can stop referring to you, even if he is not unhappy with you. But your patients, those who come to you for solace and comfort, are your real saviors. They bring more convinced patients who in turn, become your well wishers again. Many doctors spend a lot of efforts on placating the referees, little knowing that it is really not worth the effort. If you spend a quarter of that time with your own patients, the results are astounding. Nearly thirty years in practice, my referrals are still less that that magical figure. And I am in no way unhappy. A very good financial trick is to stick to the things you do best, or add someone to the team who would do something better than you. I have often seen people holding on to patients too long, and not referring out of fear of losing them. Referrals should be made early and to the appropriate person, not someone who calls you home for a weekend treat! Over time, you might lose friends, but keep only the good ones who value your intention. As I have surmised before, earning trust is worth its weight in gold, and nothing improves your stature more than the feeling you create that if you can’t do it, you will send them to someone who can.

You also need to plan a retirement. For many doctors, this is unthinkable. To prevent burn outs, and to improve your family and social life, this is of paramount importance. A simple formula is to calculate how much you need now, once your loans are paid off and then plan to have that over the next twenty years, giving 10% to inflation. So, after you have reached the fifties and if you’ve been successful, you need to delegate your practice to deserving youngsters who respect your principles of practice and think about a system which gives you a share of the practice you have so painfully built up. You should, at that time, put yourself at a premium. Reducing your consulting hours and increasing your charges will allow you to work less for the same amount of money. And, for your social responsibility to be satisfied, you can also use your free time, involving your family too, to do your mite to the society, what appeals to your heart. Finally, you need to invest in your health. Eating properly, exercising regularly and reducing stress will help you to enjoy what you’ve reaped. And for those unfortunate times when ill health can strike without warning, it is important to be properly insured. An ideal health insurance should cover even the costliest procedure done, and should cover your family too. I am currently insured for 95 lakhs, and feel safe under its umbrella, even if I don’t even have a health issue at present. It might look an overkill, but considering the peace of mind it offers- priceless.

Even more adequate should be your life insurance. This should give your family the same income even with you not being around. And do junk those policies that offer you a lot of investment benefit. The health and life insurance policies are useless for me if I am in good health and if I am alive- but I would rather be happy that I am healthy and alive! What made me want to pen this all down? Being a person who cannot resist being on social media for doctors, I see a lot of frustration and angst. I see many who feel that they are being hunted, victimized for no fault of theirs. I see people who feel that they do not receive their due. At the other end, I see the public who are critical, and out to malign the medical community for the wrong doing of a few. And there seems to be no way to make these radically different view points meet. It appears that the level of frustration is related to the failure of the medical profession to make it pay, and for the customers to realize what they are paying for. Let us not kid ourselves anymore- medical profession is just another profession, and it is no more noble than that of a lowly servant nor any worthier than that of a soldier. We have only one small difference- we aren’t in control of many things that we deal with. We deal with uncertainties and changing patterns of  ever increasing knowledge that rival most other professions. But we cannot, under the cloak of that nebulousness, neither wallow in self pity, nor puff out in artificial pride. We have to deal with this as a profession, and aim to give our very best, and by making sure we are doing so, to get in return what is due. Once we realize this, most our our helplessness should disappear. I do not consider myself a special person, and I do not ever want to think I am indispensable to many. I am here to do a job as best as I can, and with that, take my due. No one, I think, should ever suspect that I am taking more than I could, or attempting to do more than I should. This is all that I ever need.

Is AI The Worst Mistake In Human History?


One of the most intriguing public discussions to emerge over the past year is humanity’s wrestling match with the threat and promise of artificial intelligence. AI has long lurked in our collective consciousness — negatively so, if we’re to take Hollywood movie plots as our guide — but its recent andvery real advances are driving critical conversations about the future not only of our economy, but of humanity’s very existence.

In May 2014, the world received a wakeup call from famed physicist Stephen Hawking. Together with three respected AI researchers, the world’s most renowned scientistwarned that the commercially-driven creation of intelligent machines could be “potentially our worst mistake in history.” Comparing the impact of AI on humanity to the arrival of “a superior alien species,” Hawking and his co-authors found humanity’s current state of preparedness deeply wanting. “Although we are facing potentially the best or worst thing ever to happen to humanity,” they wrote, “little serious research is devoted to these issues outside small nonprofit institutes.”

That was two years ago. So where are we now?

Insofar as the tech industry is concerned, AI is already here, it’s just not evenly distributed. Which is to say, the titans of tech control most of it. Google has completely reorganized itself around AI and machine learning. IBM has done the same, declaring itself the leader in “cognitive computing.” Facebook is all in as well. The major tech players are locked in an escalating race for talent, paying as much for top AI researchersas NFL teams do for star quarterbacks.

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Let’s review. Two years ago, the world’s smartest man said that ungoverned AI could well end humanity. Since then, most of the work in the field has been limited to a handful of extremely powerful for-profit companies locked in a competitive arms race. And that call for governance? A work in progress, to put it charitably. Not exactly the early plot lines we’d want, should we care to see things work out for humanity.

When it comes to managing the birth of a technology generally understood to be the most powerful force ever invented by humanity, exactly what kind of regulatory regime should prevail?

Which begs the question: When it comes to managing the birth of a technology generally understood to be the most powerful force ever invented by humanity, exactly what kind of regulation do we need?

Predictably, last week The Economist says we shouldn’t worry too much about it, because we’ve seen this movie before, in the transition to industrial society — and despite a couple of World Wars, that turned out alright. Move along, nothing to see here. But many of us have an uneasy sense that this time is different — it’s one thing to replace manual labor with machines and move up the ladder to a service and intellectual property-based economy. But what does an economy look like that’s based on the automation of service and intellect? The Economist’s extensive review of the field is worthy reading. But it left me unsettled.

“The idea that you can pull free physical work out of the ground, that was a really good trick.” That’s Max Ventilla, the former head of personalization for Google, who left the mothership to start the mission and data-driven education startup AltSchool. In an interview for an upcoming episode of ourShift Dialogs video series, Ventilla echoedThe Economist’s take on the shift from manual labor to industrialized society and the rise of the fossil fuel economy. But he feels that this time, something’s different.

“Now we’re discovering how to pull free mental work out of the ground,” he told me. “(AI) is going to be a huge trick over the next 50 years. It’s going to create even more opportunity — and much more displacement.”

Hawking’s call to action singled out “an IT arms race fueled by unprecedented investments” by the world’s richest companies. A future in which super-intelligent AI is controlled by an elite group of massive tech firms is bound to make many of us uneasy. What if the well-intentioned missions of Google (organize the world’s information!) and Facebook (let people easily share!) are co-opted by a new generation of corporate bosses with less friendly goals?

As you might expect, the Valley has an answer: OpenAI. A uniquely technological antidote to the problem, OpenAI is led by an impressive cadre of Valley entrepreneurs, including Elon Musk, Sam Altman, Reid Hoffman, and Peter Thiel. But instead of creating yet another for-profit company with a moon-shot mission (protect humanity from evil AI!), their creation takes the form of a research lab with a decidedly nonprofit purpose: To corral breakthroughs in artificial intelligence and open them up to any and everyone, for free. The lab’s stated mission is “to advance digital intelligence in the way that is most likely to benefit humanity as a whole, unconstrained by a need to generate financial return.”

OpenAI has managed to convince a small but growing roster of AI researchers to spurn offers from Facebook, Google, and elsewhere, and instead work on what might best be seen as a public commons for AI. The whole endeavor has the whiff of the Manhattan Project — but without the government (or the secrecy). And instead of racing against the Nazis, the good guys are competing with … well, the Valley itself.

One really can’t blame the big tech companies for trying to win the AI arms race. Sure, there are extraordinary profits if they do, but in the end they really have no choice in the matter. If you’re a huge, data-driven software business, you either have cutting-edge AI driving your company’s products, or you’re out of business. Once Google uses AI to make its Photos product magical, Facebook has to respond in kind.

Smart photostreams are one thing. But if we don’t want market-bound, for-profit companies determining the future of superhuman intelligence, we need to be asking ourselves: What role should government play? What about universities? In truth, we probably haven’t invented the institutions capable of containing this new form of fire. “It’s a race between the growing power of the technology, and the growing wisdom we need to manage it,” said Max Tegmark, a founder of the Future of Life Institute, one of the small AI think tanks called out in Hawking’s original op-ed. Speaking to theWashington Post, Tegmark continued: “Right now, almost all the resources tend to go into growing the power of the tech.”

Who determines what is “good”? We are just now grappling with the very real possibility that we might create a force more powerful than ourselves. Now is the time to ask ourselves — how do we get ready?

It’s not clear if OpenAI is going to spend most of its time on building new kinds of AI, or if it will become something of an open-source clearing house for the creation of AI failsafes (the lab is doing early work in both). Regardless, it’s both comforting and a bit disconcerting to realize that the very same people who drive the Valley’s culture may also be responsible for reigning it in. Over the weekend, The New York Times op-ed pages took up the issue, noting AI’s “white guy problem” (it’s worth noting the author is afemale researcher at Microsoft). Take a look at the founding team of OpenAI: A solid supermajority of white men.

“It’s hard to imagine anything more amazing and positively impactful than successfully creating AI,” writes Greg Brockman, the founding CTO of OpenAI. But he continues with a caveat: “So long as it’s done in a good way.”

Indeed. But who determines what is good? We are just now grappling with the very real possibility that we might create a force more powerful than ourselves. Now is the time to ask ourselves — how do we get ready?

Can a small set of top-level researchers in AI provide the intellectual, moral, and ethical compass for a technology that might well destroy — or liberate — the world? Or should we engage all stakeholders in such a decision — traditionally the role of government? Regardless of whether the government is involved in framing this question, it certainly will be involved in cleaning up the mess if we fail to plan properly.

Back when AI was in early development, its single most powerful critique was its “brittle” nature: it didn’t work because it failed to be aware of all possible inputs and parameters. Now that we stand on the brink of strong AI, we’d be wise to include a diversity of opinion — in particular those who live outside the Valley, those who don’t look and think like the Valley, and those who disagree with our native techno-optimism — in the debate about how we manage its impact.