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14.08.07

Chilblains, also called perniosis or blain, a painful abnormal reaction of the small blood vessels in the skin when...

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News Flashes
Herbalife and Rare Liver Damage

04.09.07
STOP PRESS: Liver Damage associated with Herbalife use:

Herbalife results for weight control have been reported as good. The only problem is historical according to the current Wikipedia entry: "Some of the original Herbalife weight loss products contained the active ingredient Ma Huang or Sida cordifolia, two herbs containing ephedrine alkaloids.

Adverse reactions involving the company's Thermojetics original green tablets were recorded by the U.S. Food and Drug Administration and Herbalife subsequently stopped using ephedrine in its products in the face of rising insurance premiums.[3][4] The U.S. FDA banned supplements containing ephedra in 2004.[5]"

Now the following reports below of associated liver failure appear on Medline - from Spain, then Israel and Switzerland.

It is possible that the case reports below are unrelated to Herbalife itself , or that in those countries ephedra-containing Herbalife was still in use at the time, or that potentially hazardous herbs etc were added locally.

From Yahoo.com, there is an authoritative rebuttal from Iceland dated February 2007.

A score of drugs and herbs can cause liver damage, topical ones - albeit rarely- include mushrooms; black cohosh and kava - see a recent list.

Drugs like ticrynafen, methyldopa and cerivastatin were withdrawn among other reasons because of liver problems, which are among many reasons why necessary sex hormone contraception and replacement should rather not use designer patent ie synthetic drugs, and especially not by mouth (hepatic first pass effect).

So it is always difficult to blame a single product, as the ongoing debate about black cohosh shows - which many "first world" regulators have "black boxed" ie added a compulsory warning to black cohosh warnings.

As with black cohosh, with a rare adverse event report, users of such products must weigh up for themselves.

J Hepatol. 2007 Oct;47(4):521-526. Epub 2007 Jul 24.

Herbal does not mean innocuous: Ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife((R)) products. Schoepfer AM, Engel A, Fattinger K, Marbet UA, Criblez D, Reichen J, Zimmermann A, Oneta CM.University Hospital Bern, Switzerland.

BACKGROUND/AIMS: Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife((R)) products. METHODS: To determine the prevalence and outcome of hepatotoxicity due to Herbalife((R)) products. A questionnaire was sent to all public Swiss hospitals.

Reported cases were subjected to causality assessment using the CIOMS criteria. RESULTS: Twelve cases of toxic hepatitis implicating Herbalife((R)) preparations (1998-2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30-69) and latency to onset was 5 months (0.5-144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis.

Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively. CONCLUSIONS: We present a case series of toxic hepatitis implicating Herbalife((R)) products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.

J Hepatol. 2007 Oct;47(4):514-520. Epub 2007 Jul 26.
Association between consumption of Herbalife((R)) nutritional supplements and acute hepatotoxicity. Elinav E, Pinsker G, Safadi R, Pappo O, Bromberg M, Anis E, Keinan-Boker L, Broide E, Ackerman Z, Kaluski DN, Lev B, Shouval D. Hadassah-Hebrew University Medical Center, Israel.

BACKGROUND/AIMS: Nutritional supplements are frequently considered to be harmless but indiscriminate use of unlabelled ingredients may lead to significant adverse reactions. METHODS: In 2004, identification of four index cases of acute hepatitis associated with Herbalife((R)) intake led to a ministry of health investigation in all Israeli hospitals. Twelve patients with acute idiopathic liver injury in association with consumption of Herbalife((R)) products were investigated.

RESULTS: Eleven of the patients were females, aged 49.5+/-13.4 y. One patient had stage I primary biliary cirrhosis and another had hepatitis B. Acute liver injury was diagnosed after 11.9+/-11.1 months of initiation of Herbalife((R)) consumption. Liver biopsies demonstrated active hepatitis, portal inflammation rich with eosinophils, ductular reaction and parenchymal inflammation with peri-central accentuation.

One patient developed sub-fulminant and two fulminant episodes of hepatic failure. Hepatitis resolved in eleven patients, while one patient succumbed to complications following liver transplantation. Three patients resumed consumption of Herbalife((R)) products following normalization of liver enzymes, resulting in a second bout of hepatitis. CONCLUSIONS: An association between intake of Herbalife((R)) products and acute hepatitis was identified in Israel. We call for prospective evaluation of Herbalife((R)) products for possible hepatotoxicity.

Until then, caution should be exercised by consumers, especially among individuals suffering from underlying liver disease.

Med Clin (Barc). 2007 Feb 17;128(6):238-9.
[Hepatotoxicity associated with the consumption of herbal slimming products] Duque JM, Ferreiro J, Salgueiro E, Manso G. [Article in Spanish] Letter

20070905 :The July 2007 reports of the two dozen Herbalife-associated hepatitis cases from Israel & Switzerland reveal that liver problems occurred after about 5 months on the products; and that relapse occurred in about 20% on rechallenge with Herbalife ie in this percentage the association is proven.

As they say, since Herbalife tends to be custom-made in each country, with numerous ingredients (some undisclosed), it is so far impossible to incriminate whether the cause was local product corruption, or some appreoved component, of which the known possible culprits are ephedra and camelia.

Other known hepatotoxic herbs like black cohosh, kava and mushrooms were not mentioned. A few of the patients had viral hepatitis. Only 7 cases had also taken other known potential liver sensitizers - some synthetic sex hormones (4), aspirin (3), statin (1) and hydrochlorothiazide(1), of which 2 cases had positive recurrence of hepatitis on rechallenge with Herbalife.

UCT Medicines Information Centre is unaware of any such problems locally, and can recollect only perhaps 2 queries about Herbalife in some 23 years. Clarification is awaited from Herbalife headquarters.

From Swiss data the estimated incidence was below 2 cases per million Herbalife users, but both studies were based only on hospital records.

Considering the severe global problem of hepatitis from other causes (due to alcohol; obesity/diabetes (steatohepatitis, sulphonylureas, glitazones); numerous infections; carbon tetrachloride; synthetic sex hormones (oral contraception and postmenopausal hormone therapy) , mushrooms, antibiotics and antivirals, , autoimmune disease, antiepileptics, nifedipine, amitryptiline, allopurinol, nonsteroidal anti-inflammatories including aspirin and paracetamol , black cohosh, kava, antifungals and paracetamol), and that the rare adverse association of herbalife with liver damage may well have been limited only to Herbalife products made in those three "European" countries at that time, there is clearly no cause for alarm about Herbalife - just awareness.

The urgent problem of endemic liver disease is rather the avoidance of infections and potentially hazardous antimicrobials; mushrooms; carbon tetrachloride, alcohol excess; sale pf paracetamol without inclusion of protective vitamins and N-acetyl cysteine; and avoidance of potential hepatotoxins which are rarely if ever justified considering their risks, and safe effective alternatives available for eg statins, sulphonylureeas, glitazones, black cohosh, kava, non-steroidal anti-inflammatories; oral sex hormones; and sulphonylureas.


The centuries-proven plant galega officinalis (extract) metformin after 85years of modern use remains the only drug proven in longterm use to both reduce liver damage, lipidemia, thrombosis, adiposity and insulin resistance, and thus almost halve the incidence of new diabetes, hypertension/vascular disease, cancer and thus all-cause premature medical mortality.

Thus appropriate general use of metformin with long-proven vitamins, minerals, biologicals, safe herbs, fish oil and systemic human sex hormones - combined with prudent lifestyle and largely natural fresh foodstuffs- - does away with most of the well-known potential hepatitis drug risks listed above.

In defence of free market enterprise and choices, those who choose convenience safe proven food substitutes or other complementary products as part of an acceptable balanced regime advocated by suppliers like Herbalife do well, they should just be sure of the ingredients and supplier; and they should report and discuss what they use with some knowledgable up-to-date healthcare provider.


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Response from Herbalife

04.09.07
Herbalife's South Africa CEO responds reassuringly:


Good day,
Herewith a statement from Herbalife in response to the issues raised by yourself earlier in the week:

While we are aware of reports of abnormal liver function blood tests such as those reported by Dr. Oneta, our extensive consultation with internationally recognised liver experts has led repeatedly to the conclusion that these associations in time cannot be linked to any Herbalife product.

These small numbers of reports are anecdotal and millions of satisfied customers all over the world have been using our products for more than 27 years. All Herbalife products are formulated and manufactured in accordance with strict standards overseen by the Herbalife Scientific Advisory Board, which is chaired by David Heber, M.D., Ph.D., F.A.C.P., F.A.C.N. Quality control is overseen by our Scientific Affairs Group, chaired by Y. Steve Henig PhD and made up of an international panel of experts in nutrition and botanical dietary supplements.

Herbalife products, which are now sold in 65 countries, are formulated, registered and labelled in accordance with the regulatory requirements in every market where sold. All Herbalife products are safe to consume as directed.

Many consumers who choose to use Herbalife weight-management products for weight loss are overweight, some significantly so. Pre-existing medical conditions such as obesity and diabetes can be associated with non-alcoholic fatty liver disease, a disorder that may return certain types of abnormal blood test results. These test results, therefore, may have nothing to do with any herbal supplement, but rather are the result of a pre-existing medical condition. In addition, it is possible for an individual to have an allergic reaction to our products, the same way one might to any food product; for example, strawberries or shellfish. Herbalife supports the recommendation that consumers visiting their doctors for medical treatment inform them of any supplements they may be taking.

As a socially responsible company, we operate an adverse event reporting procedure that deals with the small number of queries we have from doctors and consumers and we operate an open dialogue policy with the medical community. All adverse event reports are investigated thoroughly in consultation with the consumer and the physician (if they are available) to fully understand the facts. None have resulted in the compulsory withdrawal of any product, ever. In the United States, Herbalife actively lobbied Congress to pass legislation mandating the submission of all dietary supplement and over-the-counter drug serious adverse events to the Food & Drug Administration. That new law takes effect December 22, 2007.

We still await final comment from Herbalife USA.


Dr Neil Burman


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Back Pain Sufferers Need To Work
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Parents Warned Of Additives Link
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Articles
Chilblains

Chilblains, also called perniosis or blain, a painful abnormal reaction of the small blood vessels in the skin when exposed to cold temperatures, when occurring on the feet, is a medical condition often confused with frostbite and trench foot. Chilblains usually occur several hours after exposure to the cold in temperate humid climates. The cold causes constriction of the small blood vessels in the skin and if rewarming of the skin happens too rapidly, there is leakage of blood into the tissues as the blood vessels do not respond quickly enough to this rewarming.

Chilblains are not very common in countries where the cold is more extreme as the air is drier. The living conditions and clothing used in these climates are protective. Chilblains are more likely to develop in those with
poor circulation, but chilblains are still common in those with good circulation. . Chilblains can be prevented by keeping the feet and hands warm in cold weather. Smoking cessation is advised. A consultation with a doctor is mandatory - causes are idiopathi eg Raynauds, or manifestations of serious medical conditions that need to be investigated eg lupus, leukemia.

Causes: Chilblains often occur in some people every year, for the rest of their lives. In other's, chilblains occur for several years and then just stop occurring. The reason for these patterns of occurrence of chilblains is not known. As they are more common in females, there may be a hormonal influence on the development of chilblains.
A familial tendency, poor circulation, anemia, poor nutrition, hormonal changes, some connective tissue disorders and some bone marrow disorders. Damp living conditions may also increase the risk for chilblains.

As a chilblain is an abnormal reaction to cold, these factors above increase the risk that it is going to happen. Chilblains occur when there is too rapid a change from cold to hot, so the chilblains occur after the foot is cold. Some people's circulation is so sensitive that only small changes in temperature may be enough. A typical history for the development of chilblains is after being outside in the cold, the foot is placed next to a heat source (eg heater) when coming back inside. The small blood vessels do not respond quickly enough to the change in temperature.

Features: Chilblains appear as small itchy, red areas on the skin. Chilblains become increasingly painful as they get congested and take on a dark blue appearance. They may also become swollen. As they dry out, chilblains leave cracks in the skin so the risk of getting an infection increases. Chilblains are common on the toes, but can also affect the fingers and the face (especially the nose and ears). Chilblains are also common on areas of the feet exposed to pressure, such as
bunions or where the toes are under pressure from tight shoes or where there are corns and callus.
Ulceration of the digits and toes
Itchy skin inflammation
Skin redness

Toe skin inflammation
Finger skin inflammation
Earlobe inflammation

Duration:
With treatment, chilblains usually heal within 3 weeks

Once a chilblain develops:


>> do not rub or scratch chilblains.
>> avoid direct heat (ie do not expose the feet to a heater), but keep the feet warm by the use of woollen socks and footwear
>> use soothing lotions (eg calamine lotion)
>> if the skin is broken, use an antiseptic dressing to prevent the chilblains becoming infected
>> those with diabetes or poor circulation should see a Podiatrist. The risk of further complications from the chilblains in those with a foot that is 'at risk' is too high to delay seeking professional help
>> thermal or insulating insoles can help keep the foot warm to prevent chilblains
>> lanolin or a similar lotion that is rubbed into the feet will help stimulate the circulation there are a number of natural or homeopathic remedies that are recommended for the treatment of chilblains. Some of these do appear to help some people


Podiatrists see a lot of people with chilblains in cold humid climates and can give advice beyond what is listed above:

>> padding and pressure relief may give some relief for the chilblain symptoms
>> topical steroids may need to be used in case of very swollen severe chilblains
>> corns and callus are common in the pressure areas where chilblains can occur, so reduction of these will give some pain relief
>> heparin ointment may be used in some people to improve the circulation in the area
>> a course of UV light at the start of winter in those prone to chilblains has been recommended to help stimulate the circulation in the foot

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Beauty Skin Care

Use of glucosamine looks very exciting. Hats off to Herbal Life for their Skin Activator Daily Replenishing Cream - see below. This is cutting edge stuff: developing good new safe skin products is a high and costly science. It gives us another strong reason to motivate using oral glucosamine, not just for arthritis prevention, but also for skin care and wound healing.

The abstracts below report a 34% improvement in wrinkles etc. with an oral mix of glucosamine, minerals especially nicotinamide, vit C and E and nicotinimide, aminoacids, bromelain, arginine, glutamine and aloe vera.

In the HealthSpan LIFE! range there is already the For-Skin Blend containing biotin, milk thistle, calmag and vit C; as well as vit E, bromelain, arginine and glutamine; and as always the baseline AA Blend and fish oil. As always, we offer the glucosamine as a separate tub on trial in case people are allergic to shellfish, or develop allergy - they do not then have to throw all the rest away. We have been taking both our For-Skin and our Glucosamine-Chondroitin and our For-Joints (incl. Bromelain) for some time without adverse effect.

This will supplement the benefits of a good skin prep. including aloe, like Weleda-PharmaNatura provides does.
Dr Neil Burman

Research suggests glucosamine is an effective anti-aging treatment.
By Simon Pitman 3/28/2006

The American Academy of Dermatology says that a recent study shows that glucosamine could prove to be an effective topical treatment to reverse the effects of skin cells damaged by UV exposure. Read more

Comment from Dr Neil Burman: the abstracts below from Medllne show what has already been published since 1974.

Reduction in the appearance of facial hyperpigmentation by topical N-acetyl glucosamine.
Bissett DL, Robinson LR, Raleigh PS, et al Procter & Gamble Company, Ohio J Cosmet Dermatol. 2007 ;6;:20-6 Source

Glucosamine has been reported to inhibit melanin production in melanocyte culture. It thus has a potential to reduce hyperpigmentation via topical use. In a second clinical study involving the topical combination of 2% NAG with 4% niacinamide, an agent previously shown to be clinically active, the effect on hyperpigmentation was greater. Both of these agents are well tolerated by the skin.

Do shrimp-allergic individuals tolerate shrimp-derived glucosamine?
Clin Exp Allergy. 2006 ;36;1457-61 Villacis J, Rice TR, Bucci LR, El-Dahr JM, Wild L, Demerell D, Soteres D, Lehrer SB.Tulane University New Orleans. Source

Background: There is concern that shrimp-allergic individuals may react to glucosamine-containing products as shrimp shells are a major source of glucosamine used for human consumption.. Conclusion: This study demonstrates that glucosamine supplements from specific manufacturers do not contain clinically relevant levels of shrimp allergen and therefore appear to pose no threat to shrimp-allergic individuals

Nutritional support for wound healing.
MacKay D, Miller AL.Thorne Research,Dover, ID USA. Altern Med Rev. 2003 ;8:359-77
Source

Altern Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.

The effect of an oral supplement containing glucosamine, amino acids, minerals, and antioxidants on cutaneous aging: a preliminary study.
Murad H, Tabibian MP.El Segundo, California 90245, USA.J Dermatolog Treat. 2001 ;12:47-51. Source

Background: Alterations in collagen, elastin, and glycosaminoglycans contribute to cutaneous changes seen in aging skin. METHODS: A randomized, controlled, single-blind study was conducted with 53 female volunteers with an oral supplement containing glucosamine, amino acids, minerals, and various antioxidant compounds for 5 weeks, compared with a control group of 12 individuals who did not take the supplement. RESULTS: There was a statistically significant reduction (34%) in both number of visible wrinkles (P < 0.01) and the number of fine lines (P < 0.06) in the group of women who took the supplement. No significant changes in epidermal hydration were observed in either the control or study groups. Conclusion: The use of an oral supplement containing glucosamine, minerals, and various antioxidant compounds can potentially improve the appearance of visible wrinkles and fine lines. It does not, however, affect epidermal hydration.

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Scientific Articles

Diabetes Prevention And Inappropriate New Drugs: Glitazone Woes And Ethics

Dr Neil Burman
2007.07

Why the current media glitazone hype rehashing the troglitazone tragedy within 8 years? Glitazones were successively discredited by the DPP 1998; then PROActive 2005, DREAM 2006 and ADOPT 2006 trials. The first hoped-for $billion Glaxo rain-check crashed by 1999 with liver (and weight gain and heart) problems (troglitazone-story.net) – followed within a few years by cerivastatin(Bayer), glitazars, and now torcetrapib (Pfizer) - under similar circumstances of corporate denial. No metabolic corrective- statin, glitazone, glitazar, gliptin or rimonabant - has given any reason to expect anywhere as good or safe long term as the 85year old gold standard metformin.

Useful weight loss in obese diabetics with metformin (dimethylbiguanide -1922 –Germany: Werner & Bell) was already reported by Pedersen 1965. But out-of-patent metformin was sidelined for 50 years by corporate greed - the simultaneous birth of insulin; and then sulphonylureas (1955) - whose lack of long term benefit on all-cause morbidity and mortality was first shown in the UGDP 1971 trial, confirmed in the UKPDS 1998, but which continues to be glibly ignored by manufacturers and most prescribing physicians. The estimated world diabetes prevalence is >200 million, and overweight >1billion. That’s some market. "The global diabetes market was worth $18.6bn in 2005-of which the US had half".(piribo.com; The Diabetes Market Outlook to 2011: price $2990. May 2006). Why else would a billion overweight if not diabetic patients not be on the only proven safe prevention metformin?

Reversal of insulin resistance, prevention – approximate halving - of new diabetes by metformin was already addressed in BIGPRO (Fontbonne 1991), confirmed in the 3 to 4yr China (Wenying 2001) and USA (DPP- Knowler 2002) trials in sustained effective tolerated dose (up to ~40mg/kg/day). By contrast, the prediabetic DREAM trial (Gerstein 2006) showed that while glitazone also halved incidence of new diabetes, it had no significant benefit on mortality or cardiovascular endpoints, in fact increased the incidence of heart-failure five fold.

Unlike all other drugs, metformin can sustain a mean weight loss of 5 - 8% over 4 years (Glueck 2006) irrespective of severity of overweight. In the only major long term diabetes studies (20yr UKPDS 2002; Canada- Johnson ea 2002-6), metformin (in contrast to sulphonylureas and all other modern chronic preventatives) almost halves all morbidity and mortality of all major common degenerative diseases of aging, let alone infertility and miscarriage rates(Glueck ea) - with the lowest weight gain if any.

In the ADOPT trial (Kahn 2006), metformin’s major adverse effect was gastro-intestinal - which is always the prescription ceiling: slow upwards metformin titration to tolerance just below symptoms, to limit calorie intake and absorption; and, compared to a glitazone (let alone sulphonylurea), metformin was associated with fall in weight, much lower LDL cholesterol and much less vascular disease & edema. In the European ProActive study (Dormandy 2005) in diabetics for a mean of three years, glitazone caused far more oedema, weight gain and heart failure, but failed to prove glitazone superiority to placebo in its primary endpoint.

So in contrast to glitazone (let alone sulphonylurea), metformin in appropriate maximum dose is associated with weight loss; anti-oxidant (Bellin 2006); anti-cancer (UKPDS 1998; Evans 2005; Johnson 2006) antithrombotic(Grant 2003); anti-lipidemic (Carlsen 1996); anti-hypertensive (Giugliano 1993); anti-heart failure (Johnson 2006); anti-arrhythmic (Najeed 2005); anti-anginal (Jadhav ea 2006); anti-fatty hepatitis (Uygun 2004); anti-infertility, anti-pregnancy loss (Glueck et al); performs equally well in both obese and non-overweight diabetics (Ong ea 2006), and in the presence of sepsis (Gras & Lalau 2006).

No other synthetic designer drug ever for chronic preventative use does all this, and safely –without a single significant risk in the 20yr UKPDS or in RCTs eg COSMIC(Cryer 2006 –which BMS delayed publishing for almost 8 years, presumably because the results so strongly favoured solo metformin). No synthetic designer drug for chronic preventative use has ever been (or will be) tested in a proper long term RCT (like UKPDS) for half as long as metformin and sulphonylureas were.

Apart from metformin, the only other regime that achieves such reduction is the evidence-based combination of safe preventative vitamins, minerals, human biologicals, herbs; fish oil; and appropriate balanced sex hormone replacement for proven deficiency/imbalance (eg Salpeter 2005; Heikinen 2006).

Now in an interim analysis at 3.75 years (Home et al NEJM 5 June 2007) of the unblinded RECORD trial in Europe and Australasia in 4447 mostly obese hypertensive diabetics uncontrolled on either maximum sulphonylurea or metformin (2.55g/d), addition of rosiglitazone (compared to those on sulphonylurea and metformin) resulted in 11% more primary endpoints (vascular disease with death or admission to hospital). This was not yet significant, but bears out the same trend as in the earlier glitazone trials - lack of global benefit. One cannot deduce more from this report without knowing the breakdown of how many “controls” are on SU vs metformin vs SU+metformin.

Thus it may well be asked: for the major degenerative causes of premature aging-related mortality (overweight- metabolic syndrome- diabetes, vascular, osteoporosis) - why are patients allowed to become obese with diabetes before metformin and proven safe preventative supplements are added? Why are physicians world wide not prosecuted by Regulators for failing to first prescribe appropriate long-proven combination (of multisystem protectants - metformin, vitamins, minerals, human biologicals and physiological balanced human sex hormone replacement) before prescribing in the remaining resistant cases inferior newer therapy with known serious risks and costs- sulphonylureas, statins, glitazones, glitazars, gliptins, anti-obesity drugs, biphosphonates, rimonabants, and surgery? The reason is obviously the dominant modern human deity: profit.

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