Newsletter

Dr. M’s SPA Newsletter Volume 15 Issue 13

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Literature Review

1) An exciting phase three trial with the CETP inhibitor Obicetrapib has shown serious promise for ASCVD and Alzheimer’s Disease (AD). “In BROADWAY, a pre-specified AD sub-study was designed to assess plasma AD biomarkers in patients enrolled in the BROADWAY trial and evaluated the effects of longer duration of therapy (12 months) with a prespecified population of ApoE3/4 or 4/4 carriers. The sub-study included 1727 patients, including 367 ApoE4 carriers. The primary outcome measure was p-tau217 absolute and percent change over 12 months. Additional outcome measures included neurofilament light chain (“NFL”), glial fibrillary acidic protein (“GFAP”), p-tau181, and Aβ42/40 ratio absolute and percent change over 12 months. NewAmsterdam observed statistically significant lower absolute changes in p-tau217 compared to placebo over 12 months in both the full ITT population (p<0.002) and in ApoE4 carriers (p=0.0215).” (NAMS)

Obicetrapib has shown significant LDL and Lp(a) lowering effects as well in early trials. I will be watching this discovery closely as it may be a game changer for these diseases. “In the BROADWAY trial, more than 2,500 participants with established heart disease or genetic high cholesterol were given either Obicetrapib or a placebo, in addition to their regular cholesterol medications. After 12 weeks, those on Obicetrapib had dropped their LDL cholesterol by 32.6 per cent and Lp(a) by 33.5 per cent on average – many achieved guideline-recommended targets for the first time.” (Sci Tech Daily) The drop in Lp(a) is the profound result as this is a massive risk factor for ASCVD and to date is not moveable by statins and most used meds.

2) GLP1 drugs and risk for macular degeneration?… and more

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 12

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There is a quiet truth written in the tomes of family life that science keeps confirming over and over. It’s worth pausing to reflect on.

A warm bond between a father and child lights a path toward a steady, grounded adulthood. Studies show kids with an emotionally present dad, someone who’s there with a hug or a knowing nod, are less likely to stumble into behavioral trouble. Boys, especially, often look to their fathers as a mirror, shaping themselves in the image of a dad they feel close to. It’s a simple gift: presence breeds strength, presence breeds exploration of self, presence breeds knowing, presence breeds growth in all things for men.

Now, here’s a twist you might not expect. The old-school image of the rugged, masculine dad, stoic and commanding, was once thought to mold boys into the same mold. But research, like a wise teacher, reveals otherwise. A boy’s masculinity isn’t forged by a father’s stern hand; it’s an innate spark, flickering or bold regardless of style. As a Stoic father might counsel, we can’t control the nature we’re given, only how we nurture it. So, let’s release the pressure to force a mold and instead guide with patience. This theory follows the excellence of The Carpenter and the Gardener by Gopnik…. and a recipe.

Enjoy

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 11

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Heat Exhaustion Prevention and Awareness

It is that time of year in many parts of the country. Planning ahead of an event or extended time out in the heat is very important especially as we age or while pregnant.

Summer break does not end the competitive athletics. Kids of all ages are playing sports during the heat of the day all over the country this summer. This time of year poses a major risk of overheating for children and adolescents engaged in aggressive aerobic outdoor exercise. It is prudent to try to have vigorous workouts during the early morning hours preferably or later in the evening for the older kids who get to bed later by nature.

In our clinic, we have had admissions to the hospital for heat exhaustion and muscle breakdown known as rhabdomyolyisis. For example, a young man was practicing on the football field and overheated due to a combination of under hydration and excessive ambient temperature. Symptoms included excessive sweating, rapid pulse, muscle pain, nausea, vomiting and dizziness… and a literature review.

Enjoy, Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 9

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Today, I’m diving into a fascinating article by Scott Zimmerman and Russel J. Reiter, titled Melatonin and the Optics of the Human Body, published in Melatonin Research (2019). This piece flips the script on what we thought we knew about melatonin, light, and how our bodies interact with the sun’s rays. It’s a game-changer, especially for how we think about kids’ health in our modern, screen-filled indoor living world.

First, what is melatonin? Melatonin is a hormone made from the essential amino acid, tryptophan. It was first isolated from a cow’s pineal gland. It is an old molecule as primitive bacteria made melatonin probably 2.5 billion years ago. Its synthesis in bacteria and eukaryotes is a common linkage. Most of us know that melatonin is the “sleep hormone,” produced by the pineal gland in the brain when it gets dark at night, signaling to our bodies that it’s time to wind down and prepare to sleep. It’s the chemical expression of darkness, driving our circadian rhythms and helping us catch those precious brain cleansing moments. Zimmerman and Reiter argue that this is only half the story or maybe even less than half. For decades, research has hyper-focused on pineal melatonin that is regulated by visible light hitting our retinas. Blue visible spectrum light in the early morning suppresses pineal melatonin, which is why we should dim those screens before bed. But here’s where it gets interesting, the pineal gland isn’t the only place melatonin is made, and darkness isn’t its only trigger. Our bodies are producing melatonin in ways we’re just starting to understand, and it’s tied to light in a way that was unexpected and evolutionarily fascinating. As with all things in science and evolution, we learn what we did not know and it all makes sense once the aha moment occurs…. and a literature review. Oh and a recipe.

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 8

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Itaconate, what is it and why does it matter?

Science Heavy – skip to the bold for take home if you want to avoid the science.

The biggest takeaway from this complex science is this: High fat, high sugar diets (Ultra Processed Foods) are associated with decreased itaconate activity and increased inflammation. The science further answers the question of whether we should allow ultra processed food in schools.

Ultra Processed Foods likely reduce itaconate production driving inflammation, metabolic dysregulation, and gut dysbiosis, which could worsen active disease. Lower itaconate levels likely impair your body’s ability to resolve inflammation, potentially leading to prolonged issues with healing and repair. To support itaconate’s anti inflammatory activity, shift away from UPFs toward an anti-inflammatory diet (e.g., Mediterranean, rich in vegetables, omega-3s, and fiber) to reduce inflammation, support gut health, and enhance itaconate’s immune-regulating effects.

Science:…..

Enjoy,

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 7

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Let’s dive into articles that have been critical to understanding type 2 diabetes and Insulin Resistance: the Ominous Octet and now the Egregious Eleven from the BMC Medicine paper and the 2009 Diabetes paper by Dr. Ralph DeFronzo. Peter Attia recently interviewed Dr. Defronzo and I am on listen #3 because it is so good and yet incredibly complicated. This piece is a compilation of that interview and reviewing Dr. DeFronzo’s papers.

“…all too often, the risk factors for these disorders are not addressed promptly in clinical practice, leading to irreversible pathologic progression… Traditional approaches to treatment involving sequential therapy, in which agents are added only after one has failed, contribute to clinical inertia and often prevent goal attainment, leading to adverse outcomes…. in turn contributing to increased morbidity and mortality. In contrast, early diagnosis and prompt, intensive intervention, often with initial combination therapy, leads to faster goal attainment and improved outcomes for at-risk patients.” (Handelsman et al. 2023)(Schwartz et. al. 2024)

…literature review.

Enjoy,

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 6

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This is such an important topic to cover, even for a pediatrician. Dementia!

This problem is slated to exponentially worsen in the coming decades. And it starts at birth!

​In the intricate landscape of Alzheimer’s disease (AD), emerging research underscores a pivotal yet under explored facet for the why?, the brain’s energy immunometabolism. A recent study by Patel et al., titled “Global Energy Metabolism Deficit in Alzheimer Disease Brain,” delves into this domain, revealing significant metabolic disruptions that may illuminate novel upstream causes and possible therapies.

​ For the better part of the last few decades, all AD research centered on the amyloid and tau plaques as the causative problem. However, billions of dollars and many drugs later, this hypothesis has crashed and burned. Failed therapies coupled to the skyrocketing volume of AD patients in the US over the next few decades will burden the US healthcare system and families alike. Folks, we need better answers and therapies rapidly. Thus, I have been following this information on and off over the years looking for answers. Last month, Dr. David Perlmutter gave an excellent lecture on microglial cells in the brain and their impact on AD and neurocognition in general. One paper that he cited was the Patel paper. Let’s look at it.

Dr. M

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