Dr Scott Jensen

“Life is infinitely stranger than anything which the mind of man could invent. We would not dare to conceive the things which are really mere commonplaces of existence. If we could fly out of that window hand in hand, hover over this great city, gently remove the roofs, and and peep in at the queer things which are going on, the strange coincidences, the plannings, the cross-purposes, the wonderful chains of events, working through generations, and leading to the most outre results, it would make all fiction with its conventionalities and foreseen conclusions most stale and unprofitable.” - Sir Arthur Conan Doyle, The Adventures of Sherlock Holmes

Sir Arthur Conan Doyle was a physician who based his main character, Sherlock Holmes, on his mentor, who was a physician known for being exceptionally skilled at the physical exam. I used to read the stories and marveled at the power of observation and I think physicians today can still learn from that. Here is a link to one of my favorite books on the subject. The best functional doctors I know of can look at the physical exam and judge what the nutritional deficiencies are with some accuracy without the aid of labs.

One such way we are now being startled as we peel of the roof in medicine is being able to now see clearly how much pharmacies are charging for drugs. There are more ways consumers can gentle remove the roof and see who is charging what, and make a more informed choice.

I want to alert you to use goodrx.com each time you have a prescription and make sure you and your loved ones are getting the best price. Generally, costco is quite competitive, but goodrx.com definitely has “removed the roof” on the pharmaceutical industry. Do use it. My daughter found a way to get a free pill box for her vitamins. I verified it did indeed come to the house.

iMalachi 4:2 KJV ¶ But unto you that fear my name shall the Sun of righteousness arise with healing in his wings.

Once I learned of the power of sunlight, through vitamin D, that messianic scripture had a new dimension of understanding for me.  The sun through its light sustains life in the world. Vitamin D3 is the vitamin our bodies get from the sun’s power.  Also, not only that. But, the skin makes nitrates from the sun, independent of vitamin D, which does the circulatory system good (skin viagra as I am want to call it - cheaper than the infamous blue pill).  With vitamin D being important, and each person needing this power and light, it is also another thing to consider that we all have different bodies with slight differences in how much of this vitamin is needed.  This has now been documented by science.

From Malachi to Michaelis

Leonor Michaelis is famous for the Michaelis-Menten equation.  This equation can help us understand how individuals are different in their need for vitamin D and other vitamins as well.  It turns out this true principle is found in many places in nature and he and his colleague, Maud Menten, were able to express it as an equation.  Leonor Michaelis first began working with Paul Ehrlich in his lab in Frankfort, Germany.  That spot has a place in my heart now because my daughter is serving an 18 month mission for our church there right now.

From Michaelis to Menton.....

The beautiful and brilliant, Maud Menten, who helped Michaelis to formulate the before mentioned equation.   Just like Michaelis, she was an M.D. by training, who became a researcher after finishing her medical degree.  She subsequently joined the faculty at University of Pittsburgh medical school as a pediatric clinical pathologist. 

Lets see how Malachi, Michaelis and Menton are connected:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897595/figure/F1/

The above comes from Dr Cicero Coimbra and colleagues study published in Dermatoendocrinology in 2013.  In this study individuals with psoriasis and vitilligo were successfully treated with high doses of vitamin D3.  In this first, graph we consider the enzyme that activates vitamin D (alpha hydroxylase or CYP27B1) and how fast it is able to perform its work. In this case, a normal dose of vitamin D (substrate concentration - think of this as sunlight itself providing the vitamin D or the individual would take a supplement) is able to help this person make enough activated vitamin D.  The activated vitamin D is needed to help provide normal immune function.  In contrast to the two examples that follow, the enzyme in this person works normally.  This person is less likely to have vitilligo or psoriasis or autoimmune disease.  

Now, see more sunlight is needed (or a higher dose of vitamin D3) is needed for this person in order to have their enzyme work properly.  Their enzyme requires a higher level of vitamin D in order to work properly.  This person needs DOUBLE the amount of substrate (sunlight) to get the same benefit as the first person.  This person might have fatigue, or a mild autoimmune disease such as hashimoto thyroiditis (one of the more common autoimmune diseases seen in a primary care clinic for example).  More vitamin D in is needed for this person than the first person to get enough activated vitamin D made to have normal enzyme function and normal immune function.

Lastly, we see this person who has the enzyme that is the most sluggish type  yet graphed and it requires three times the level of substrate (sunlight converted to vitamin D3 or a supplement of D3) to get the same enzyme activity.  This person might have a more serious autoimmune condition such as multiple sclerosis for example.  

Thus we see from Malachi, Michaelis, and Menten that different individuals will have different needs for the sun’s healing power brought about by vitamin D.  This reality is often explanatory in defining why some suffer from autoimmune disease and others remain with normal immune function.

Lastly, please don’t take high doses of vitamin D as listed in this study without monitoring.  For any dose of vitamin D, watch for any signs and symptoms of nausea, palpitations, or excessive thirst and stop the vitamin D until your blood and urine is checked to make sure it is not from vitamin D that you are ill. The majority of the time, doses of 10,000 IU/day can be used for adults, but there are exceptions to this at times in cases of poor kidney function and in cases of high blood calcium from uncontrolled hyperthyroidism or hyperparathyroidism.  In these cases, care and careful monitoring should be undertaken by a physician to reduce the risk of harm.

Right now, there is no drug induced way to persuade our fat cells to burn energy.  However, In nature, two general types of fat exist: (1) white (storage fat) and (2) brown fat (metabolically active fat that burns off energy).  The brown color derives from when mitochondria are added to the cells allowing for more metabolic activity.  It turns out, intermittent fasting causes a physical change in our fat, turning it from white (storage) to brown (fat burning energy).  The key is that the fasting must be intermittent.  Typically this would be 2-3 days per week of going 18-24 hours in between meals (i.e. skipping one to two meals every other day).  Skipping two meals can be quite difficult for many, so I would recommend just starting with an 18 hour period.  There is no fluid restriction for zero calorie fluids (water, herbal tea, and even bone broth is permitted).   I find this a very good strategy to maintain weight (1-2 days per week).  For those who want to be more aggressive (2-3 days per week), weight loss may occur.  If no progress occurs after 2-3 weeks, make sure you see your doctor to make sure you don’t have some metabolic condition making weight loss more difficult.  Please remember on the non-fasting day, eat 2-3 meals as normal.  Its important to maintain the every-other-day pattern with intermittent fasting.

http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30504-1

A good handout on what was known up to 2008 - I am looking for a new handout, yet this still contains much good information.

While in process of completing my fellowship in 2013 I heard Andy Weil say in lecture to the fellows one day that one of the biggest impact steps we could take as providers would be to encourage patients to avoid sugary drinks.  See his posts on this here and in the next sentance. This would be avoiding all soda, both diet or juice or otherwise.  Here is a picture of Andy Weil and myself just after that lecture.

I heard Richard Carmona, former surgeon general, say the same thing to us in lecture at that time.  So, I had 2 independent witnesses I respect saying the same thing.   

I will add my 3rd witness, that I have seen patients make great health gains by giving up sugary drinks.

It would help, I think, to consider that soda is a faux food (false or fake food) largely based on the true old fizzy drinks of old that are actually quite healthy (i.e. water kefir, kambuucha etc).  These drinks contain probiotic organisms that aid health and give you something good along with the fizz you get (ie similar to soda).

In a 2013 analysis of the women’s health study, it was suggested that for every 1000 women taking calcium supplements for 5 years (with or without vitamin D) 6 women experience a heart attack and 3 women are prevented from a fracture.  Overall, we are harming more than helping in using these supplements.  Overall, I would say that casts a cloud of concern over the practice of using calcium as a supplement.  The authors wonder what the possible mechanism could be that could lead to calcium being a culprit in heart attacks.  I suspect the issue is due to vitamin K2 deficiency, specifically us missing the MK-7 fraction of K2 in our diets.  When we get enough of this MK-7 vitamin, the calcium we eat is properly managed by a mechanism in which K2 activates a transport protein (MGP).  The calcium then ends up where it belongs, in the bones, and the person is prevented from forming a vascular plaque from too much calcium.  I mentioned this in my last post how important this vitamin K2 is.  The other reason I dislike calcium supplements is because is limits the amount of vitamin D one can receive and vitamin D has many more benefits to health that are needed in all of the systems of the body. 

There is a new blood test that does somewhat differentiate some patients with fibromyalgia from other pain related diseases with an autoimmune component.  This is the anti polymer antibody reactivity test.  There are some preliminary studies to suggest it has a sensitivity of around 47% or so.  This means 53% of fibromyalgia patients may test negative.  Yet, its a start, in a disease where there have not been any testable labs to help with diagnosis before. A good sign things are going in the right direction to help these patients.

Part I of my December message covers the 1st of the 3 gifts of the Magi in Matthew 2:11 - “...they saw the younger child...and fell down and worshipped him...opened their treasures...they presented unto him gifts; gold.  Gold is known for being a store of true wealth having the chemical properties of scarcity, malleability, inertness, durability, and uniformity (Jim Rickards, The New Case For Gold, p 29-33).   The magi gave three gifts that were a shadow or a type of the child who was to become the Messiah.

First, gold is scarce. The child was himself a gift bestowed by God the Father of great value as the only Begotten son. The child would also bring the gift of eternal life. This gift was of the greatest eternal value, as gold brings a more durable store of wealth in today’s temporal world (Rev 3:16).  

Second, gold is malleable. It can be molded into any shape...rings, jewelry, or coins for example, and yet not be destroyed. Yet, then it can be melted down and reshaped into any other form after that. Perhaps this was the fact that the child was “made flesh” and dwelt among men. He would be “taking shape” as the Word (Greek Logos) made flesh.  (see John 1:1, 14). Later, He would be “changed” from death to a state of resurrection, seemingly being indestructible. 

Third, gold is inert. It is not changeable. It is not likely to “mix” with other elements in nature, or be changed by them chemically. This is just as the Christ would be from eternity, and unchangeable.

Fourth, gold is durable and keeps its store of value when other sources of wealth might be unreliable, such as fiat money today. Through His atonement, the Christ child would through the culmination of His mission, bring about the availability of the everlasting mercy of God (1 Chron 16:34).  It is significant that the mercy seat of the arc of the covenant was constructed of pure gold (Exodus 25:17).  Again, eternal life is also prefigured as being durable in its value (Proverbs 8:18).

Lastly, gold is uniform. Gold is recognized throughout time to be a dependable form of currency in all the world. One day it is said “every knee shall bow and every tongue confess” that Jesus is the Christ.

Maybe.  This came up with a child today in the clinic and growing pains is a common complaint and a concern parents have about their children. 

How do we know it is growing pains? I use the Peterson diagnostic criteria.  Very simple.  It should have the characteristics on the left side of the table (inclusional criteria) and NOT those on the right (exclusion criteria).  The signs or symptoms on the right require more evaluation including labs and possibly x-ray.

Once we are sure a child meets criteria for growing pains, lets consider what we can do for treatment.  It turns out, vitamin D supplementation is quite helpful and safe and can reduce symptoms of growing pains.  How common is it, about 94% in one study.  Vitamin D deficiency is thus highly likely when a child has growing pains.  I recommend considering the dose for vitamin D by RDA doses appropriate with age before beginning supplementation. Generally, it is not wise to exceed these levels of supplementation without checking lab work.