Sometimes I think I could do more for mental health in the long term by decreasing risk of stroke -- prescribe metformin, a statin, and an ACE inhibitor, but I make a much better psychiatrist than a primary care physician. I often prescribe metformin along with the psychotropics given the metabolic side effects and the abundance of obesity.
Are you aware of any evidence in favor of using metformin for adults with no/few cardiac risk factors?
We are not physical or mental-we are one thing. Physical illness and mental illness are often related. If you have primary aldosteronism or Cushing's disease you are more likely to be depressed. Aldosterone and cortisol both activate the MR receptor and are increased in obese people. Your are on the right track!
Hear 👂 hear! The $100 Million Dollar and now 15 years “Ischemia” study showed exactly the same conclusion. The problem is that the beliefs of the “experts” are mistaken for facts and evidence. Facts and evidence are not factored in for decision making, even it they are better for patients and costing much less. There is no rational thinking in the 19th Century Analog legacy medicine at all! It’s 💯% expert opinions driven not based on merit or empirical data.
That is why I wrote this piece. These issues are settled science. We have proof of the nature of heart artery disease and the best practices to treat it. More to come. This is the critical issue in medical care. We must follow proven science.
It is not science. The science is clear. We don't follow the science because the best care is less expensive care. Those who stand in the way of proven science are motivated by money, power, and control. Another more charitable explanation is they just don't understand the issues.
If you go to a great journal like the New England Journal of Medicine you will see that the vaccine is very effective at preventing death and hospitalization due to COVID. You will also see that Ivermectin and hydroxychloroquine don't work. Politics and medical science are like oil and water.
Also, did I read correctly that people taking metformin live longer than people with no diabetes? What is the implication? I know there are planned studies to explore metformin's utility as a longevity drug
Yes. That IS what you read and the implications are HUGE!!! Metformin directly blocks the master metabolic genetic switch mTOR and activates the master metabolic genetic switch AMPK. AMPK is a survival switch. In the fetus and child, if there is no food, AMPK is activated to mobilize calories from fat and muscle to provide energy so that the child survives. AMPK continues that function throughout our lives. My entire site is about these relationships.
Dr. IK Jang (Interventional cardiologist from MGH) also shares your view. Apparently there are two camps here: clinicians such as you and Dr. Jang and others who feel proactive stunting can prevent MACE. In this case, what is the justification for the copious research being done on vulnerable plaques? If nothing can be done about them, why discover their existence?
This is settled science. Go to the links in the article. Here are two articles from Circulation in 1995 that answer your question. The hardest lesson for a man to learn is on that lowers his income.
Brilliant post!
Sometimes I think I could do more for mental health in the long term by decreasing risk of stroke -- prescribe metformin, a statin, and an ACE inhibitor, but I make a much better psychiatrist than a primary care physician. I often prescribe metformin along with the psychotropics given the metabolic side effects and the abundance of obesity.
Are you aware of any evidence in favor of using metformin for adults with no/few cardiac risk factors?
We are not physical or mental-we are one thing. Physical illness and mental illness are often related. If you have primary aldosteronism or Cushing's disease you are more likely to be depressed. Aldosterone and cortisol both activate the MR receptor and are increased in obese people. Your are on the right track!
https://williamhbestermannjrmd.substack.com/p/tying-it-all-together-3ed
Hear 👂 hear! The $100 Million Dollar and now 15 years “Ischemia” study showed exactly the same conclusion. The problem is that the beliefs of the “experts” are mistaken for facts and evidence. Facts and evidence are not factored in for decision making, even it they are better for patients and costing much less. There is no rational thinking in the 19th Century Analog legacy medicine at all! It’s 💯% expert opinions driven not based on merit or empirical data.
That is why I wrote this piece. These issues are settled science. We have proof of the nature of heart artery disease and the best practices to treat it. More to come. This is the critical issue in medical care. We must follow proven science.
Agreed! 👍
Apparently, The Science (promoted by the politically motivated) has trumped science…
It is not science. The science is clear. We don't follow the science because the best care is less expensive care. Those who stand in the way of proven science are motivated by money, power, and control. Another more charitable explanation is they just don't understand the issues.
Fauci. Science or The Science?
He did pretty well with a totally new disease
If you go to a great journal like the New England Journal of Medicine you will see that the vaccine is very effective at preventing death and hospitalization due to COVID. You will also see that Ivermectin and hydroxychloroquine don't work. Politics and medical science are like oil and water.
https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
Also, did I read correctly that people taking metformin live longer than people with no diabetes? What is the implication? I know there are planned studies to explore metformin's utility as a longevity drug
Yes. That IS what you read and the implications are HUGE!!! Metformin directly blocks the master metabolic genetic switch mTOR and activates the master metabolic genetic switch AMPK. AMPK is a survival switch. In the fetus and child, if there is no food, AMPK is activated to mobilize calories from fat and muscle to provide energy so that the child survives. AMPK continues that function throughout our lives. My entire site is about these relationships.
https://williamhbestermannjrmd.substack.com/publish/post/140681753
Dr. Bestermann,
Dr. IK Jang (Interventional cardiologist from MGH) also shares your view. Apparently there are two camps here: clinicians such as you and Dr. Jang and others who feel proactive stunting can prevent MACE. In this case, what is the justification for the copious research being done on vulnerable plaques? If nothing can be done about them, why discover their existence?
This is settled science. Go to the links in the article. Here are two articles from Circulation in 1995 that answer your question. The hardest lesson for a man to learn is on that lowers his income.
https://www.ahajournals.org/doi/full/10.1161/01.CIR.91.11.2844
https://www.ahajournals.org/doi/10.1161/01.cir.92.3.657?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
America's for-profit healthcare system makes it much more difficult for interventional cardiologists to stop placing unnecessary stents.