From: Sent: To: Subject: call him and ask he would love it Jeffrey Epstein <jeevacation@gmail.com> Tuesday, August 14, 2012 2:36 AM Re: On M=n, Aug 13, 2012 at 7:21 PM, > wrote: =blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:lp= ticcc solid;padding-left:lex"> It's hard to know if his encephalopathy is a primary =ymptom or the result of hypoglycemia. Anyway — was thinking through weird causes of hypogly=emia. Best way to think about it is: 1. Either his bod= doesn't know how to regulate basic metabolism (reactive hypoglycemia) 2. He has fasting=hypoglycemia 3. He's under-p=oducing glucose There are only these three paths (above) to hypoglycemi=. I've exclude the common stuff or the "not likely" stuff since I am sure Mayo=has already tried those things. If his hypoglycemia is postprandial (after meals), then there are some very real things to think of in the category of reactive hypoglycemia — some are straight forward mechanical and the others are er=ors of metabolism: =span>* =AO Postoperative =apid gastric emptying (alimentary hyperinsulinism) =span>• =AO Fructose intol=rance =span>. =AO Galactosemia * =AO leucine intole=ance His diet sounds varied to me. Beans and rice means prot=in and carbohydrates are tolerated to some degree. If it is a primary structur=l issue (like a glucose transporter gene mutation in the brain GLU-1 or GLU-3) or simple sugar or carbohydrate intolerance, you'd think he would do really =ell on a ketotic diet, like super Atkins. Has he tried that? You gotta wonder too about what happens when he fasts. =s that when he gets hypoglycemic? Cancer seems unlikely since he's had this=whole life. Antibodies or weird islet cells could be the case. Carnitine is reall= interesting, and he can buy it over the counter and give it a try. =span>• =AO Islet cell dis=rders (adenoma, nesidioblastosis, cancer) seem unlikely given chronicity =span>* =AO Excessive isle= cell function =span>* =AO Antibodies to =ndogenous insulin * =AO Carnitine defi=iency Finally, he might be under-producing glucose. There are=tons of tests for this and I bet Mayo has run most of them.=/font> =span>• =AO Glycogen metab=lism (glycogen phosphorylase, glycogen synthetase) =span>* =AO Hexose metabol=sm (glucose-6-phosphatase, fructose-1,6-biphosphatase) * =AO Glycolysis, Kr=bs cycle (phosphoenolpyruvate carboxykinase, pyruvate carboxylase, malate dehydrogenase) I guess to start we'd need to know: ...When is he hypoglycemic?=/div> ...Has he tried a protein / ketotic diet?=/font> ...Has he tried supplementation with carnitine?<=> ...Do any of these things look familiar to him?<=> ...Does he get googly eyes after eating? Or even while sleeping? Interesting case. Between you and I — I bet we can fi=ure it out. Original Mes=age Fr ' <* " < ' ." » Se . EFTA_R1_01718273 EFTA02558534 so Jeffrey west gets goofy sleepy confused dazed every single time he=eats anything„ sugars worse than other he has live on r=ce and beans„ they say he is also severyly hypoglycemic. 20 and =nder. mayo couldn't figure it out, he has been to sleep strudies= mri, blood up the kazoo no answer. probarbly stimulatin= the vegus nerve.???? The information contained in this communication is confidential, may be attorney-client privileged, may constitute inside information, and is intended only for the use of the addressee. It is the property of Jeffrey Epstein Unauthorized use, disclosure or copying of this communication or any part thereof is strictly prohibited and may be unlawful. If you have received this communication in error, please notify us immediately by return e-mail or by e-mail to jeevacation@gmail.com <mailto:jeevacation@gmail.com> , and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved The information contained in=this communication is confidential, may be attorney-client privileged, =ay constitute inside information, and is intended only for the use of the a=dressee. It is the property of Jeffrey Epstein Unauthorized use, di=closure or copying of this communication or any part thereof is strictl= prohibited and may be unlawful. If you have received this communication in error, p=ease notify us immediately by return e-mail or by e-mail to jeevacation@gmail.com, =nd destroy this communication and all copies thereof, including all attachm=nts. copyright -all rights reserved 2 EFTA_R1_01718274 EFTA02558535