EFTA01872381.pdf

To: From: Jeffrey Epstein Sent: Tue 8/14/2012 3:24:29 AM Subject: Re: i told him you would help On Mon, Aug 13, 2012 at 8:39 PM, wrote: Am at airport.... Isn't stuff like this personal??? From: Jeffrey Epstein Sent: 8 13 2012 7:35 PM To: Sub; : e: call him and ask he would love it On Mon, Aug 13, 2012 at 7:21 PM, a(it aol.com> wrote: It's hard to know if his encephalopathy is a primary symptom or the result of hypoglycemia. Anyway — was thinking through weird causes of hypoglycemia. Best way to think about it is: 1. Either his body doesn't know how to regulate basic metabolism (reactive hypoglycemia) 2. He has fasting hypoglycemia 3. He's under-producing glucose There are only these three paths (above) to hypoglycemia. 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 errors of metabolism: • Postoperative rapid gastric emptying (alimentary hyperinsulinism) • Fructose intolerance • Galactosemia • Leucine intolerance His diet sounds varied to me. Beans and rice means protein and carbohydrates are tolerated to some degree. If it is a primary structural 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 well on a ketotic diet, like super Atkins. Has he tried that? You gotta wonder too about what happens when he fasts. Is 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 really interesting, and he can buy it over the counter and give it a try. EFTA_R1_00278977 EFTA01872381  • Islet cell disorders (adenoma, nesidioblastosis, cancer) seem unlikely given chronicity • Excessive islet cell function • Antibodies to endogenous insulin • Carnitine deficiency Finally, he might be under-producing glucose. There are tons of tests for this and I bet Mayo has run most of them. • Glycogen metabolism (glycogen phosphorylase, glycogen synthetase) • Hexose metabolism (glucose-6-phosphatase, fructose-1,6-biphosphatase) • Glycolysis, Krebs cycle (phosphoenolpyruvate carboxykinase, pyruvate carboxylase, malate dehydrogenase) I guess to start we'd need to know: ...When is he hypoglycemic? ...Has he tried a protein / ketotic diet? ...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 figure it out. —Original Message— From: Jeffre E stein <j vacation mail.com> To: , MD > Sent: Mon, Aug 13, 2012 4:13 pm so lets goofy sleepy confused dazed every single time he eats anything„ sugars worse than other he has live on rice and beans„ they say he is also severyly hypoglycemic. 20 and under. mayo couldn't figure it out, he has been to sleep strudies, mri, blood up the kazoo no answer. probarbly stimulating 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 retum e-mail or by e-mail to jeevacation@qmaitcom and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved ************************************ *********************** The information contained in this communication is EFTA_R1_00278978 EFTA01872382 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 [email protected], 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, 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 [email protected], and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved EFTA_R1_00278979 EFTA01872383