From: Jeffrey Epstein <jeevacationggmail.com> To: <1 Subject: Re: Date: Tue, 14 Aug 2012 03:24:29 +0000 i told him you would help On Mon, Aug 13, 2012 at 8:39 PM, Am at airport.... Isn't stuff like this personal??? wrote: From: Jeffrey Epstein Sent: 8/13/2012 7:35 PM To: Subject: Re: call him and ask he would love it On Mon, Aug 13, 2012 at 7:21 PM, < > 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. • Islet cell disorders (adenoma, nesidioblastosis, cancer) seem unlikely given chronicity EFTA00941332