WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Telephone: (212) 535-1012 Fax: (212) 535-1172 Date: July 27, 2011 Patient: Jeffrey Epstein (Email: [email protected]) rim • Call me Monday afternoon, or sometime early next week to review today's lab results • Supplements to begin for now: o Niacin 500mg twice a day (taking with food may reduce flushing); if flushing is too much, call me or Rony for a prescription for a sustained release form o One Enteric-coated baby aspirin every 1 to 2 days o Because of partial folic acid enzyme converting deficiency (MTHFR), take FolaPro form of folic acid by Metagenics; 1 twice a week o Nordic Naturals Omega 3 Fatty Acid Fish Oil; 1 capsule twice a day or 2 capsules once a day (approx 800 mg OPA/DHA) o Magnesium Citrate (Solgar is a good brand); 200mg once a day (taken at bedtime may act as a mild muscle relaxant) o Sublingual (under the tongue) B12 (Solgar is a good brand); 1,000mcg daily o Culturelle is an excellent brand of probiotic (acidophilus) to help digestion and intestinal immunity; one capsule/day • Give a trial of a very low dose of Crestor. Start with /2 of a 5mg tablet twice a week. If no side effects occur (usually musculoskeletal or cognitive) after 2 weeks, increase to every other day. After 3-4 weeks on this dosage regimen recheck cholesterol blood test. Stop at any time if side effects occur • Follow up with Dr. Rony Shimony 110 East 59th Street 8th Floor NY NY 10021 - - 212- 752-2700 for cardiovascular cholesterol consultation after above blood test: I will send him a note with a copy of today's • Schedule a one hour visit for an annual check up in the fall • We discussed that the triglycerides are still high; cut back not only on starches, but also oils (this will help with weight loss as well) • Due to a tendency for slightly high blood sugar (elevated glycohemoglobin), eliminate all refined carbohydrates (sugar, white flour, white rice, rolls, p