From: Sent: To: Subject: call him and ask he would love it Jeffrey Epstein <[email protected]> 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 Ant