From: Jeffrey Epstein <jeevacation@gmail.com>
Sent: Tuesday, August 14, 2012 2:36 AM
To:
Subject: Re:

call him and ask he would love it

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

=A0 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>*'

=A0 Glycogen metab=lism (glycogen phosphorylase, glycogen synthetase)

=span>* =A0 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-----

From: Jeffrey Epstein <jeevacation@gmail.com <mailto:jeevacation@gmail.com> >

To: 
Sent: Mon, Aug 13, 2012 4:15 pm

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.????



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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