Use Caution when Prescribing Entyce (capromorelin oral solution) for Feline Use

Our cat, Tabatha, should be quite familiar to those reading this blog. Tabatha has been part of our family for nearly 16 years and, as such, she has grown quite attached to us. Because she’s elderly and seems more comfortable with us than with a pet sitter, we decided to take her with us on a lengthy car trip over spring break this past March. This was a bit of an experiment because, prior to this, Tabatha had typically been in the car only to and from the vet. This would be, by far, the longest car trip she had ever taken.

Tabatha seemed to be doing well on the trip and seemed to be relaxed and happy. However, much to our alarm, halfway through our road trip Tabatha suddenly stopped eating. All attempts to bribe her with various foods failed. After she had fasted for 36 hours we became quite concerned. (Cats do not tolerate periods of fasting very well. It’s very easy for cats who have not eaten to suffer from a potentially fatal condition known as feline hepatic lipdosis, which is caused when the liver’s function is compromised by a buildup of fat cells.)

Alarmed by her continued fasting, we sought help from an emergency vet clinic that we found on our route. The wonderful folks at the clinic ran a bunch of tests and decided that Tabatha had stopped eating due to stress from the road trip. Because we had another day’s travel, we had to do something to compel Tabatha to eat. The veterinarian suggested that we try treating Tabatha with a relatively new medication, Entyce (capromorelin oral solution). Entyce is a medication that has been FDA approved only for use in stimulating appetite in dogs, typically for dogs whose appetite has been suppressed by other therapies, such as chemotherapy. Entyce stimulates appetite by binding to certain receptors in the brain. The veterinarian’s thinking was that prescribing Entyce for Tabatha might effectively stimulate her appetite as it does in dogs. (While Entyce has been approved only for use in dogs, it’s not uncommon for medications to be prescribed “off label,” for various other uses. This is true for human medications, as well.)

The Entyce worked like a charm. Within hours Tabatha was eating like a lumberjack. We gave her one dose a day for three days, just as prescribed. The rest of the vacation was uneventful, even the long drive home. We were very relieved that Tabatha tolerated the trip home and we figured that her stress on the outbound trip was solely because she hadn’t traveled that far before.

Fast forward five months and it was time for another road trip. This time just as long, but in an entirely different direction. Because Tabatha had done so well on the return trip during spring break, we decided to take her with us again. We explained her history to our local vet and obtained another prescription for Entyce to take with us, just in case she stopped eating again.

As it turns out, Tabatha did stop eating again, just as we reached our destination. Fortunately, we had the Entyce with us and we gave her the first daily dose, shortly after dinnertime. We were relieved to see her eat some dinner a few hours later.

The following morning we didn’t see Tabatha up and around so we went searching for her to offer her breakfast. To our horror, we found her on her side, under a bed, staring unblinkingly as she lay motionless. We picked her up and examined her and she was completely limp. She was alive but it appeared that she had suffered a massive stroke and was completely unaware of her surroundings. We quickly got online, found the nearest emergency vet, and whisked her there. Their initial diagnosis was that she had suffered a massive stroke. The only way to be sure, they said, was to perform an MRI. The challenge, however, was that a cat of Tabatha’s age (especially one with a heart murmur, which Tabatha had developed in recent years) needed full cardiac workup before they would feel comfortable administering the general anesthesia necessary to perform an MRI on a cat. The cardiac workup, including an EKG and consult from the cardiologist, took a few hours, with us agonizing all the while over Tabatha’s unresponsive form.

By late morning, it appeared that Tabatha was a little more responsive. She was raising her head and seemed to recognize us. One possible explanation, the vet said, was that she was stabilizing a bit after her stroke. As we continued to wait or the report from the cardiologist we noticed that Tabatha continued to improve. By early afternoon she was attempting to stand.

At this point, because she was showing steady improvement, we decided to watch her overnight instead of subjecting her to the risk of the general anesthesia and the MRI. We decided to take her home to watch her so that she wasn’t in an unfamiliar place all night. We told ourselves that if she took a turn for the worse we could zoom back to the emergency vet.

To our incredible amazement, by early evening Tabatha was 90% better and the following morning she was perfectly fine.

This was no stroke. Nobody, human or animal, is perfectly fine 24 hours after a massive stroke. This had to be something else. But what?

We think it was the Entyce.

Even though Tabatha tolerated Entyce perfectly in March, we think that this time Entyce caused a reaction that mimicked a stroke.

Remember, this is a medication that was created for dogs and has been officially approved only for dogs, so there’s not much history with the off label use of Entyce with cats.

I researched the issue and only found one other person who reported this same result; however, based upon her comments, it appears that neither she nor her vet made the connection between the Entyce and the stroke-like result.

I offer this story as a caution against the off-label use of Entyce in cats. Entyce may work wonders in dogs that need their appetite stimulated, but it doesn’t appear to be suited for use in felines.

Medical Experts Once Again Helping People Become Diabetic


Yet another absurdity in diabetes advice comes from the staff at Harvard Medical School and it illustrates quite nicely why we have become a nation of diabetics.

In an article entitled Sugar’s Role in Diabetes (on a web site with the laughable title Better Medicine), physician author Robert Shmerling argues that elevated blood sugar levels are the result of having diabetes, not the cause.

Improved blood sugar control may reduce the chances that certain complications of the disease will develop. But just because the disease is characterized by an elevated blood sugar level and because lowering the blood sugar level is an important goal of therapy, a high-sugar diet does not cause the illness. An elevated blood sugar level is a result of having diabetes, not the cause.

Dear Dr. Shmerling: I’ve got news for you: Elevated blood sugars are both. They are the result of diabetes and a significant cause.

In his own definition of Type 2 diabetes, Shmerling states:

…the body’s tissues become resistant to insulin, requiring more insulin than the pancreas can produce to keep the blood sugar normal (type 2 diabetes).

What does he claim causes a person’s tissues to become resistant to insulin?

He says that heredity, obesity, and medications are the culprits.

Here’s a CDC graph showing the growth of diabetes in America:


While I’m sure genetic factors play a role in determining the likelihood and the rate at which one develops Type 2 diabetes, is he really arguing that our population’s genetics have changed so dramatically during this time as to explain this rise in diabetes?

In other words, a rapid and unexplained genetic shift in the modern world’s population, not diet, is causing the incidence of diabetes to skyrocket?

Uh, ok. Sure, doc.

I would have to practice in front of a mirror so that I could say that without bursting into laughter.

And, medications? Please tell me what medications have caused such an alarming increase in diabetes over the past 50 years. The attorney general in every state in America would like the answer to that question, too.

And finally, Shmerling states that obesity causes diabetes. I knew that one would rear its head soon enough. That’s laughable from a man that states:

Assuming an elevated blood sugar level is the cause of diabetes is like assuming that coughing is the cause of pneumonia.

Let me channel Dr. Shmerling:

Assuming that obesity is the cause of diabetes is like assuming that coughing is the cause of pneumonia.

Obesity isn’t the cause of diabetes, it’s simply another result of insulin resistance and elevated glucose levels.

Shmerling seems to have forgotten that elevated insulin levels trap fat in fat cells, preventing weight loss.

In my book, Don’t Die Early, I talk about the effects of insulin on weight retention:

“It may seem unbelievable that having an elevated insulin level could prevent the body from burning fat when we’re hungry, but it’s true. Insulin is amazingly powerful at keeping fat locked into fat cells where it remains inaccessible and cannot be metabolized for energy. How powerful? Obese rats that are given insulin injections to maintain high insulin levels and then put on a starvation diet remained obese while dying of starvation. These starving, yet obese rats digested their own muscles and organs for food until they died from starvation, without losing any of their body fat.

“Yes, even though they were starving, the elevated insulin levels prevented their body from metabolizing fat from their fat cells for energy, forcing their bodies to digest their own organs and muscles for nourishment. Think about this the next time you wonder why people can’t lose their unwanted body fat even though they are not eating much. It’s very likely that the foods that they are eating are causing a large insulin response, which is keeping the fat locked into their fat cells.”

And while we’re on the subject of weight, Shmerling states:

And not all persons with diabetes are overweight — that’s another myth. For these patients, heredity and perhaps other undiscovered factors are more important.

Dr. Shmerling, let me explain the “mystery” of why some diabetics are thin and some are not. (Again, I’m quoting my own book. Sorry to be so self-serving here, but I wrote this book to help enlighten people about the causes of diabetes and other maladies affecting us today. I didn’t think Harvard Medical School staff members were part of my target audience.)

“The most surprising thing about the effect of insulin resistance and trapping fat in fat cells is that despite what I’ve just said about this effect, we cannot determine how insulin-resistant we are by how much extra fat we are carrying.

“While it’s true that an overweight person is almost certainly insulin-resistant, a thin person is no less likely so. Why is this? It’s because fat cells can become insulin resistant at different times in different people. If you’re “lucky” enough to have fat cells that become insulin resistant quickly, before they expand considerably, then you’re a thin, insulin-resistant person, subject to the same damage from elevated glucose and insulin levels as an obese insulin-resistant person.

“Everything I’ve said in this section about fat being trapped in fat cells and about a person becoming hungry every couple of hours and spending the majority of the time with elevated glucose and insulin levels can be just as true for a thin person as for an overweight person. In fact, it’s probably the thin person who is less fortunate when it comes to insulin resistance because the thin, insulin-resistant person’s diabetes will go undetected far longer, due to the false sense of security that being thin brings.”

So back to the original question, what does cause insulin resistance, the definition of Type 2 diabetes?

Why, it’s exposure to increased levels of glucose, of course!

I’ll once again quote from my own book:

“Let’s think about the amount of glucose in a healthy, non-diabetic person. In such a person, the total amount of glucose in the blood-stream during the fasting state is less than a teaspoon (which is less than 4 grams of glucose). An 80-pound, fasting, non-diabetic child has less than one-half teaspoon of glucose.

“What do you think happens when a person eats a meal that dumps ten or a hundred times the fasting amount of sugar into the bloodstream? The body simply cannot allow the blood glucose level to suddenly become 100 times the normal fasting amount. That much glucose in the bloodstream would be acutely harmful, perhaps even fatal, if not metabolized quickly. The body reacts to elevated glucose levels by doing whatever it must do to quickly metabolize the glucose. This means secreting insulin. Lots of insulin! Way more insulin than was ever necessary for a person before the advent of refined white flour, 64-ounce sodas, tortilla chips, and candy bars. 

“Over time and with frequent exposure to high levels of insulin, the cells in the body become increasingly resistant to insulin, requiring more and more insulin to accomplish the same glucose transport functions as before.”

In other words, repeated and significantly elevated glucose levels, the levels caused by our daily diet of grains, 64-oz sodas, chips, and other crap, cause insulin resistance.

What other problems do elevated glucose levels cause?

In a sad, cruel irony, elevated glucose levels damage the very components that are responsible for producing insulin: the beta cells of the pancreas.[1]

That is, elevating one’s glucose levels causes beta cell death, which causes glucose levels to rise, thus hastening beta cell death.

It’s what I call a “shit spiral.”

But in his thoughtful assessment of diabetes, Dr. Schmerling completely ignores the role that elevated glucose levels play in damaging the beta cells of the pancreas.

Oh, I forgot. Sugar doesn’t cause diabetes.

In conclusion, Shmerling states:

…the notion that a high-sugar diet causes diabetes is a medical myth that demonstrates how the effect of an illness may be mistaken for its cause.

And I submit to you, Dr. Shmerling, that by ignoring the role of excessive carbohydrate intake in the development of Type 2 diabetes, you are propagating a horribly damaging falsehood.

The advice from physicians of your ilk are a significant factor in the rise of diabetes and the decline of this nation’s health.

[1] Gleason, CE, et al. Determinants of glucose toxicity and its reversibility in pancreatic islet Beta-cell line, HIT-T15. American Journal of Physiology, Endocrinology, and Metabolism 2000;279: E997–E1002.

This is only one of many studies showing how elevated glucose levels kill pancreatic beta cells, thus hastening the onset of Type 2 diabetes.

Promoting Honesty Through Subterfuge

If the dairy industry has its way, we’re about to see even more options for feeding our children ultra-sweet tasting, low-fat dairy products, under the guise of providing “more healthful eating practices” so we can “reduce childhood obesity by providing for lower-calorie flavored milk products.”

According to an announcement in the Federal Register, the International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF) have filed a petition requesting that the FDA amend the standard of identity for milk (and 17 other dairy products) to provide for the “use of any safe and suitable sweetener as an optional ingredient.”

“Safe and suitable” according to the petition, includes “non-nutritive sweeteners such as aspartame.”

Aspartame? Ick.

And the best part is, this petition would allow the dairy industry to add such non-nutritive sweeteners to milk without indicating this in any way on the label, arguing that “…the proposed amendments to the milk standard of identity would promote honesty and fair dealing in the marketplace…”

Only in today’s insane world of food politics does hiding food ingredients promote honesty.

If you’re confused about how secretly adding artificial sweeteners to our milk could possibly promote “honesty and fair dealing,” the petitioners kindly explain:

“…IDFA and NMPF argue that nutrient content claims such as “reduced calorie” are not attractive to children, and maintain that consumers can more easily identify the overall nutritional value of milk products that are flavored with non-nutritive sweeteners if the labels do not include such claims.”

 Currently, you see, non-nutritive sweeteners may only be included in an unlabeled product if a the product packaging bears a nutrient content claim (e.g., “low-calorie). So, by removing the “low-calorie” label that drive the kids away, we can ensure that they drink more aspartame-enriched, low-fat milk.

And remember, it’s all about the consumer.

As the dairy industry states:

“Accordingly, the petitioners state that milk flavored with non-nutritive sweeteners should be labeled as milk without further claims so that consumers can more easily identify its overall nutritional value.”

 I don’t know about you, but I can more easily identify a food’s nutritional value when the &*#$@*! label reveals everything that’s in the product!

Thanks to the International Dairy Foods Association (IDFA), the National Milk Producers Federation (NMPF), and the FDA (who will undoubtedly bend over for the milk industry), our kids will suffer even further damage from a lack of healthy fat and will be further bombarded with aspartame (a substance the neurologist Russel Blaylock refers to as an “excitotoxin”), all while cultivating a further desire for heavily sweetened foods.


Wheat Belly Cookbook

I was pleased to find a copy of the Wheat Belly Cookbook under my tree this Christmas. Written by Dr. William Davis, the author of the #1 New York Times best seller Wheat Belly, the Wheat Belly Cookbook is loaded with recipes for those seeking a healthful, wheat-free diet.

In the cookbook, Dr. Davis carefully makes the distinction between healthful, wheat-free eating and simply going “gluten-free.” Unlike gluten-free cookbooks that replace wheat with damaging, high-glycemic ingredients such as rice starch, tapioca starch, or potato starch, the Wheat Belly Cookbook uses far more favorable foods like chickpea flour, almond flour, and flaxseed meal. The result is tasty, healthful that doesn’t promote a damagingly high glucose response.

One of the first recipes we tried was the Basic Focaccia. After nearly three years being wheat-free, I thought my days of dipping focaccia bread into a dish of flavored olive oil were long gone. Even though I no longer crave bread or bread-like foods, it’s nice to find a healthful substitute for something that I thought I’d never eat again.

In less than 20 minutes, we whipped up a batch of focaccia bread, which we used as a principal component of a wine and cheese dinner.

Eating healthfully doesn't have to be boring.

Wheat Belly Cookbook is divided into sections dedicated to breakfasts, sandwiches and salads, appetizers, soups and stews, main dishes, side dishes, and, finally, the chapter that may be most welcome to those new to a wheat-free life: the Wheat Belly Bakery. If you’ve gone wheat-free and you’re craving chocolate chip cookies, breadsticks, or pizza, this is the chapter for you.

Perhaps best of all, Wheat Belly Cookbook’s introductory chapters very effectively summarize the content of Wheat Belly, Dr. Davis’ best selling indictment of today’s frankenwheat. If you haven’t read Wheat Belly and are curious to know more about why so many of us are giving up wheat, these introductory chapters will certainly deliver.

While Wheat Belly shows us that a life without wheat is beneficial, Wheat Belly Cookbook shows us that a life without wheat can be tasty and fun, too!


Keeping Your Medical Records

I was chatting the other day with a family member about the importance of vitamin D for optimal health. I mentioned that vitamin D metabolism can vary significantly from person to person and this is why just telling someone to “take x amount of vitamin D” is less useful than saying “maintain a healthy level of vitamin D in your bloodstream.”

“My doctor checks my vitamin D level twice a year,” he said. “Great!” I replied. “What is your vitamin D level?”

“My doctor said it’s fine,” came the response.

I replied that many doctors think a vitamin D level of 30 is “fine,” while others recognize that   values in the 60 to 80 range are preferable and I asked if he had ever been told his vitamin D value.

“Nope. But the doctor says it’s fine.”

Ok, then, but you still don’t know what it is!

While it’s perfectly admirable to have a trusting relationship with one’s physician, staying in the dark about things like your vitamin D level, lipid studies, or other lab tests doesn’t allow you to check for yourself whether or not your doctor’s opinion of “fine” is really in line with your opinion of fine. Moreover, having ready access to your labs will make discussions with other physicians easier, either because you’re seeking a second opinion or if it’s an unrelated matter (for example, your OB/GYN asks you what your vitamin D level is, you can give a number instead of saying “fine”). If you change physicians, having a copy of important test results can be a godsend if your records are lost or delayed in being transferred from your previous physician.

As useful as medical records are in preventive care, they’re even more important if you are being treated by multiple physicians for a more serious or chronic matter. In such cases, having copies of your records, and being familiar with them, can help you ensure that your physicians are communicating thoroughly and accurately. Ive been in a situation where one physician says “I’d like to run a blah blah test on you” and I respond, “Dr. X ran that test last month and here are the results.” In an ideal world physicians would communicate so effectively that there would never be a case of a needlessly repeated test but the last time I looked out my window, it wasn’t an ideal world. It’s up to each of us to be the principal advocate for our health and a backup custodian of our vital records.

It’s pretty simple to do: each time your doctor orders a test, ask for a copy of the results to take with you. I’ve never had a physician hesitate at such a request.

Most seem pleased that I care enough about my test results to keep a copy.

This Is Not Paleo

As careful as we are with our diets here in the Don’t Die Early household, there are still times when ya gotta say, WTF (or WTH for the g-rated among you).

Halloween is obviously one of those days:

Fortunately, our daughter will only eat a few pieces a day of this Halloween bounty and then lose interest in less than a week, at which time we’ll give the remainder away to the farmers who are feeding stale candy to their cattle.

A Case for Skepticism

Unlike most people who had routine births, mine was far from routine. Born very early and alarmingly small, I struggled for months before becoming strong enough to even leave the neonatal intensive care unit. From the time I was old enough to understand, I heard stories of repeatedly being pulled from the brink of death during those formidable first months. As one can imagine, my appreciation of those who had worked so hard for my survival grew into something quite akin to hero worship.

While a bit more precarious than most people’s experiences, I don’t think I’m unique in developing a bit of hero worship for the doctors and nurses who care for us and our loved ones. This is only amplified by the air of authority bestowed by the news media, as well as by fictional television, movies, and books, which further elevate medical practitioners and scientists, sometimes to near sainthood. The reality, however, is that the medical practitioners, scientists, and researchers among us today are still human beings who are given to errors, political maneuvering, and self-deception.

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