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Degenerative Conditions of the Back and Neck

“The Disease of Aging”

Are All Back/Neck Pain Conditions a Matter of Degeneration and Old Age?


Definition: Degeneration: Progressive decline or breakdown of normal function

Study into Aging is barely off the ground. They appear to have come to some conclusions - some of which appear to be pretty good news.  Before it is possible to adapt these findings to back and neck pain conditions, it may help to clarify the difference between what we can expect in the way of degeneration from simply getting older, and the degeneration we can expect that results from Premature Aging.

While research into the "causes" of normal aging is still in its infancy some aspects of normal age degeneration have been identified.  One of those is that,  as a species, we are genetically programmed to live to 100 to 120 and beyond.  Degenerative processes, in theory, should not result in observable dysfunction of organs and tissue until well past 75 to 80 years of age.  One only has to look at many centenarians, and centenarian societies to back this up.

Why we do not live to these ages in active, good health as we should is also under study.  Some early results demonstrate there are various life style decisions (factors) we make that affect our body's ability to maintain it's normal homeostasis, resulting in the creation of various types of metabolic imbalances.   Metabolic imbalances, which it is believed hasten our normal, genetically programmed, degenerative aging processes.  They have also identified outside factors which are a consequence of the way we choose to live as societies or nations.  It does not seem to matter where these factors originate they appear to result in "Premature" aging. 

They result the premature or early development of all the lethal diseases we are battling today - i.e. cancers, cardio-vascular diseases, adult diabetes, pulmonary, liver, kidney, neurological disease. This would also include many more disorders, pain, syndromes, illness, including some back and neck pain disorders, which may exist as consequences of these diseases, or simply as disorders in their own right, like lupus, fibromyalgia, rheumatoid arthritis, allergies,  bowel, bladder, digestive, sleep, thyroid dysfunctions, and more.  These diseases and disorders are not real "diseases" they are "symptoms" of a body running out of natural resources to keep us healthy and fit. 

An even stranger phenomena with either normal aging or premature aging is the number of similar changes found in the Mitochondria, organs, and to the cells in general.  Much more about this can be found in the article on Aging and the Mitochondria.  For now it is enough to remember there are numerous fundamental changes taking place as we get older and similar changes taking place that result in Premature aging.

The difference is - if we are in the grip of accelerated premature aging and the development of diseases and disorders associated with normal aging, we have great control over that.  We do not have any control over our normal, genetically programmed aging processes.

There is little doubt that most western societies are suffering the ravages of premature aging.  One only has to look at what is happening to the health of peoples in all of those countries - and then evaluate how the same life styles (factors) are affecting both our bodies and that health as well as theirs.  Contrary to most statistical information that comes from through the medical network - not only are the dis-eases we associate with normal aging increasing, we actually are not living as long as we previously did.  Statistics is a highly complicated subject, but it appears that recently entirely new factors have been introduced to how our government calculates the average life span.  Additionally, research also turns up another discomforting statistic - for those who do not succumb at early ages to the dis-eases medicine is battling today, more and more of us are  spending an ever increasing number of years with major infirmities, disabilities, and a poor quality of life.  Powerful drugs and various procedures may in fact save our lives, but too many of us pay for this with a greatly reduced quality of life during our remaining years.  And this is not necessary.

The Differences in Aging and Premature Aging

 Before weighing how "degeneration" or aging may be playing a role in most back pain disorder, we should perhaps take a closer look at the differences in how normal and premature aging affect our bodies.

Without getting too technical, normal aging is a slow, relentless consistent, "degenerative" process that affects our entire body.  "Degenerative" (aging) processes can be found occurring in every part of the body.  They don't stop and start or affect only a few of our bodies' "parts."  No matter how ideal a life we have led, how ideal our diet has been, or how free of stress, how far we live from toxic chemicals - the older we get the less sensitive the cells in our bodies become to insulin.  Our blood sugar levels rise, as well as our cholesterol and homocystine.  Scientists studying aging don't understand why such changes occur the older we get, but they do know they occur. These are a just a few of the biological changes that will develop as we reach the end of our life span.

Premature aging, on the other hand, has been known to demonstrate "selective" degenerative processes and cause selective disease and disorder development.  Premature aging of the brain, circulation, heart, joints, skin, digestive tract, and immune system can begin at any time of life.  An extremely high number of the population have already developed or are developing insulin sensitivity problems, as well as increased levels of blood sugar, homocystine, and cholesterol.  These are "signs" usually associated with normal aging, yet are  being found in children as young as 5 - 6 years of age.  To help understand better what happens and why it happens we need to look at the identified "life" factors that effect premature aging which result in the premature development of the diseases and disorders of "Old Age."

The Contributing Factors


OUR FOOD
We live in an age where much of the food we put into our bodies, expecting our bodies to make healthy repairs with, is non-food, or dead and poisoned food. These foods are full of toxic, brain cell destroying chemical additives, loaded with pesticides, herbicides, artificial hormones, and antibiotics, bad fats, high levels of refined sugars, poisonous artificial sweeteners, and other damaging additives, or have been genetically modified,. Most of our food is "refined" meaning it no longer comes to us as it came from nature.  For instance, removal of just life sustaining amino acids, for instance means this food is no longer able to make necessary repairs to a variety of tissues. Many additional "changes" occur during the refining of our food and they all essentially mean we are eating "dead" food. 

STRESS
We live in a world full of every conceivable type of stress (remember pain itself is a stress) and many of us overeat and carry excess fat, both of which are known stressors. 66% of the U.S. population is overweight or obese.  There is a huge variety of stressors we are exposed to everyday.  It is believed by many scientists who study the subject of "Stress," that stress is one of the greatest contributors to the development of disease processes.  Ordinary digestion of food is a "form" of stress to the body.  As is the pesticide you may be trying to digest.  Which is the greater stress?  Our bodies have not yet (if ever) evolved the ability to effectively deal with a toxic chemical, especially if it asked to do so daily, so this is a "no-brainer" question.

TOXINS & ENDOCRINE DISRUPTORS (The Air We Breath & The Water We Drink)
We live in a world where environmental toxic, and endocrine, hormone disrupting chemicals and metals, come at us from every possible direction (including our food, plastic food wrap and bottles, personal hygiene products, etc). Every one of us carries an average “body burden” of at least 100 of these toxins.  One does not have to live close to, or work for, a particular chemical plant to carry a "body burden" of their toxin.  In the US alone the chemical industry has developed and uses over 80,000 different chemicals.  

The pharma industry must also be included in this category, not only are many pharma drugs highly toxic and are known metabolic/endocrine disruptors, but the factory processes used to make these drugs  use and dump into our environment chemicals produced by the chemical industry. 

As does the food industry.  

LACK OR EXCESS OF PHYSICAL ACTIVITY
Most of us do not get enough appropriate physical activity. Even for those who are active, over or incorrect exercise can be almost as damaging to the body as a lack of exercise. 

INCREASED FREE RADICALS
ALL of the above contribute to skyrocketing free radical production in the mitochondria.  The more free radicals the greater the damage.  The data suggests that most of the increase in free radicals occurs as a result of the foods we ingest.  Changing the diet to one the body can make healthy repairs with not only cuts down on this type of free radical production but a body that can make necessary healthy repairs is far better equipped to manage the free radical production produced as a result of our toxic chemical "body burden" and other sources of toxic chemicals.

All these factors are known contributors to premature aging degenerative processes in the body.  All affect, in one way or another, the homeostasis and healthy metabolic processes of our body.

Degeneration and Back or Neck Pain

A great number of "conditions" fall under the broad umbrella of "Degenerative Spinal Diseases"  Using medicine's own estimates such "conditions" possibly cause 90% of all back or neck pain. Traditionally, medicine has explained this degeneration as being the result of "normal aging” changes in the spine.  Medicine also has accepted such “aging” changes as beginning in a person’s 30’s.  Defining conditions under this umbrella also provides an excellent explanation for why we can't expect successful resolution of our pain.  Medicine can treat the "symptoms" (i.e. disc problems, facet problems) of this "normal aging" degeneration.  But they cannot guarantee the success of those treatments either, and they certainly cannot treat "old age."  

Our goal to help people with back and neck pain find better understanding of back and neck pain as well as optimum relief, encouraged us to look at these degenerative conditions and asking why such “old age” changes seem to be occurring in such young people. In fact many such "degenerative" changes are found in people far younger then in their 30's.  If such changes are the result of normal old changes, one would not expect to find such frank pain causing changes even in people in their 50s or 60s.  So, if it is totally the result of degeneration it only makes sense that the degeneration must be the result of premature aging.

If this is so, then medicine is not helpless and has tools and treatments which can provide their patient with the expectation of real relief without waiting until changes in the spine are so bad there is no choice but to perform invasive surgical procedures.  It may not be able to effect much change once a disease or disorder is the result of normal aging process, but it can effect great change if it is due to premature aging factors.

Don't misunderstand - we are not trying to say that all the illnesses, people are suffering with, is the result of premature aging and the factors that cause it.  Without doubt some people are succumbing to the diseases that are a part of actually growing old.

 

Can Premature Aging "Degenerative" Conditions Be Prevented?

In General
The science tells us there is actually a great deal that can be done to prevent premature degenerative conditions (dis-eases) of western nations. However, these are not treatments one can expect to receive from any medical practitioner, orthodox or natural – these are all self-treatments and require personal responsibility. These treatments are not a cure-all for all dis-ease, but they do appear to have great significance in maintaining health, and where possible reversing dis-ease processes. Certainly, they hold greater possibility for this then we are currently experiencing.  If prevention is to take place it can only happen when we ourselves become “pro-active in controlling our own health care.  To do that we have to first look at all the factors said to be associated with premature aging.  No one can do this for us.  We need to do an honest assessment of these factors and ask ourselves how many of these are a part of our lives?  Then we need to ask if we are willing to make the changes required. 

Back and Neck Pain Prevention
We would have to say there are a number of back and neck disorders, which can, we believe be linked to aging and premature aging degeneration and some that are simply the result of genetic problems.  Some degenerative conditions have a genetic component like AS (ankylosing spondylitis) and, also, some forms of rheumatoid arthritis and others.  However, so very little is understood about these conditions and their possible causes it is difficult to discuss them with any certainty. Some conditions MAY also have a bacterial, fungal or virus component. There are others, like , kidney and liver disorders as well as osteoporosis or cancer that can cause back and neck pain which have clear links to both normal degenerative aging and premature aging.  Certainly it would appear that changes in our life style may help to prevent such conditions.  Once we have them these changes to our lifestyle - removal of factors linked with premature aging  - can most certainly allow the body to return to a more coherent homeostasis which would be of great help with any of these disorders.

We understand conditions such as these can and do strike very young people as well as older people and may therefore be considered "degenerative."  All can and do create or result in back and/or neck pain.

Is All Our Back and Neck Pain Degenerative?

It seems when medicine discusses the disorder of back and neck pain, it considers these "more serious degenerative disorders" to strike a relatively small number of people.  We have heard stats ranging from 2-10%This then leaves a great many more people who also fall under the rubric of "degenerative spine disease" which is also blamed on simple old age.  However these involve rather less serious physical changes to various "parts" of the spine and muscles that end up causing our pain.  Our comment here is when looking at some of these various tissue changes one could say they appear to be degenerating.  But, are they all caused by aging or even premature aging?  We think the answer is  - Perhaps not.

There are a number of "causes" of back and neck pain we never found listed in medical literature.  We discuss these causes in greater detail in our article "Identifying All the Causes".  But here is a quick listing of them from that article:

1. Pain-Causing Physical Changes - "Symptoms" (AKA Back Pain Conditions)
2. Improper diagnose and treatment
3. Inadequate Pain Control (Under treatment)
4. Lack of adequate and/or correct information
5. Ignoring the Signs/Lack of treatment
6. Underlying Metabolic Imbalances
7. Muscle Imbalances
8. Personal non-adherence to a specific treatment program
9. Stress Chemicals

As you can see factors which cause underlying metabolic imbalances of premature aging is just one on the list of "causes" of back and neck pain. 

Connecting The Dots

Evaluating where you might be in this aging continuum and what, if any of the proven life factors that result in premature aging may be present, could not only help eliminate or control your back and neck pain, it just might save your life, add years to your life, and provide you the opportunity to live in health.


Sound Too Good To Be True?
We trust this article will help you evaluate the knowledge behind this new medical paradigm. You don’t need to be a doctor or a scientist – you will discover it just makes sense and it explains why orthodox medicine has had so much difficulty in maintaining the “Health” of our populations or in finding “cures” for the dis-eases and conditions plaguing us.

It is a probable explanation for why the numerous degenerative pain causing conditions of the back and neck are so difficult to diagnose and treat.

Quick (non-technical) Tutorial


What is Dis-ease?
All dis-ease is nothing more than alterations of the normal, regular state of heath. Any orthodox medical person who understands this also understands they can do nothing to “cure” any dis-ease. There is no “magic Bullet.” What they can do is provide the body with necessary tools to “enable” it to find its own way back to normal balance and health. And balance and health is its natural state. If it were “natural” for our bodies to allow our immune systems to attack our own body’s tissues, as in the case of autoimmune disorders, we would never have survived as a species.

It took millions of years for our bodies to evolve the wonderfully intricate systems they have to maintain themselves in a constant state of “health.” As long as it has what it needs, the body is able to maintain this state of health into old age. Yes even being able to fight and recover from terrible bacteria and virus attacks.

The poor state of health for so many people today, is a recent phenomenon. In just over 100 years we have destroyed most of those tools our bodies evolved to use and we have set up dis-eases and pain in their place. This problem has now accelerated to creating aging factors and old age dis-eases in younger and younger people. Many of these factors or symptoms manifest as pain and inflammation in the back and neck. Yes, elsewhere too, but our concern is about back and neck pain.

Happily, we also possess much greater knowledge and superior methods for testing exactly how these factors have manifested into specific metabolic imbalances, thus allowing us to see what dis-ease processes may be developing in our bodies. Once determined we also have the means to correct or reverse many if not all of these imbalances.

These “treatments” can both slow the relentless progression of degenerative conditions and improve overall health and longevity at the same time. This new understanding of the causes of Aging includes some very specific “markers” that can be tested for. These markers can be changed through the use of specific treatments tailored to the individual patient.

Healing, can only take place – will only take place - when
the body is “healthy” enough to heal itself.


Sounds a bit oxymoronic doesn’t it? Ah, but we do have the knowledge and the tools to help the body return to the best possible “state of health” and as it makes that return it automatically heals itself. We only have to make sure the easily available tools are provided. And we have to decide which medical model can best help us to achieve our personal health goals.

How Old is Old?
As we discussed above, the majority of people living in westernized countries are suffering from the premature aging metabolic consequences of our current life style in one degree or another.  The factors we outlined above are simply too prevalent today and we can't escape them all.   Therefore it is a possibility that degenerative premature aging can certainly be making things more difficult for all back and neck pain sufferers.

We thought the following information may be of interest
 

Comparing Societies


Centenarian Societies
In areas of the world where populations live an average of 80 – 100 years, and older, outward degenerative signs (pain, stiffness, loss of flexibility and function) are rare. The physical changes that do occur in the spine and supporting tissues is rarely as extensive as found in our western societies. Often these people never suffer from this type of degenerative disabling change and loss of function. Remember these are people who put in hours of daily hard physical labour to survive. Much of their labour is repetitive but does not contribute to early painful spinal degeneration in these people.

CAN BIOLOGICAL (LIFESPAN) AGE BE TESTED FOR OR PREDICTED?

YES
As they are finding in the centenarian studies -  the single greatest marker for determining a person's biological age, is insulin. Specifically, insulin sensitivity (resistance) - which may turn out to be much older than their actual, or chronological age.

There is an avalanche of new data coming from every type of scientific and medical direction which seems to be proving there is a specific type of synergistic damage related to all the  life style factors that acts in concert with these factors to greatly speed development and progression of metabolic disorders (dis-eases of the aged.)

Curiously, it also turns out to be one of the greatest causes of mitochondrial cellular damage relating to premature aging, which also links to ALL of those so called incurable dis-eases of westernized nations.

It is Called “Insulin Resistance”
We talk about this here because while not everyone is in danger of developing or already has Insulin Resistance, studies are pointing to a minimum of 64 – 93% of the US population (it’s the country that provided the overall data for such a figure) who may already have Insulin Resistance, are just starting to develop it, or are now suffering from its massive longer term metabolic complications - the dis ease of adult diabetes being one of those complications. Most people think about “sugar” when talking about Insulin Resistance.

Sugar is not always the problem behind insulin resistance – but it does appear to be the greatest “problem.”

Other Contributors to Insulin Resistance
There is strong evidence other causes of Metabolic Imbalance, such as Stress can also contribute to the development of Insulin Resistance. As can some popular pharmaceutical drugs in today’s society, as well as the fight the body has with environmental and food toxins.


Sugar/Insulin Appears to be the Greatest Synergistic Contributor to Premature Aging

Imbalances created in the Endocrine (Hormone system) and eventually, all the other systems of the body caused by high sugar/insulin could be one of the most significant contributors to AGING and Premature Aging and all of its diseases. If insulin itself was not toxic enough to our tissues, when glucose molecules linger in the bloodstream, they link up with collagen and other proteins to wreak havoc on nerves, organs and blood vessels.

Insulin Resistance and the Links Found in Chronic Degenerative Dis-eases
Insulin Resistance has been linked to cardiovascular dis-ease, diabetes, cancer, alzheimer’s, obesity, and osteoporosis - all the so-called chronic dis-eases of westernized countries. It has been linked to other symptoms, illnesses, conditions, and syndromes, such as, autoimmune dis-eases, fibromyalgia, osteoarthritis, chronic fatigue syndrome, chronic inflammation, pain, and many others.

The type of fats and bad fats we eat appear to be the next biggest factor in the cellular conditions leading to premature aging.

It’s Still All About Aging – Normal or Premature
When you think about AGING – think METABOLIC process. When you think about back and neck pain due to what is commonly diagnosed as “Degenerative” processes – think “Metabolic” processes. Degeneration anywhere in the body especially in areas of the body that should not normally be degenerating at a particular age means, “Premature Aging” is occurring in the body.”  If its not the underlying cause for your back or neck pain condition it could be making it more difficult for you to resolve your back or neck pain.

A more scientific perspective on the big connection to the sugar/insulin problem can be found in the article about “Aging and the Mitochondria.”


WE ARE WHAT WE EAT
It’s an old expression and one people really paid little attention too – not recognizing its significance. Everywhere today you can hear and see information about our “poor” diet and how we need to change that diet, especially once we become diabetic. Now according to the new sciences what we are eating today is the main contributor to premature aging dis-eases.

Food is the “primary tool” our bodies use to maintain homeostasis and health. And it is easy to see most of the damage occurring today can be directly linked to the foods we are eating.


If we changed nothing else but this ONE factor we would be able to turn most of the premature aging metabolic disorders around that are being caused by all the other factors.


Metabolically our bodies are absolutely unable to make normal or healthy regenerative repairs with the types of “non-food,” high sugar, bad fat diets we are eating.

How Bad is our Diet?
US Government Agencies completed studies that showed: 90 cents out of each dollar spent in the average weekly American food budget is spent on these “non-foods.” 

The average person in the US consumes 160 pounds of sugar a year = 1 cup of sugar per day = 5 regular cans of pop.  This does not include sugars from raw fruit or vegetables.

Over time, as the body continues to seek to provide optimum health with this poor diet, it is forced to do so at the expense of various body systems. Organ after organ, system after system begins to either over activate or slow down, as the body attempts to maintain its balance and preserve its life. The result is none of these systems function properly. For some people this breakdown takes years before unmistakable symptoms of dis-eases begin to appear - for others with specific types of genetic problems, it happens much quicker.

If this was not problem enough for the body - add things like ongoing or chronic stress and the 17 damaging chemicals it creates; outside-chemical toxins to deal with; and a lack of healthy exercise and we only create greater problems for the body as it valiantly tries and fails to maintain “health.”

For those who have to add to this life destroying mix the massive endocrine and overall metabolic changes caused by any sugar/insulin problem is it any wonder so many people are dying from all these dis-eases we would normally attribute to the very aged in our society?

Without eating foods we have evolved to digest and work with, it is impossible for the body to make necessary repairs.  Our westernized diet slowly strangles each cell and its ability to function and correctly communicate with other cells. This causes the brain to begin sending messages out to dampen down our systems in an effort to save us from death. Our METABOLISM is slowly shutting down. This is exactly the same thing that happens when our cells begin to “run-out of gas” as we reach our genetic end-of-life span and we die. But we are creating and enabling this effect – it is certainly not a natural process in young people.

Listen to back and neck pain it is a “symptom.” The body’s way of “speaking” telling us something is not working properly – this is especially important if the person receiving this message is young.


IF WE CAN CREATE IT - WE CAN UN-CREATE IT

All is Not Lost
Long before real unmistakable life-altering symptoms of most degenerative dis-eases/disorders begin to appear, we start being plagued with a host of common types of unpleasant symptoms. These “symptoms” are signals the body is having some problem maintaining homeostasis. These “symptoms” are embryonic dis-eases in the making requiring immediate and proper intervention.

If we don’t listen to these early warning symptoms the symptoms can become more deadly – because most are silent unless tested for. Orthodox medicine rarely, if ever, tests for silent symptoms (prevention). They must wait until the symptoms become pronounced enough they could indicate a "frank" dis-ease is present.

There are many reasons for metabolic imbalances to begin and even more for exactly where they start. But, once again let us repeat the single greatest synergistic contributor to metabolic imbalance and for rapid development of dis-ease appears to be INSULIN RESISTANCE. Any genetic “predispositions” are simply hurried along. While not everyone has insulin resistance, the more research is done in this area the more it is being found in people suffering from all types of dis-eases, disorders, and illnesses. Most important of all is that everyone can make changes that will aid in preventing this dis-ease development.
 

The Proof of the Sugar/Insulin Connection
(Should There be a Doubt)


Once again, we don’t ask you to accept our word about this new discovery.

There are a staggering number of people estimated to have a connection to the metabolic imbalances created by the sugar/insulin problem. Because Insulin Resistance is also a complication in metabolic mitochondrial dysfunction now being related to premature aging - AND, because it can RAPIDLY increase development of premature aging dis-eases we felt it really necessary to provide some proof of the connection.

What follows may be one of the most important pieces of information when looking at tying in “premature aging” to how dis-ease, degeneration, back and neck pain really begin. Additionally, what follows has far reaching implications not only for the resolution of your back and neck pain but for finding the possible underlying metabolic cause and therefore the best way to treat it. Without the genetic component if you are under age 50 in the end – this is all about “premature aging” and the effects it has right down at the mitochondrial level. We have covered the data from those scientists who are researching aging and premature aging linked to mitochondrial dysfunctions and the causes of those dysfunctions. The following article is an example how insulin resistance has been linked to degenerative dis-ease based upon decades of Endocrinology research.

While it is important to consider and make changes relative to all of the above listed underlying contributors - the connections to sugar/insulin metabolic problems are far too strong to ignore and if the science is correct – it may be the greatest contributor to the killing dis-eases western countries are all dealing with – It has been known about for 75 years - and it is so easy to fix.

Please Go To Metabolic Syndrome – Syndrome X

If you are not interested to dig deeper into this subject or don't have the time right now, but still are searching for some answers and concrete help for resolving your back or neck pain, skip on over to Muscle Imbalances and Its Not Degenerative Aging.  This information is probably the best we have to present.  It may provide answers for most people. Not just answers, but really effective treatment methods, and where to find them. Treatments that are reported to be quick in resolving back and neck pain for people suffering with this specific type of muscle problem.




References
[1] Cheryl Duxbury. Aging and the Threshold of Disease, University of Waterloo, CA. Course Notes Biology and Human Aging

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Reaven GM. Role of insulin resistance in human disease. Diabetes 37:1595-1607, 1988

Skott P, Vaag A, Bruum NE, Hother-Nielsen O, Gall M-A, Beck-Nielsen H,Parving H-H. Effect of insulin on renal sodium handling in hyperinsulinemic type 2 (non-insulin-dependent) diabetic patients with peripheral insulin resistance. Diabetologia 1991; 34:275-281.

Vgontzas AN, Bixler EO, Chrousos GP. Metabolic disturbances in obesity versus sleep apnea: the importance of visceral obesity and insulin resistance. J Int Med 2003; 254; 32-44.

Facchini FS, Riccardo A, Stoohs A, Reaven GM. Enhanced sympathetic nervous system activity- the linchpin between insulin resistance, hyperinsulinemia, and heart rate. Am J Hypertens 1996; 9:1013-1017.

Juhan-Vague I, Thompson SG, Jeppesen J, on behalf of the ECAT Angina Pectoris Study Group. Involvement of the hemostatic system in the insulin resistance syndrome. Arterioscler Thromb 1993; 13:1865-1873, 1993.

Abbasi F, McLaughlin T, Lamendola C, Reaven GM. The relationship between glucose disposal in response to physiological hyperinsulinemia and basal glucose and free fatty acid concentrations in healthy volunteers. J Clin Endocrinol Metab 2000; 85:1251-1254.

Sanyal AJ, Campbell-Sargent C, Mirashi F, Rizzo WB, Contos MJ, Sterling RK, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001; 120:1183-1192

Seppala-Lindros A, Vehkavaara S, Hakinen AM, Gotto Takashi, Westerbacka J, Soviharvi A, Halavaara J, Yki-Jarvinen H. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 2002; 87: 3023-3028.

Argiles JM, Lopez-Soriano. Insulin and cancer. Int J Oncol 2001; 18:683-687.

DelGiudice ME, Fantus IG, Ezzat S, McKeown-Eyssen G, Page D, et al. Insulin and related factors in premenopausal breast cancer risk. Breast Cancer Research and Treatment 1998; 111-120.

Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madamas Y, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2001; 20:42-51.

Lehrer S, Diamond EJ, Stagger S, Stone NN, Stock RG. Serum insulin level, disease stage, prostate specific antigen (PSA) and Gleason score in prostate cancer. Br J Cancer 2002; 23: 726-728,



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