WOODSON C. MERRELL, M.D.

WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Telephon Fax: Date: July 27, 2011 Patient: Jeffrey Epstein (Email: [email protected]) • 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 % 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 u with Dr. Rony Shimony 110 East 59th Street 8th Floor NY NY 10021 -11. for cardiovascular cholesterol consultation after above blood test: I 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, potatoes, etc.). Use small amounts of complex carbohydrates (whole grains); use lots of vegetables and a couple fruits as your main source of starch • Eliminate all saturated fats from your diet. This is obviously important for your cardiovascular and cholesterol issues, but saturated fat also promotes inflammation (inflammatory prostaglandins, cytokines, etc) in the body in general • Begin a regular aerobic exercise program • Try to do a daily breath-based session/meditation (at least 2 minutes, preferably 15) with frequent breath breaks throughout the day. This will not only reduce stress in general and on your cardiovascular system, but reduce cortisol levels as well • If your PTH has gone up significantly from previous, you should see your Yale parathyroid specialist (depending on today's lab results) • Try as much as possible to go on a plant-based diet. Consider reading Arthur Agatston's "The South Beach Diet" and Dean Ornish's "Reversing Heart Disease" EFTA01106920 All supplements are available at: Winner Chemists Life Science Pharmacy VitaHealth 100 Park Avenue 144 Route 17M 1235 1' Ave NYC NY 10017 0926 - 65 Pharmacist: Scott Berliner Pharmacist: David Restrepo EFTA01106921