Monthly Archives: January 2010

Smoking, Weight Gain and Hypothyroidism; Maya Shares Her Story


Maya Sarkisyan, a consultant with metabolism.com, shares her life experiences with smoking, gaining weight and hypothyroidism. If you want to ask Maya questions about her methods please do not hesitate to make use of our forum page. Once on the forum look for the “Latest Discussions” column and then click on Topic “Add New”. Then you are ready to post questions or your own opinions and comments.

Here is what Maya writes about her own life:

I replied some time ago to this thread and would like to add something. Everybody here posted a personal story of dealing with weight gain after quitting smoking. I went through that too. I smoked since I was 15, quit to have a child, picked up just that one cigarette a year after…, and than quit again 7 years ago for good. I did start gaining weight and was diagnosed with hypothyroid condition right prior to quitting. However what was effective for me is to modify almost all my life habits, not only eating and exercising. I did go to gym every day (and worked out hard) , ate small portions, meditated, made peace with few people in my life, looked at the bright side of things, etc. I even got certified as a fitness trainer! By no means it was easy but it was worthwhile doing. I wrote down all my life patterns and changed them all – even good ones modified slightly. I did it to reset my system completely. All the women in my family are very overweight and I’m not – only due to the discipline and frame of mind I choose to keep.
I started helping people to quit smoking with customized individual hypnosis sessions, because it is the best thing you can do – quit smoking forever. All it takes is a firm decision and sometimes some help.
I know that you can do anything when you make a decision to do it. Real firm once-and-for-all decision. I came to Dr. Pepper four years ago as a mess on Synthroid, and now with Armour, Selenium, meditation, and holistic medicine even my antibodies levels are going down. I decided to get healthier and did everything it took that is healthy for me. We all are not getting younger so I choose to take care of my body and eliminate unhealthy habits on daily basis, and help my patients do the same.
Good luck to you all, congratulations on quitting, and I wish you health.

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Beth Ellen DiLuglio, Certified Clinical Nutritionist Offers Personalized Services


Beth Ellen DiLuglio M.S., R.D., C.N.S.D., C.C.N., LD/N,  is a Certified Clinical Nutritionist and Registered Dietitian with certification in nutrition support.  BethEllen is now offering personalized nutrition programs to help you reach your goal. Beth Ellen has the training and experience required to analyze your past and present efforts and help you overcome the obstacles which have prevented you from achieving the results you strive for.

To learn more about Beth Ellen’s background or to sign up for her personalized programs click here.

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New Diabetes Treatment Guidelines Flawed


New Diabetes Treatment Guidelines Lack Credibility:

Recently the American Academy of Clinical Endocrinologists issued new treatment guidelines for treating Type 2 Diabetes. Complex medical guidelines are often referred to as a treatment algorithm. One of the stated goals of the AACE algorithm is to focus primarily on the theoretical ability of the diabetic medications to control blood sugar while ignoring the cost of the medication. The rationale to this approach is that controlling blood sugar with more expensive drugs will cost less in the long run since patients will be healthier and have less complications due better control of the blood sugar. On the surface this philosophy seems sound but digging beneath the surface reveals dangerous flaws in this thinking.

1. The first assumption, that newer medications for diabetes are better than older drugs is unsubstantiated. In fact there is ample evidence that newer diabetic drugs are no better than the older drugs for controlling blood sugar. The latest study finding no benefit of the newer diabetes medications is the FIELD study conducted outside of the U.S. This study showed that 5 years of treatment with the older diabetic drugs (sulfonylureas, metformin and insulin) resulted in adequate and prolonged control of blood sugar. In 2007 researchers from Johns Hopkins Bloomberg School of Public Health summarized the results of major studies using older and newer anti-diabetic medications and found no significant benefit of the newer medications.

2. The next assumption, that cost is not a key factor in treatment success contradicts most clinicians’ experience in diabetes care. It is clear to me, that patients are far less likely to comply with using expensive drugs than medications they can more easily afford. Looking at the numbers reveals the vast cost differences between the older (generic) versus the newer (brand) medications. Using figures provided by a local pharmacy I found that the retail cost of a typical two drug therapy for diabetes using older drugs is $59 per month. The retail cost of using two of the new drugs for a month ranges from $481 to $570. In more severe diabetes three drugs per day may be needed. The low cost alternative amounts to $185 per month while the high end alternative with new drugs is $610 per month. Looking at the cost of using insulin shows a similar vast cost difference between the older and newer drugs. Older forms of insulin may cost $100 for a month’s supply while a similar course of therapy with the newer insulin preparations will cost almost $250 per month. How many people will be willing and able to afford the new versus the old drugs, particularly knowing that there may be no health benefit to the more expensive drug combination?

The end result of not being able to afford these prices is non-compliance with medications and the result of non-compliance is higher costs passed on to the medical system. The Medco study from 2005 showed that the least compliant patients were more than twice as likely to be hospitalized compared to the most compliant, and that the yearly cost of caring for non-compliant patients is double that of compliant patients.

3. My next point is possibly the most contentious. The AACE guidelines were produced by a committee of physicians chaired by two distinguished endocrinologists, Dr. Paul Jellinger and Dr. Helena Rodbard. Both doctors are highly respected and accomplished. They are also both highly compensated consultants to the pharmaceutical companies which market the newest generation of diabetes medications. In the disclaimer attached to the committee’s recommendations, both Dr. Jellinger and Dr. Rodbard admit to consulting arrangements with virtually every one of the pharmaceutical companies whose interests are effected by their committee’s findings. I too am a consultant to many of these same companies (at least, until now), but I am not responsible for developing national guidelines for diabetes care. In my opinion the close association of both committee chairmen to the pharmaceutical companies detracts heavily from the credibility of their recommendations. The need for credibility is even more important when the AACE committee advises physicians to avoid using sulfonylureas, the only class of drugs not marketed by any of the big pharma companies. and which also happens to be the cheapest drug class, the drugs with the longest history of use, and the class of drugs many regard as the most effective at lowering blood sugar levels. The sulfonylurea class of drugs is so effective at lowering blood sugar, in fact, they are used as the gold standard by which the effectiveness of all new diabetic medications are compared.

4. In contrast with the AACE, the American Diabetes Association (ADA) has issued more conservative guidelines for diabetic therapy, preserving the role of the older generic drugs. My recommendation is that AACE go back to their committee and reconsider the way they have produced their algorithm. Appointing new leadership whose credentials do not lend themselves so readily to skepticism, would be an important first step in that process.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

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Thank You for Understanding; By Gary Pepper, M.D.


Debbi and Terri:

The Comments section at metabolism.com is a place where members have the opportunity to get their questions and opinions posted to the homepage for maximum visibility. Every day thousands of people have the opportunity to see what is on your mind. I try not to intervene too much in Comments so people feel free to say whatever…including what may seem negative about the website.
Everyday, Chris (our webmaster) and I review the Comments section several times. I try to find topics that have general interest which I then turn into a blog. I hope you have noticed that many member questions wind up in my main blog. It takes me a lot of time and effort to prepare a meaningful blog post. I also try to choose a wide variety of issues to cover the whole spectrum of metabolic issues, from the Armour Thyroid crisis, to diabetes care, to smoking cessation, weight loss, low testosterone, Vitamin D, estrogen replacement, osteoporosis, adrenal disease etc.
There is a serious shortage of Endocrinologists and the situation is going to get worse before it gets better. At metabolism.com I try to share my experience with as many people as I can even though I can’t get to every question. I regret if it appears I am ignoring anyone’s concerns.

Many of my opinions run counter to the medical establishment so I am not universally appreciated by my peers. But by countering some of the less insightful policies of the medical establishment I think I reach people who have been left feeling hopeless by their healthcare professionals. My next blog on the flaws in the latest Diabetes Treatment Guidelines recently released by my professional society, is probably going to make me even less popular at my next professional meeting.

Many thanks to you and other members of Metabolism.com for your support. And thank you for understanding the mission and limitations of Metabolism.com.

All the best,
Gary Pepper, M.D.

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Low Testosterone May Signal Serious Medical Conditions


Dennis is a middle aged man with a testosterone of 70. He suffers with weakness, muscle aches, soreness of the breast, and carries a diagnosis of fibromyalgia. He inquires if treatment with testosterone will benefit him (see his inquiry in our Comments section).

While I cannot offer medical advice on this website I can make some general comments that may be helpful. In my medical practice I see many men of this age with low testosterone. Usually the testosterone levels are in the low 200’s or slightly less. Symptoms of moodiness, fatigue, weakness, low motivation, and loss of sexual interest and function are the most common complaints. Evaluation for causes of low testosterone usually reveals a failure of the pituitary gland to make enough gonadotropins, the hormones that cause the testicle to manufacture testosterone. In almost all these cases the pituitary gland appears otherwise normal. Many of these men are started on testosterone replacement and generally have a nice improvement in their complaints.

What concerns me about Dennis is that a level of testosterone of 70 is extremely low and can suggest more unusual causes of low testosterone. Tumors of the pituitary gland, injury to the testicle, or rare genetic defects (usually discovered in childhood), cause testosterone levels as low as this. Alcoholic liver cirrhosis may also have similar effects. The fact that his breast is tender is another clue that this is a severe form of testosterone deficiency. My advice to Dennis is to have his V.A. doctors perform a full endocrine evaluation to make sure nothing else is causing the low testosterone. Giving testosterone replacement may only cover up the symptoms of a more significant medical condition.

I hope that helps. Dennis…let us know how this turns out.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com
The disclaimer of metabolism.com applies to this and all of my posts.

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Can Adkins Help When Stopping Smoking?


Amie wonders whether the Adkins Diet is the way to go for those who want to avoid weight gain after stopping smoking. Just yesterday one of my patient’s admitted she would rather face lung disease than gain the 20 lbs. she fears would result if she stopped smoking.

Here is what Amie has to say:

POSSIBLE SOLUTION: I have only quit for a month and so far (with ridiculous excersize and dieting) only gained 4lbs. I’m only 5ft tall and I can’t afford to gain much more. My co-worker (age 38 smoker for 17years) quit a year ago and gained 20lbs. Last April of 09 she went on the Atkins diet and lost almost 35lbs WITHOUT EVEN EXERCISING! She looks great and has been able to keep the weight off. Has anyone else had success with Atkins? If not it’s worth a try since nothing else is working. If I gain another pound I’m going on it. Good luck!

Amie

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Can Eating Carbs Reduce Food Cravings?


In a new book, The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, the authors Judith J. Wurtman, PhD and Nina T. Frusztajer, MD, propose that eating carbs before a meal can actually help weight loss efforts. The connection between carb consumption and appetite suppression is due to a change in brain chemistry that occurs when carbs are eaten before a meal. Their theory is supported by independent research conducted by the authors.

I am intrigued by this new concept because until now I have always considered carbs an appetite stimulant because of their action to raise insulin levels which can then cause blood sugar levels to drop a few hours later, resulting in relative hypoglycemia (low blood sugar) which is a powerful trigger to more eating.

Thanks to the authors and their publisher we are able to provide an excerpt from the book The Serotonin Power Diet, and you can decide for yourself if this is an idea you would like to pursue.

Serotonin: What It is and Why It’s Important for Weight Loss
By Judith J. Wurtman, PhD and Nina T. Frusztajer, MD,
Authors of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain

Serotonin is nature’s own appetite suppressant. This powerful brain chemical curbs cravings and shuts off appetite. It makes you feel satisfied even if your stomach is not full. The result is eating less and losing weight.

A natural mood regulator, serotonin makes you feel emotionally stable, less anxious, more tranquil and even more focused and energetic.

Serotonin can be made only after sweet or starchy carbohydrates are eaten.

More than 30 years ago, extensive studies at MIT carried out by Richard Wurtman, M.D., showed that tryptophan, the building block of serotonin, could get into the brain only after sweet or starchy carbohydrates were eaten. Although tryptophan is an amino acid and found in all protein, eating protein prevents tryptophan from passing through a barrier from the blood into the brain. The reason is simply numbers: Tryptophan competes for an entry point into the brain with some other amino acids. There are more of those other amino acids in the blood than tryptophan after protein is eaten. So in the competition to get into the brain, tryptophan is at a total disadvantage and very little gets in after a protein meal like turkey or snack like yogurt.

But carbohydrates tip the odds in tryptophan’s favor. All carbohydrates (except fruit) are digested to glucose in the intestinal tract. When glucose enters the bloodstream, insulin is released and pushes nutrients such as amino acids into the cells of the heart, liver and other organs. As it does this, tryptophan stays behind in the bloodstream. Now there is more tryptophan in the blood than the competing amino acids. As the blood passes by the barrier into the brain, tryptophan can get in. The tryptophan is immediately converted to serotonin, and the soothing and appetite controlling effects of this brain chemical are soon felt.

Our studies with volunteers found that when people consumed a pre-meal carbohydrate drink that made more serotonin, they became less hungry and were able to control their calorie intake. Volunteers whose drinks contained protein — so that serotonin was not made — did not experience any decrease in their appetite.

Most of us have experienced the carbohydrate-serotonin effect on our appetite even though we were not aware of the connection. Have you ever munched on rolls or bread while waiting for the main course to be served in a restaurant? By the time dinner is served, twenty minutes or so after you ate the roll, your appetite has been downsized. “I don’t even feel that hungry” is a common response when the plate is put down on the table.

This blunting of appetite is not because you may have eaten 120 calories of roll. It is caused by new serotonin putting a brake on your appetite.

Successful weight loss depends on the power of serotonin to control food intake.

The carbohydrate-serotonin connection has a direct impact on our emotional state, too. Drugs that increase serotonin activity have been used for several decades as a therapy for mood disorders. However, our studies showed that natural changes in serotonin could have a profound impact on daily fluctuations in mood, energy levels and attention. In one of our early studies, we found that our volunteers became slightly depressed, anxious, tired, and irritable around 3 to 5 pm every day. At the same time, they experienced, in the words of one volunteer “a jaw-aching need to eat something sweet or starchy.” Several studies later, we were able to state that late afternoon seems to be a universal carbohydrate-craving time, and people who experience this craving use carbohydrates to “self-medicate” themselves. Carbohydrate cravers who consume a sweet or starchy snack are increasing serotonin naturally.

We carried out careful clinical studies to measure the effect of carbohydrates on mood and to make sure that the effect was not just due to taste or the effect of taking a break from work. Volunteers, all carbohydrate cravers, were given a carbohydrate or protein- containing food or drink that had identical tastes. Their moods, concentration and energy were measured before and after they consumed the test beverages. The carbohydrate serotonin-producing beverage improved their moods but the protein-containing beverage had no effect on either their mood or their appetite.

Eating carbohydrates allows serotonin to restore your good mood and increase your emotional energy.

Eating low or fat-free, protein-free carbohydrates in the correct amounts and at specific times potentiates serotonin’s ability to increase satiety. You will eat less, feel more satisfied and lose weight.

Here are five tips to get serotonin working for you:

Eat the carbohydrate on an empty stomach to avoid interference from protein from a previous meal or snack. Wait about 3 hours after a meal containing protein.

The carbohydrate food such as graham crackers or pretzels should contain between 25-35 grams of carbohydrate. The carbohydrate can be sweet or starchy. High-fiber carbohydrates take a long time to digest and are not recommended for a rapid improvement in mood or decrease in pre-meal appetite. Eat them as part of the daily food plan instead for their nutritional value.

The protein content of the snack should not exceed 4 grams.

To avoid eating too many calories and slowing down digestion, avoid snacks containing more than 3 grams of fat.

Do not continue to eat after you have consumed the correct amount of food. It will take about 20-40 minutes for you to feel the effect. Eating more carbohydrates during the interval is unnecessary and may cause weight gain.

Stress may increase your need for serotonin and make it harder to control food intake. Prevent this by shifting protein intake to the early part of the day; i.e. protein for breakfast and lunch and switching to carbohydrates by late afternoon. Eating a carbohydrate dinner with very little protein increases serotonin sufficiently to prevent after dinner nibbling. And the soothing effect of the serotonin prevents stress from interfering with sleep.

Boost Serotonin to switch off your appetite and turn on a good mood.

©2009 Judith J. Wurtman, PhD and Nina T. Frusztajer, MD, authors of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain

Author Bios
Judith J. Wurtman, PhD, co-author of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, has discovered the connection between carbohydrate craving, serotonin, and emotional well-being in her MIT clinical studies. She received her PhD from George Washington University, is the founder of a Harvard University hospital weight-loss facility and counsels private weight management clients. She has written five books, including The Serotonin Solution, and more than 40 peer-reviewed articles for professional publications. She lives in Miami Beach, Florida.

Nina T. Frusztajer, MD, co-author of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, counsels private weight management clients and is a practicing physician and certified professional life coach. She received her master’s degree in Nutrition from Columbia University and her medical degree from George Washington University. She lives in Boston, MA.

For more information, please visit www.SerotoninPowerDiet.com and Amazon.com.

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Buying Medicine Off the Internet: Look Before You Leap


Some of our members are suggesting that buying medication off the internet is the way to get around the Armour Thyroid shortage in the U.S. and elsewhere. Although there are sources of genuine high quality dessicated thyroid available, I am recommending that a thorough investigation be conducted before making an internet purchase of thyroid medication or any medication, for that matter, particularly from less developed nations.

I found this brief item on an Australian Health blog which highlights one potential danger of buying drugs from Thailand on the internet:

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A 20-year-old patient was referred for management of anxiety and polydrug misuse. The patient related that anyone could be a misuser and pusher of drugs without relying on illicit suppliers of such drugs or “doctor shopping”. A click of a mouse could supply whatever drug a patient wanted from online pharmacy services available 24 hours a day. These sites are easy to use and often require little more than a credit card number to gain access to a wide range of prescription drugs, such as diazepam, alprazolam, temazepam, methylphenidate, morphine and codeine.
The patient had a 2-year history of using large amounts of zolpidem, temazepam, alprazolam and diazepam with alcohol, as well as regular use of marijuana. These medications were originally obtained by doctor shopping for prescriptions. However, while researching these medications on the Internet, our patient discovered the online pharmacies that dispensed prescription medication without a script. Zolpidem, oxycodone and methylphenidate were all ordered by the patient from online pharmacies based in Mexico and Thailand. He “surfed” the Internet for the site with the cheapest drugs and found one that sold 100 zolpidem, his drug of choice, for US$70.00, with a delivery charge of US$5.50. He was able to order quantities of 100, 200 or 500 tablets. It took 2 weeks for the discreetly packaged drugs to arrive at the patient’s door.
The patient volunteered this information during therapy for drug addiction and was quick to see the negative implications. After a period of counselling about the causes of medication misuse, he was motivated to cease further ordering and willing to undergo drug detoxification.
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Although I have been accused by members of this blog of being ignorant for advising extra caution when purchasing drugs on the internet, I stand firm in my opinion that you need to know exactly what is in the pill you are about to swallow.

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Wondering if t4 (Synthroid) Treatment of Hypothyroidism is the Answer


Prosanta asks metabolism.com if her thyroid blood test results indicate that treatment with t4 is required. I suspect that she is also wondering if other forms of treatment might be better (Armour Thyroid for example).

Here is what Prosanta writes:

Iamsuffering from Diabetes type2.recently on routine Blood test—
FT3(ECLIA) 2.33pg/ml
FT4 1.07ng/ml
TSH 9.32microIU/ml
AntiThyroid Peroxidase 37.02IU/ml
Do I need to take only Levothyroxine

In response to her question I offer my thoughts on whether someone beginning with thyroid hormone replacement therapy should start with t4.

Hi Prosanta

You know I can’t recommend medical therapy in this forum. I can make some general comments, however.

There is debate among endocrinologists about what level of TSH indicates a clinical degree of thyroid deficiency, but there is no doubt that a TSH of 9 is abnormally high. Since elevated TSH almost always indicates that the pituitary gland is releasing excessive TSH in response to thyroid hormone deficiency, unless there is a pituitary tumor (exceedingly rare), replacement therapy with thyroid hormone is indicated.

Thyroid hormone replacement therapy in the U.S. usually consists of taking a pure t4 product such as Synthroid or levothyroxine (generic t4). On this website you will notice extensive posting about treating hypothyroidism with alternative forms of thyroid hormone replacement, particularly desiccated thyroid products such as Armour Thyroid. An appropriate concern in a situation like yours is whether to take t4 only or to use desiccated thyroid or t4 plus t3 therapy.

If you are like most people in this country being treated with t4, you will wonder why someone might need alternative forms of thyroid hormone replacement. In the past year or so researchers have discovered that a portion of the population lacks the ability to normally metabolize t4 into the highly biologically active t3. This means that affected individuals may continue to experience symptoms of thyroid hormone deficiency when treated with conventional t4 therapy [http://www.metabolism.com/2009/11/07/breakthrough-discovery-thyroid-hormone-therapy-part-2/ ]. How does a person know if they won’t respond to t4? The simpliest approach is to try t4 and see how you feel. Then you and your doctor can decide whether you are a t4 responder or not.

You may be aware that Armour Thyroid and similar products are in very short supply in the U.S. Even if some advocates of desiccated thyroid therapy for hypothyroidism argue that only desiccated thyroid can result in a full return to normal, in my opinion the present shortage makes t4 therapy the clear initial choice. If symptoms of hypothyroidism persist even after a full course of t4 has been tried, then you may be forced to join the ranks of those struggling with the pharma industry to get desiccated thyroid products.

Please discuss these ideas with your own physician.

The disclaimer and terms of service of metabolism.com applies to this and all my posts on this website.

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