Monthly Archives: August 2010

The “HCG” diet…. the controversy continues.


I received several inquiries about the “HCG” diet and my first response is a question in itself.  “Do you know what HCG is?”  So far there has been no lay person that actually knew what HCG was or what the diet entailed.  I will make just a few brief remarks to start the conversation and you can add comments as we go.  First of all, HCG is “Human Chorionic Gonadotropin” hormone.  It is made either by a developing embryo, the woman’s placenta while pregnant (!) or by a tumor in the human body.  Think about whether or not that is something you want to take into your body!  Second of all, the original “HCG diet” is based on a 500 Calorie per day diet that is severely restricted and nutrient deficient.  Weight loss without appropriate nutrition support is a recipe for a detoxification disaster that can do much more harm than good.  So, let us know what you think of ingesting a hormone made by a tumor or  during pregnancy, while starving yourself on a nutrient deficient diet! OR consider a professional nutrition consultation here at Metabolism.com that will walk you through the steps necessary to achieve balance and healthy weight loss without any gonadotropin!

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Growth Hormone Deficiency Tied to Obesity and Accelerated Aging in Young Adults


Due to the potential for abuse and high cost, growth hormone treatment in adults is the subject of much controversy. I believe that treating adults with growth hormone deficiency is many times an appropriate and beneficial choice. Firming up my conviction for treating adult growth hormone deficiency is a recent study conducted in the Netherlands and UK published in the Journal of Endocrinology and Metabolism (JCEM 95:3664-3674, 2010). The researchers compared Body Mass Index (BMI), waist circumference, triglycerides, and HDL (good cholesterol), between normal adults and those with low growth hormone levels due to deficient pituitary function (hypopituitarism). All measurements of obesity and lipid metabolism were significantly worse in the young adults (younger than 57 years) with growth hormone deficiency compared to normal adults of a similar age.

As I pointed out in previous articles at metabolism.com, growth hormone levels naturally decline as we get older. The authors of the present study note that growth hormone levels decline 14% per decade in adults. I conceive of this as one of the ways nature gets rid of us after we complete our biological/reproductive functions, since without growth hormone our muscles, immune and nervous systems, decline, leading to death. It’s planned obsolescence… what is typically referred to as aging. In the recent study senior citizens have equivalent levels of obesity and abnormal lipid metabolism as young adults with growth hormone deficiency. The authors note the effect on the body of growth hormone deficiency in young adults is equivalent to 40 years of aging. The theory that growth hormone functions to preserve our tissues during youth and aging results from its absence, appears confirmed by these results.

Most normal young adults aren’t growth hormone deficient and the population that would qualify for growth hormone treatment from this group is small. What about older adults with low growth hormone who are troubled by the “natural” decline in their body function? Should or could we treat this much larger population with growth hormone? It is my experience that private and federal insurers will not pay for this treatment regarded as “cosmetic”. On the other hand, there will be physicians who will comply with a request for growth hormone treatment from individuals who possess enough cash and motivation. Less affluent or determined individuals will have to contend with natural aging just as our ancestors have done for thousands of years.

This information is for educational purposes only and is not intended as medical advice or treatment.

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

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Chubby Neck Becomes the New Normal


After reading the latest research on the metabolic hazards associated with chubby necks I am more sensitive to the size of people’s necks then ever. Of course I look at the size of my patient’s neck but people who I pass in the street or supermarket may find me staring. Watching TV a few days ago I was startled by a series of people in one commercial for Quicken Loans who definitely qualify for the metabolic high risk category based on neck chubbiness. One after another the characters in this commercial walk on, outdoing each other in this physical trait. Has the chubby neck become the new normal? If so, the incidence of diabetes and heart disease is sure to continue to rise.

Let me know if you agree with my impression, or am I biased by being an endocrinologist?

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

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Large Neck Size Equals Big Metabolic Problems


Large Neck Size Equals Big Metabolic Problems:

A bulging stomach is widely accepted as a sign of poor metabolic health. A recent study published in the August Clinical Endocrinology and Metabolism (95:3701, 2010), finds a chubby neck is likely to hold even a worse prognosis for metabolic health.

The research team evaluated the relationship between waist circumference and neck circumference with levels of blood sugar, good cholesterol (HDL), bad cholesterol (LDL), triglycerides, and insulin resistance, as well as blood pressure. What was found was that neck circumference was a better predictor than waist circumference of elevated blood pressure, LDL, triglycerides and insulin resistance, with lower levels of HDL. All this amounts to a greater risk of cardiovascular disease as neck size increases. As an example, an increase in neck circumference of about one inch is expected to result in a 2.5 point rise in blood pressure.

The authors point out that the neck circumference was a more accurate predictor of cardiovascular risk in women than men. The average neck size for men in this study was about 16 inches (40.5 cm) and about 13.7 inches for women (34 cm).

Alfred Hitchcock, the famous director of suspense movies, made a trademark of his corpulent silhouette with bulging chin and abdomen. Thanks to this research we know his silhouette can signify more than a movie that will thrill you but also a metabolism that will kill you.

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

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Trying to Cope with Symptoms of Low Testosterone


One of our members notes loss of sex drive, strength, motivation. He is concerned that this could be due to low testosterone levels;

Here is his comment;

I’m 64 years old. Excellent health. 6 ft tall, 177 pounds, work out three times a week…….finding my self depressed, losing strength…..haven’t had any sexual desire in last 3 years……..I use the VA for all my health issues. My doctor said he tested my levels and they were normal, but he wouldn’t let see the results. Based on my info could someone tell me what my level should be at. Also, I noted someone said they got tested free…how is that ?? My only option without paying is to use the VA, and I’ve already noted that experience. Thank You.

My reply:

My first thought is to find out what the actual testosterone level is, as well as free testosterone. A doctor that refuses to share a patients lab results with them has lost credibility. Many “normal” results are subject to interpretation but the doctor may not want to be bothered explaining the finer points of diagnosis. This applies to many medical conditions but is particularly common when diagnosing low thyroid or gonadal (testicular) function. Additional testing may be necessary to make the diagnosis. If any of the pituitary hormones, prolactin, LH or FSH are abnormal then testosterone levels could be in the “normal” range and yet the patient can be suffering from significant disease. Finally, it is still possible that symptoms like those you describe are not related to testosterone deficiency and a search for other medical explanations seems appropriate.

As far as getting free testing for medical conditions I am not able to provide a clue. Perhaps one of our members knows of a way and I would welcome their comments.

Best of luck.

Dr. Gary Pepper, Editor-in-Chief, Metabolism.com
These comments are for informational purposes only and are not intended as medical advice or therapy.

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