Another misconception about PCOS is that it only occurs in overweight women. Obesity is common in PCOS but thin women are also capable of developing PCOS. The underlying hormone problems are complex but are thought to be at least in part due to high insulin levels in the blood resulting from insulin resistance. With insulin resistance the body requires high levels of insulin due to insensitivity of the tissues to insulin’s presence.
What treatments are available for PCOS? There are very few, if any, drugs specifically approved for the treatment of PCOS. This is probably because of the low profit potential for treating this disorder. Drug companies cannot afford to invest millions of dollars in research because almost all of the existing standard therapies are generic drugs. Some of the most useful medications for treating PCOS are drugs used to treat type 2 diabetes because of their effect to reduce insulin resistance. These drugs are metformin and Actos. Metformin is the most popular oral medication for diabetes treatment in the U.S. Actos has been available for about 10 years but due to recent negative publicity about an unproven risk of bladder cancer, its popularity is declining. Neither drug is approved by the FDA for treatment of PCOS but multiple studies confirm the clinical and hormonal benefits of using these medications in this disorder. In 2011 research was published in the Journal of Clinical Endocrinology and Metabolism suggesting that the generic cholesterol lowering drug, simvastatin may also show benefits similar to metformin for the treatment of PCOS.

In the late 1980’s, I along with Dr. Lester Gabrilove at Mt. Sinai Hospital in New York, published our research showing that an anti-fungal medication, ketoconazole, could reverse the hormonal, physical and metabolic problems associated with PCOS. Due to the potential toxicity of ketoconazole this therapy never gained wide spread acceptance. The manufacturer refused to fund additional studies to determine how to more effectively use this drug, due to the low profit potential and liability concerns.

This information is strictly for educational puroses. Due to high risk of toxicity of medical therapy in young women who can potentially become fertile under treatment for PCOS, no drug should be taken without the close supervision of a physician. The reader agrees to the Terms of Service of this website, metabolism.com

Maintaining ideal body weight with diet and exercise is also crucial for avoiding diabetes and prediabetes.In overweight adults for each2.2 pounds(1 kilogram) gained per year the risk of developing diabetes increases about 50% over the next ten years. By losing 2.2 pounds per year the risk of developing diabetes is reduced about33% for the next 10 years (J Epidemiol Community Health. 2000; 54(8):596-602).

Speak to your healthcare professional to find out if you are at risk for developing diabetes and to learn ways you can avoid it.

Gary Pepper M.D.

Editor-in-Chief, Metabolism.com

The terms of service for metabolism.com apply to this and all posts; http://www.metabolism.com/2008/09/06/terms-conditions-service-agreement/

Here’s what SweetiePie has to say;

Hello:

55 Year old female here, 200 lbs, hypothyroid smoke free for 6 months. Feeling great about being smoke free and this time its permanent and for real.

I have quit smoking and relapsed so many times in my life. And dieting, on again and off again for 40 years. Pfffft…..This time what prompted me to go to the doctor and quit was that my heart feels heavy and hurts sometimes. Not angina yet, but scary and depressing. I’m fine, it turns out, but I definitely needed to quit smoking and still need to exercise more and lose weight . I am no expert in the weight loss department, having had limited success with that over the years. I can see from this interesting thread that I am not as weight conscious as most of you, but I still thought I’d share what my doctors told me because it may help and inspire you the way it did to me: When I tried to bring up the weight gain and the overweight with doctors heres what they said: CARDIOLOGIST told me I’d have to be about 100 lbs over my ideal weight of 145 for the weight to be as stressful and damaging on my heart and cardiovascular as SMOKING, GP #1 told me the key was, instead of focusing on an ideal weight and size, was to focus on preventing DIABETES through NONSMOKING, AND EXERCISE just as important as wholesome diet, and GP #2 (I moved and needed a new doctor for my thyroid perscription) told me, after my bloodwork tested all ok, “why don’t you just forget about losing weight for a little while and focus on quitting SMOKING? Well, I took all of that advice, and this time, it worked! I’ve really kicked the smoking habit and finally found freedom from that deadly addiction. The “permission” from doctors to stop beating myself up about my weight freed me up mentally to do what I needed to do (giving myself plenty of rewards, including food treats and being lazy treats!) in order to become smoke free and never going back! I am ready now to step up to exercise and weight loss this year with the same strategy: Increased exercise first, food modification instead of deprivation. The reason for my post is to say stick with it but your QUIT is SO IMPORTANT – don’t ever let your desire to be thinner or to get back down to an ideal outweigh your resolve to stay SMOKE FREE. SMOKING is the singlemost damaging behavior -don’t lose sight of that! Never take another puff! Oh, btw I gained about 5% while quitting and my first goal is to go back down 5%.

Chapter 1: What Is Metabolism? 9

Turning Food into Energy 10
The Importance of Hormones 11
Role of Metabolism in Weight Loss or Gain 14
Is My Metabolism Healthy? 16

Chapter 2: What Makes Your Metabolism Fast or Slow? 17

The Role of the Thyroid 22

Chapter 3: How to Increase or Decrease Metabolism 25

Problems with Losing Weight 25
Problems with Gaining Weight 34
A Pleasurable Exercise Routine is a Must 39

Chapter 4: Fact vs. Fiction—Smoking and Weight Loss 41

Chapter 5: Thyroid Treatment 47

How Are T3 and T4 Regulated? 48
Types of Thyroid Diseases 49
Hyper- and Hypothyroidism 49
Thyroid Nodules 51
Is Your Thyroid Nodule Hot? 53
Thyroid Treatments 54
Using Thyroid Function Tests To Diagnose Disease 56
Hyperthyroidism Treatments 57
Hypothyroidism Treatments 58
T3 Plus T4 Combination Therapy 59
How to Talk to Your Endocrinologist 66
The Recent Shortage of Armour Thyroid 67

Chapter 6: Diabetes Treatment 73

The Bad News—Major Stumbles in the Treatment of Diabetes 74
The Call for Tight Glycemic Control 74
2010 Diabetes Treatment Guidelines Lack Credibility 76
Setbacks in Diabetes Drug Development 81
The Failure of Inhaled Insulin 86
Dangerous Commercial Weight Loss Programs 87
Perhaps the Biggest Stumble of Th em All 89
The Good News—What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Incretins 95

Chapter 7: Hormone Treatments 99

Hormone Replacement Therapy—Estrogen 101
Heart Health 101
Breast Cancer 103
Benefits of Estrogen: Brain Function and Blood Pressure 104
Testosterone Replacement for Men 106
Testosterone Replacement Options 107
Benefits of Testosterone Replacement 108
Potential Risks 109
Human Growth Hormone in Adults 111
Diagnosing Growth Hormone Deficiency 113
Benefits of Growth Hormone Supplementation 113
Adrenal Fatigue: Fact or Fiction? 115

Conclusion 117

The Birth Of Metabolism.com 119
My Path Into Endocrinology 121
Recent Contributors On Metabolism.com 125

Appendix 1: Personal Nutrition Profile 127
Appendix 2: Ultimate Weight Gain Program 145
Appendix 3: Food Journal 165

Relevant Studies

Last week Helen, a friend of the family, called to brag she had lost 12 pounds in 4 weeks and also to ask if she had given herself cancer in the process. What was the connection between her supposed miracle metabolism and cancer? Helen was taking HCG injections and just read this hormone was somehow related to cancer. I reassured her that I didn’t think she was giving herself cancer by taking HCG but I did let her know that very soon she was likely to resume her normal metabolism and regain the weight she lost. Unfortunately her wallet was never going to recover what it lost in this process. Many services prescribing HCG treatment for weight loss are charging $400 or more for a course of treatment.

Now what about the cancer-HCG connection?

HCG is a hormone normally produced by the fertilized egg in the earliest stages of fetal development and then later by the placenta itself. Since rising HCG level is one of the earliest hormone changes during pregnancy, measuring this hormone is the basis for the everyday pregnancy test. HCG also causes the ovary to make progesterone which is essential for preparing the uterus to become a nesting ground for the developing embryo. HCG may also suppress immune function so that the fetus is not rejected by the mother’s immune system.

The placenta forms at the onset of pregnancy to support the developing embryo and later the fetus. If a sperm fertilizes an empty egg at the onset of pregnancy a Hyditidiform mole can arise in conjunction with or instead of the normal placenta. This is also referred to as a molar pregnancy. HCG levels can rise to extreme levels in the presence of the Hyditidiform mole particularly if it goes on to become an invasive cancer known as a choriocarcinoma. Body chemistry gets a little weird at this stage. HCG is slightly similar in structure to TSH, the pituitary hormone that stimulates the thyroid. The result is that when HCG levels are extremely high as with a molar pregnancy, the thyroid can be stimulated to make excess thyroid hormone resulting in hyperthyroidism in the mother. Typical symptoms of hyperthyroidism can occur including feeling hot, shaky, sweatiness, palpitations, vomiting (which can be severe) and diarrhea. Curing the cancer will cure the hyperthyroidism as well.

Other cancers of the reproductive system can make HCG as well. Certain testicular cancers can make HCG. Since HCG is the hormone responsible for a positive pregnancy test, testicular cancer can sometimes be diagnosed in men by a positive pregnancy test. For tumors making HCG, measuring levels of this hormone during cancer treatment can aid doctors in determining whether therapy is working or not.
Certain cancers are termed “hormone responsive”. That means the cancer will grow more aggressively in the presence of a particular hormone. Tumors that grow faster in the presence of estrogen include receptor positive breast cancer and endometrial cancer. A tumor that grows faster in the presence of testosterone is prostate cancer. Since HCG is likely to increase these hormones, it is conceivable that should a hormone responsive tumor already exist in the body it could grow faster during HCG treatment.

So Helen, I don’t think HCG is going to give you cancer, but it may cause you to grow a beard. Why is that? I’ll be explaining my theory in the next article, “HCG is a Hairy Hormone”. Visit metabolism.com for more on this, in the very near future.

Although this study shows a very high success rate, in the real world medical practice I have seen many people who are able to eat their way out of weight loss success after bariatric surgery. Eating small amounts of very high calorie food is still possible and unfortunately is not all that uncommon. Not to say that bariatric surgery is not helpful, because when it works the results can be spectacular, but as always the degree of motivation of the patient is crucial to success.

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

Beach Gal writes:

10 months on Nov 15!
Weight has plateaued at 15lbs gained. 48 years old with perimenopause too.
So here are my thoughts….you have to surrender to the fact you might gain some weight or even maybe alot. We’ve done years of damage to our metabolisms and it will take time to correct that. Also, surrender to the fact you might not be your size 6 or 8 anymore. So what? We don’t smoke. Nothing is more ugly than smoking. There are plenty of heavier women out there who embody beauty. Their spirit shines and they have confidence and self esteem. Smoking robs us of both. Have you ever tried dating online? NO ONE wants to date a smoker.
Anyway, single or married, it doesn’t matter. We matter. I have never laughed so much in my life as I have in the last 2 months. Really laughed. And this while I’m unemployed, my father has cancer, my dog died, and my boyfriend and I are on the rocks. We come first. Period.

Regarding weight…..if you have an “orange theory fitness” near you, join. It’s the cost of 1 month of smoking and will reinforce your quit. Great for us gals in our 40′s 50′ and 60′s too. They know how to get your metabolism cranking. 3 days a week. And could you be drinking a little more wine than usual? I found that I started drinking too much wine….and i don’t even like wine. So had to cut that out!

Here is what V has to say about quitting the cigarette habit:

I agree that the weight was the worst thing. As unhappy as I am about the weight, I am so very happy that I have been quit for 1 year now. With the money I have saved, I have picked up some other hobbies that I enjoy so much, that I would never be able to afford by wasting my money on cancer sticks daily. And, not to mention the health benefits, like being able to breathe, by not sucking down those stupid things. I feel so free when I watch or listen to people scramble trying to figure out how long the cigarettes they have in their pack will last because they don’t have the money or the time to get to the store for another pack, or they can’t wait to leave a non-smoking establishment. I’m not unhappy because I’m fat, it’s just a minor set back. Maybe there are days I get upset over it, but it doesn’t cause me to be an unhappy person. I hope you can overcome your fear of whatever weight gain you may have (it is different for everyone).

Lizzy adds her experience:

Elisa, the benefits of quitting are unreal. I have my first cold since this all happened, yes I still have the weight gain, its not been a year quite yet and I have to say this cold is quite different then I have ever had, it has not settled into my lungs. The weight has leveled off and it seems i am turning the fat into muscle by walking so much. Elisa you have gotten over the nicotine in the system, you need to cut the habit of hands and grabbing, you will be fine, not all people gain 40 or 50 pounds. I have always been a size 6 and now a 12 to 14 and yes that’s killing me, but it too will pass, i have never breathed so deeply in my life. i have never smelt things quite the way I smell them now, and wow food is so different too. You will gradually find out all these things. Honestly the worst thing was the weight gain, but the other benefits make up for some of that.

Dana writes:

I was diagnosed as hypo a few years ago and my doctor just added 25 mcg of liothyronine (Cytomel) along with 100 mcg of Synthroid. In the past year I have gained 35+ pounds and it’s been alomost impossible to take it off. Last year I competed in my very first fitness/ figure competion. At 135lbs I came in 2nd place. I play softball and basketball on competitve level teams for the psat 15 years and I run about 3-4 times a week. I eat relatively healthy and have recent gone gluten-free, soy free, and nitrate free. Today is my very first day on the combined T3/T4 thereapy. I steppeed on my scale and it said 174lbs. Im hopeful that not only my weight will decrease but my hair will stopp shedding, dry skin/ scalp, joint pain, hopelessness and depression, and fatigue will all go away. I know patience is the key so I will be patient and wait.

My response:

Hi Dana

As you read here, some people are unable to return to normal thyroid equilibrium on t4-treatment alone; this may be due to an inherited form of enzyme defect preventing the normal conversion of the t4 hormone into the more potent t3 hormone; I am happy you found a doctor who will prescribe T3. Sometimes this needs to be given twice daily since t3 is a short acting hormone and the benefit may wear off within 6 to 8 hours. Some people don’t notice this while others definately do.
Good luck with your treatment. Also remember, thyroid hormone allows you to lose weight normally but doesn’t make weight “melt off”. You still have to do the right things with diet and exercise but at least your efforts should start paying off.
Good luck.

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

The other established diabetes medication generating new warnings is Actos (pioglitazone). I have written a number of articles on the sister drug Avandia, defending its usefulness despite possible cardiovascular risks, but the cancer warning for Actos is a new angle on this class of drugs (thiazolidinediones). Actos has been withdrawn in France due to concerns that it may cause bladder cancer but no such action has been taken in the U.S. The FDA this month did issue a warning that individuals with bladder cancer or at risk for bladder cancer, should be advised not to use Actos. If Actos is hit hard by these actions this whole class of diabetes drugs will have been eliminated from use.
A sure sign of trouble for Actos is that a “google search” for Actos is now showing lawyer websites as the first 5 citations.

Being sick is dangerous. Treating illness also has dangers. I am concerned that our cultural zeal for uncovering scandals and for pursuing litigation will lead us to sterile treatment options and doctors who are unwilling to risk helping.

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

Zach writes:

Hi everyone. From what I can gather, most posters here are women, well I’m a guy with similar problems. I thought my story might be useful so that men don’t think it’s a women only problem. I gained a hypothyroid diagnosis at the age of 25 due to Hashimodo’s. There was no direct cause, it runs heavily in my family. For a year, or two, maybe even three (it’s hard to tell due to widespread symptoms), I was feeling nervous, bad memory, attention problems, sleep problems, low appetite, and easily fatigued from a normal 8 hour work day. I assumed my lifestyle choices were causing these symptoms so didn’t go to the doctor for years.

Finally when I was diagnosed I was put on levothyroxine. The very first day I took it I felt IMMENSLY better. However, months down the road the symptoms gradually built up again. Every time my dose was raised, I would feel better for about 2 days, but the symptoms would gradually return. My endo decided to drop my T4 dosage and put me on a combo T4/T3 (T4 was dropped by 50 mcg and one quarter of the drop was added in as T3, so 12.5 mcg of T3). This is the first day I’ve tried it, and instantly the morning of starting on T4/T3 my body aches have almost disappeared and I am feeling much less sleepy at my desk during work.