Eric writes:

The entry Eric, Metabolism.com member, explains why T4 only doesn’t work was published at Metabolism Blog . Get the Metabolism book from the same author.

Most physicians and nutritionists will advise against having too much fat in the diet for a number of reasons. First, and most obvious, fats have lots of calories. In addition dietary fat can increase the bad cholesterol (LDL) content of the blood leading to increased risk of heart attack and stroke. Among the different kinds of fat that raise LDL the worst are the saturated fats. One tablespoon of coconut oil contains about 120 calories with about 90% of the coconut oil being saturated fat.  In fact the saturated fat, palmitic acid, takes its name from the plant that produces coconuts, the palm tree. Compare this to the fat in dark chocolate which is 30% oleic acid, the healthy monounsaturated fat found in olive oil.

Oils which are far more beneficial for preparing foods are unsaturated fats including the monounsaturated and polyunsaturated fats. I like canola, safflower and olive oil due to their high content of these healthier fats.

Coconut oil has many other applications which are useful outside the body. It can be used as a diesel fuel, deodorant, insect repellent, to make soap, and as a moisturizer for hair and skin.  My advice is to think twice however, before supplementing your diet with it.

The entry Coconut Milk as Health Food? You’ve Got to Be Kidding. was published at Metabolism Blog . Get the Metabolism book from the same author.

Evolution tells us that we were born to eat. The earliest creatures in the world’s history were simple eating machines. Their bodies consisted of an entrance for food, a digestive tract and an exit for refuse. In order to become more efficient at getting food creatures developed a system to locate food and to move toward it. This system is known as a nervous system. The first creature to have this ability is the worm. Eventually the nervous system controlling the digestive system (enteric nervous system) began to sprout nodes which were early brains.  As time went on and the brain became better developed it split off from the nervous system that controlled the digestive tract. Everything that followed in evolution, has served the purpose of developing  increasingly efficient brains (central nervous system) for acquiring the fuel of life.

Another example of how deeply connected the gut and brain are, is to look at the development of the fetus. When a human fetus is still just a lump of jelly, the digestive  and nervous systems are one structure. Soon this organ splits into two, one to become our gastrointestinal tract and the other the brain and spinal cord (central nervous system). Even though they become physically separated the chemical signals used by the gut and nervous system remain virtually identical. These chemicals comprise the groups known as neurotransmitters and hormones.

The same chemicals in the digestive tract that cause the intestines to twist and convulse (peristalsis), in the brain stimulate the emotion of anxiety. This explains why people get “butterflies” in the stomach or diarrhea when they are nervous.  The brain chemicals involved in depression can cause constipation.  The syndrome of irritable bowel disease (IBS) with its cycles of diarrhea and constipation is thought to be a reflection of an emotional rollercoaster.  The chemical relationship between mood and appetite is even more complex but no less real. One of the most common side effect of mood altering drugs is increased appetite and weight gain. Just ask anyone who has been on an anti-depressant drug such as Prozac, Zoloft or Abilify.  The chemical in marihuana that gets people high is famous for triggering the eating binge called “the munchies”.

Appetite suppressant drugs often have effects on mood and can be the source of major side effects. One new generation of appetite suppressants being developed, Acomplia, failed to be approved by the FDA because it caused severe depression and suicidal thinking.

In the next part of this series we will look at ways we can influence the brain to control our appetite.

The entry Why Emotions Trigger Food Cravings was published at Metabolism Blog . Get the Metabolism book from the same author.

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

The entry Polycystic Ovarian Syndrome Is Common in Adolescent Girls was published at Metabolism Blog . Get the Metabolism book from the same author.

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%.

The entry SweetiePie Doesn’t Need a Shrink to Quit Smoking was published at Metabolism Blog . Get the Metabolism book from the same author.

My boyfriend is in his early 40′s and has been taking testosterone therapy. Instead of his levels increasing, they have decreased…his total is now in the single digits. He takes very good care of himself as he is a fitness trainer and body builder (takes vitamins, etc.). Obviously, with his total level being in the single digits, he has all the “symptoms” of low-T and is frustrated that the therapy is having a reverse reaction. He also suffers from Migraines and has recently been in a car accident that he suffered brain trauma in. I’m wondering if there could be a connection between the trauma and low-T or lower T. Any advice or direction you can head us in would be much appreciated.

In reply Dr. Pepper writes:

Hi Lu

You can’t pour water into a cup and wind up with less water in the cup then what you put in. Likewise, if someone takes testosterone supplement they will have more testosterone in their body then they started with. However, some things can influence the blood levels so one person will have higher or lower levels then someone else taking an identical dose. I have seen a wide variation in how testosterone gels are absorbed through the skin. These products include Androgel, Androderm, Testim, Axilron and Fortesa. One person may not see much of an increase in blood levels of testosterone on one of these gels while another will see levels zoom up to a 1000. Absorption of testosterone that is injected with a needle is less variable. Levels go very high in the first few days after the the injection but after 2 or 3 weeks levels will be low again. Here’s an important point. Since testosterone replacement turns off the body’s production of testosterone, if you stop taking replacement your body will not be making testosterone for weeks to months after resulting in very low levels on blood tests. People who abuse testosterone know this and will have the doctor check their testosterone level a month or two after their last dose, so the doctor will see the low levels and give them a prescription for more medication.

Can head trauma effect the testosterone level? For that to occur the pituitary gland would have to be damaged and that will often be associated with other obvious brain damage. In children less severe trauma can hurt the pituitary.

Hope some of this information is helpful in trying to figure out what is going on with your boyfriend. Good luck.

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

The entry Boyfriend Has Low Testosterone. What Can Lu Do? was published at Metabolism Blog . Get the Metabolism book from the same author.

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

The entry Diabetes Medications, One Old and One New, Run into Trouble was published at Metabolism Blog . Get the Metabolism book from the same author.

Avandia, one of only two available medicines with unique properties to treat diabetes, was approved in 1999. From the very first day Avandia was approved a heated debate arose whether Avandia or its sister drug, Actos, was the better drug for diabetes treatment. Both had similar abilities to lower blood sugar and both had the same downside of causing significant weight gain and fluid retention. Avandia showed a slightly worse effect on cholesterol profiles which convinced many diabetes specialists to choose Actos over Avandia. The choice between drugs has also been heavily influenced by cost considerations such as whether the drug was covered by the patient’s insurance carrier. I personally treated numerous patients with both drugs and found them about equal in all respects.

The lawsuits against Avandia will contend that the medication caused heart attack or stroke. The truth of this contention is very much in question, but the murkiness of the water doesn’t stop the lawyers from trying to take a bite out of the flesh of GSK (GlaxoSmithKline), the maker of Avandia.

Several years ago research studies seemed to indicate a small increased risk of heart attacks in users of Avandia. Ever since there has been a heated debate about whether this was a true risk or just the result of overly aggressive interpretation of the available data. There are two major analyzes on the subject of heart attack risk with Avandia. One, written by a doctor on the payroll of a competing drug company, looked at results from 14 thousand patients on Avandia and found a small increased risk of heart attack or stroke and the other study analyzed another 14 thousand Avandia users and found no such association. Under pressure from the public, in 2007 the FDA placed a strong warning on the label of Avandia regarding the possibility of the drug causing heart disease, but Avandia was permitted to remain on the market. The FDA warning was updated and upgraded in 2010. The publicity surrounding Avandia’s potential risks basically halted the use of the drug in the U.S.

Now enter the opportunists. Advertisements fill my email in-box from lawyers looking for customers who want to sue the drug manufacturer in class action law suits. Try goggling “Avandia side-effects” and you will find the first several pages of results are ads looking for lawsuit clients. In the last month I received two requests for patient records from these lawyers. Both patients had heart disease at the time they started the medication. One patient who recently died was over 80 years old, and the other who had significant heart disease and other diabetes complication to begin with, is still alive more than 7 years after treatment with Avandia. I wonder how much benefit these patients received from the medication which allowed them to survive as long as they did despite all the other problems they had related to their diabetes.

Why should you care about whether a small army of opportunists each get a few thousand dollars from the drug manufacturer and a few lawyers become millionaires? Because it is just this sort of legal action which is convincing drug makers to back away from developing other potential diabetes treatments. It takes a decade and a billion dollars to bring a new drug in front of the FDA. This doesn’t include the cost of developing drugs which fail to even make it to FDA review. Then the FDA approval process is tortuous and uncertain. Passing this hurdle, any new drug can come under attack (like Avandia) for “possible” side effects making the company vulnerable to devastating legal costs and bad publicity. It isn’t economically feasible to develop new diabetes drugs in the United States. As a result, new drug development is grinding to a halt. We will all suffer due to lack of innovation, not only for diabetes treatment but for treatment of many other dangerous diseases.

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

The entry Avandia Law Suit Brings Out the Opportunists was published at Metabolism Blog . Get the Metabolism book from the same author.

Historical data shows the average age of puberty today is many years sooner than in previous generations. Most experts attribute earlier puberty to better nutrition. A recent article in metabolism.com reviewed how “over-nutrition” accelerates obese children into puberty sooner (referred to as precocious puberty) than normal weight children. The latest studies on causes of precocious puberty suggests that a child’s social environment also exerts an important influence on the timing of puberty. Researchers in Madrid publishing in The Journal of Clinical Endocrinology and Metabolism 95:4305 2010 analyzed the age of puberty in normal children, adopted children and children whose families immigrated (children not adopted but subject to high levels of personal stress) to Spain. Adopted children were 25 times more likely than other groups of children to undergo precocious puberty (breast development before the age of 8 years in girls, and boys under 9 years of age with testicular growth). Over-all girls were 11 times more likely than boys to demonstrate precocious puberty.

Researchers speculate that socio-emotional stresses early in life of children who are later adopted result in changes in the brain that cause premature maturation of vital nerve pathways. This early brain maturation later results in stimulation of the pituitary gland, turning on the hormone pathways that cause puberty. This seems strange to me because various forms of deprivation in childhood can also delay puberty. For example, girls who have anorexia remain child-like in their body development and may fail to menstruate even into their late teens. A decade ago I studied hormone levels in adults during the stress of illness and surgery and found this lowered the sex hormone levels in their blood. This makes sense from an evolutionary point of view because during stressful conditions nature wisely cuts off the reproductive hormones. Why make babies if the environment is hostile in some way? Why the opposite occurs in children under stress of adoption is an interesting but unanswered question.

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

The entry Adopted Children Experience Early Sexual Maturity was published at Metabolism Blog . Get the Metabolism book from the same author.

The entry The “HCG” diet…. the controversy continues. was published at Metabolism Blog . Get the Metabolism book from the same author.