Treatment of the excess hair growth associated with PCOS often consists of using the drug spironalactone and the use of birth control pills. Spironalactone is a very interesting drug used for decades as a salt depleting diuretic but also has an effect to block the action of the male hormone testosterone. The action of spironalactone to block testosterone was discovered when it was noticed that men using this diuretic developed tender nipples and breast enlargement (gynecomastia). Oral contraceptive agents are also useful to combat hirsutism because these agents also cause reduce testosterone levels by putting the ovary in a dormant “resting” state.  Cosmetic procedures are always another option to treat unwanted hair growth. Laser hair removal appears to be replacing the older modality of electrolysis for this purpose.

Can PCOS be cured? Once PCOS develops it can be controlled but not cured unless the ovaries are removed. At menopause  PCOS-related problems diminish as the ovary stops making sex hormones including testosterone which is one of the culprits during the reproductive years. A recent study published this year in the journal Pediatric Endocrinology showed that using metformin treatment in pre-adolescent girls thought to be at risk for PCOS reduces the risk and/or the severity of PCOS in later years. It may do this by blocking fat accumulation in the abdomen and liver which seems to set off the insulin resistance. Metformin is not FDA approved for this purpose and as a generic drug there is little profit potential in developing this treatment. I expect it will be many years before preventive therapy for PCOS will come before the FDA for approval .

This information is strictly for educational purposes. 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

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%.

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

Greg writes:

I hope what I am about to write will be an inspiration for those who are truly serious about quitting AND losing weight. I have now been almost five months without a cigarette (the longest I have EVER lasted) and unlike every other time I tried quitting, this time I FEEL its for good. Truthfully, no temptations other than a quick subconscious glance (like noticing cleavage on a woman)!

Every time I quit in the past, I gained at least five pounds, then lost it as soon as I started smoking again. This time I tried a different strategy overall and it has made a world of difference. Instead of making my goal “quitting smoking and holding weight”, I made my goal far more ambitious: “quitting smoking and losing weight..gaining muscle, and looking 100% better overall.”

I am now 42. About ten years ago (while I was still smoking), before I met my wife, I lost about 20 lbs (and 12% bodyfat) in four months by simply using a bodybuilder’s type workout (3-5 set pyramid, every five days upper body and lower alternating), light-medium cardio two to three days per week, plus eating on the “Zone Diet” (40 Protein/40 Carb/20 Fat) and five time per day. The results were so dramatic and so fast that one of my teachers at college thought I was sick or on drugs.

When I quit smoking in October, I started the same routine. At first, my goal was to hold weight only…not to gain. But now, four and a half months later, I went from 200 lbs to 184 lbs and over 29% bodyfat to under 22% bodyfat. Now that’s not nearly as dramatic as the last transformation when I was 32 and smoking, but hell, at 42 and no longer smoking I am beating the monster and looking and feeling better every day.

Truth be told, if I was smoking and my metabolism was up, I’d probably be losing faster. But who cares, the fact is I’m clean of smokes and feeling and looking better than I did this time last year.

This isn’t a pitch for supplements, a workout program, or any other BS. I am just saying, if you truly want to quit AND lose weight, it is possible even at 42. Just be smart about it AND totally committed. I think this time what made the big diffrence was making my mind up that I will settle for nothing less. Now, four and a half months into my quit, my goal is 170 lbs and 12% bodyfat. F#@k smoking! F$#k gaining weight! I want to breathe a full breath of air and see a six pack of abs in the mirror!

Anyone who tells you that gaining weight is the price of quitting is lying or, more likely, just doesn’t know otherwise yet. Keep the faith!

In the latest issue (March 24, 2011) of the New England Journal of Medicine research was published stating that Actos (pioglitazone), a popular medication used to treat type 2 diabetes, could substantially reduce the percentage of people at high risk for developing diabetes who progress to actual diabetes. 600 people with a form of pre-diabetes known as impaired fasting blood sugar (fasting blood sugar levels between 95 and 125), were divided into one group given placebo and the other group given Actos. After 2.5 years Actos reduced the incidence of developing type 2 diabetes by 72% compared to placebo. Initially, I was very impressed with these results.

Actos is the sister drug to Avandia and Rezulin. All of these drugs show similar ability to reduce blood sugar in diabetics. Rezulin and Avandia fell into disfavor due to the potential for side effects. Actos is considered safer.

It seems almost a little too obvious that if diabetes is defined as elevated blood sugar that if the test medication reduces blood sugar, diabetes can be “prevented”. Since Actos lowers blood sugar, the conclusion that Actos reduces the progression of pre-diabetes to actual diabetes seems inevitable. A substance that does not already lower blood sugar which prevented elevated blood sugar from developing would be far more impressive.

Side-effects of taking Actos need to be considered, as well. In this research study (New England J of Medicine 364; 12, 2011) the group taking Actos gained an average of about 9 pounds. That doesn’t include the 3% of test subjects who dropped out of the study because they gained too much weight. Edema (puffy ankles) was also more common in those taking Actos. We know that weight gain, particularly in pre-diabetics, is not a good thing. What are we hoping to accomplish by using Actos to prevent diabetes when at the same time, we make people chunkier and puffier?

To be fair, the family of medications known as “glitazones” which contain Actos, Avandia and Rezulin, have some intriguing properties. Years ago, the Triad Study, showed that women with gestational diabetes who received Rezulin, did not go on to develop type 2 diabetes nearly as often, even years after stopping this medication. This does seem like a true preventive benefit.

I am dubious about using Actos to prevent diabetes at this time. My patients, I suspect, will agree with that decision. I don’t think I would survive very long in practice, if my patients gain 10 or more pounds as I try to “prevent” their progression to diabetes.

This information is for educational purposes only and is not intended as medical advise or treatment. Always consult with your physician when deciding whether to use a prescription drug.

Gary Pepper, M.D.

Editor-in-Chief, Metabolism.com

Jim writes:

Ambient Light During Sleep and The Affect on Metabolism

By Jim Rollince of Gym Source, distributor of home gym equipment, including treadmills, ellipticals and other home gyms.

Frustrated that your exercise routine and constantly calorie counting has not yielded any weight loss results? Are you in fact gaining more weight then before you began exercising and monitoring your food consumption? The key to your weight gain could be a result of an external factor that you never took into account, the exposure to light at night.

New research in sleep science has shown that prolonged exposure to light during the regular nighttime sleeping hours may cause weight gain. This weight gain occurs independent of daytime calorie consumption and physical activity.

These research findings came out of a study by the Proceedings of the National Academy of Sciences. The study tested animals, and the findings have begun to raise discussion from the scientific community based on whether the human body experiences metabolic sluggishness and weight gain as a result of too much light exposure at night.

A research team from Ohio State University discovered that mice exposed to a dim light during the course of a night for roughly a two-month period, gained 50 percent more body mass than mice exposed to a regular light-dark cycle. “Although there were no differences in activity levels or daily consumption of food, the mice that lived with light at night were getting fatter than the others,” said Laura Fonken, a neuroscience doctoral student at Ohio State and director of the study.

Although the lab mice were exposed to nighttime light they did not become less active nor eat more. However, they did eat at times when they normally wouldn’t. In fact, in one part of the study when the mice were exposed to light at night and then restricted from eating with the exception of their normal feeding times, they did not experience more weight gain.

“Something about light at night was making the mice in our study want to eat at the wrong times to properly metabolize their food,” Randy Nelson, professor of neuroscience and psychology at Ohio State and co-author of the study.

The researchers found that levels of the stress hormone corticosterone were not different among the mice exposed to the dim light and mice exposed to standard light-dark. This finding was surprising for the research team since corticosterone is connected to changes in metabolism. The research has shown that changes in metabolism have the potential to cause weight gain independent of corticosterone levels.

What is the link between dim light at night and fat-causing changes in one’s metabolism? The Ohio State research team postulates that the presence of light during the night works to disrupt hormone melatonin. Hormone melatonin plays a significant role in the functioning of the metabolism. To this end, light exposure at night could in fact disrupt expression of clock genes, which aid in controlling the time animals choose to be active and eat.

Dr. Nelson furthers her comments by saying that if her team’s research results are confirmed, eating late at night is a serious contributing factor to obesity. “Light at night is an environmental factor that may be contributing to the obesity epidemic in ways that people don’t expect,” he said. “Societal obesity is correlated with a number of factors including the extent of light exposure at night.”

Past research similar to this study have been prolonged television and computer use as contributing risk factors for obesity. Yet these studies were centered in the idea that engaging in prolonged television or computer usage contributed to a lack of physical activity. The current connection between weight gain and the light coming from a TV or computer, is related to the disruption of the metabolism via the negative bodily effects of getting too much light exposure at night and eating at the wrong time.

“Clearly, maintaining body weight requires keeping caloric intake low and physical activity high, but this environmental factor may explain why some people who maintain good energy balance still gain weight,” Dr. Nelson’s press statement.

Here is Sarah’s story:

I was diagnosed with hypothyroidism in my early twenties and Synthroid did not help. I did not know at the time that many of my symptoms were due to hypothyroidism. After changing to my long time physician, I told her of my original diagnosis some years back. She did only the TSH and told me I was no longer hypothyroid! So for some 15 years after being in her care and continuing to feel crummy, then for the last 8 steadily gaining weight and feeling worse, I was not on any medication. I begged her for Cytomel several years back and was denied…she said she didn’t treat with that. When I finally was deemed hypo by her, she put me on the smallest dose of levothyroxine. It did not help. I finally went to see a shrink and he put me on 25 mcg of Cytomel. For the first time in my post pubescent life, I feel like living. My dose was upped to 50, and I felt even better but my thyroid levels were off, so we are now working on that and I am back to 25 mcg per day. If you can’t get Cytomel from your regular physician, you might get a psychiatrist to prescribe it. It changed my life and I finally feel alive. I’ve since switched primary physician because she wouldn’t listen to me, and she didn’t like that I was on Cytomel. I don’t know what it is about this medication that regular physicians don’t like and make them refuse to treat with it, especially when so many can benefit from it. I’ve lost only 12 lbs since being on it, but I gained nearly 35 unnecessarily while not being properly treated and was told to eat less and exercise more…I only ate about 1500 calories a day and walked my dog 2 miles each day, so I don’t feel it had anything to do with my diet!

The intestines produce hormones which regulate blood sugar and appetite. GLP-1 is among the best known of these intestinal hormones. GLP-1 is the basis of a whole new generation of medications used to treat diabetes such as Byetta, Victoza, Januvia and Onglyza. GLP-1 lowers blood sugar, stimulates the pancreas and reduces appetite. After gastric by-pass increased amounts of GLP-1 are produced by the remaining intestine. In a study published in the Journal of Clinical Endocrinology and Metabolism (95:4072-4076, 2010), researchers at St. Luke’s Hospital in New York discovered that levels of oxyntomodulin, another intestinal hormone that suppresses appetite and acts like GLP-1 on blood sugar levels, is doubled after gastric by-pass.

These exciting discoveries help explain why obese diabetics can often be sent home without any medication to control blood sugar immediately after undergoing gastric by-pass surgery. Although most insurance plans do not cover gastric by-pass surgery, dramatic improvements in patients after the procedure with greatly reduced medication costs may convince insurance companies that paying for the procedure will result in better outcomes and save them money in the long run.

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

Debbi writes:

Melanie: Not sure if you have read all of these posts, but a few years back, I quit and gained THIRTY pounds just as you described. Made me feel exactly like you say “humongous slug” and buying bigger clothes every 4 weeks. It drove me back to smoking. Recently, (Nov. 14, 2009), I quit again and gained 13 lb. by Christmas!!! I had to buy new clothes once again & could feel the depression rolling in again, but instead of smoking this time, I started going to the gym like a total maniac. I follow Weight Watchers also. I am 54 years old, 5′ 2″and have weighed 120-125 most of my life – now I’m ‘hanging tight’ at 135 by doing what I’m doing. It will be 6 months smoke-free for me on Friday and I don’t feel too bad about it. I love going to the gym, especially my weight-lifting classes 2x week. I also do Pilates and a lot of walking and rowing. I just came back from a 18 day vacation and only gained 2 lb. – which isn’t bad considering I did NO exercise at all! Hang in there….things WILL even out. I am waiting for the day I can drop these 10 unwanted pounds and I know eventually it will happen. Be proud of yourself for not smoking – I am!

Melanie: Not sure if you have read all of these posts, but a few years back, I quit and gained THIRTY pounds just as you described. Made me feel exactly like you say “humongous slug” and buying bigger clothes every 4 weeks. It drove me back to smoking. Recently, (Nov. 14, 2009), I quit again and gained 13 lb. by Christmas!!! I had to buy new clothes once again & could feel the depression rolling in again, but instead of smoking this time, I started going to the gym like a total maniac. I follow Weight Watchers also. I am 54 years old, 5′ 2″and have weighed 120-125 most of my life – now I’m ‘hanging tight’ at 135 by doing what I’m doing. It will be 6 months smoke-free for me on Friday and I don’t feel too bad about it. I love going to the gym, especially my weight-lifting classes 2x week. I also do Pilates and a lot of walking and rowing. I just came back from a 18 day vacation and only gained 2 lb. – which isn’t bad considering I did NO exercise at all! Hang in there….things WILL even out. I am waiting for the day I can drop these 10 unwanted pounds and I know eventually it will happen. Be proud of yourself for not smoking – I am!
hogan55@cogeco.ca
Debbi
1

Anyway, here is Carol’s secret to weight gain:

Carol writes:

Ok, I found something that helps me to maintain what I have, but as yet I haven’t been able to actually gain any weight: Dairy products, lots of them, and don’t go for the lite or skim version – go for the gold. I have been going through about a gallon to a gallon and a half of soymilk (the one with the extra vanilla in it. Has about 190 calories per serving. Also I make sure to have yogurt every day and I put honey in and granola on top. Cheese and cracker snacks are good too. I have also find that if I do anything physical (walk the dog, work in the yard etc) I need to have a large heavy (but healthy) snack right after and sit quietly for a good 20 or 30 minutes. The key seems to be stay away from the junk food….for most it packs the calories on but for us it burns right through and you just end up not feeling good as your body doesn’t get what it needs.
Take heart – most of you that I am hearing from are much younger (I am 52, 5′5″ and 103 pounds) I have been battling this since I was a kid. I was always told after kids, age 40 etc it would get better – it didn’t for me, but maybe it will for you.