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My ebook Metabolism.com became available from the Kindle Store at Amazon.com for $4.95 . Buy it now for $0.99.  For those interested in why endocrinologists behave the way they do or achieving healthy weight loss (or weight gain)….and much more, visit Kindle books on Amazon.com. You can even preview the book for free using the functionality on their website.

Dr. G. Pepper

Who Will Pay for Your Fracture?

Most of my patients initially refuse when told that they need to start medication for osteoporosis. Why such an overwhelming negative response? The ads soliciting supposed victims of anti-osteoporosis drugs such as Fosamax, have been so wide spread and convincing that the general population is now convinced that the treatment is worse than the disease.

The high level of fear among woman regarding treatment of osteoporosis worries my colleagues and I. Although it is likely that after many years taking drugs such as Fosamax can cause bones to become brittle, the type of fracture they may contribute to is less than one percent of all fractures related to osteoporosis. Some experts believe that for about every 300 osteoporotic fractures there may be one fracture related to treatment.

How dangerous are fractures related to osteoporosis? The rate of people dying within a year after suffering a hip fracture is almost double and the risk seems to be higher the younger you are when the fracture occurs.

The question in my mind then is, who will compensate woman who fracture due to osteoporosis after being frightened away from treatment by lawsuit ads? When pharmaceutical companies promote a drug treatment they must provide “fair balance” resulting in promotional drug ads which devote most of their time to the negative aspects of the drug. Not so with the “have you been injured by Fosamax?” ads. The scarier the ads the more effective they are, which serves their purpose very well.

I propose that a fund be set up by those broadcasting, “have you been injured” ads to compensate people who have been injured because of their scare tactics. My thought is that many people are hurt by these ads because of their unbalanced and purposefully frightening message. Why shouldn’t there be a way to provide the resources needed to help the victims of such propaganda?

Am I off here, or do you think I’m right?

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

Coconut Milk as Health Food? You’ve Got to Be Kidding.

Much as has been said recently about the health benefits of coconut milk and coconut oil. Coconut milk is a white liquid mixture of water and the white “flesh” of the coconut and is considered a more diluted form of coconut oil a thick clear liquid. Coconut extracts have been used in commercial food products, non-dairy creamers and cooking for many years but lately there has been a burst of publicity for coconut oil and milk as a new form of health-food with beneficial properties including increasing energy, preventing cancer and speeding weight loss.  I have seen it being added to ice cream and even bottled water. I want to sound a note of warning here.

 

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.

Should You be Concerned About Your Cortisol Level and What Can You Do About it?

Many members at metabolism.com have expressed concern that their cortisol level is either too high or too low. I thought it would be helpful to highlight the latest exchange I  had on the subject.

Mohammed writes:

Hello:   My overall dhea and cortisol levels are ok but cortisol is a little high what can i take to stabilise the level of cortisol, i know reducing stress and exercise e.t.c but i mean in terms of products is there anything that can balance cortisol, because i am suffering from low t3 and i know without good adrenal fnx
thyroid supplemts wont be as effective

My reply:

As you know the adrenal gland produces a hormone that is vital to survival known as cortisol, cortisone, or glucocorticoid. You are correct that during stress the adrenal will produce more cortisol which helps prepare the body for aggressive activity or injury. When the stress is relieved cortisol levels return to normal. Excess of cortisol causes a disorder known as Cushing’s Syndrome and a deficiency is called Addison’s Disease or adrenal insufficiency. Both of these disorders can cause illnesses serious enough to result in death. Fortunately cortisol excess or insufficiency is very rare and when diagnosed in time can be controlled. Several years ago there was an unethical company marketing a product called Cortislim which they claimed reduced cortisol levels to induce healthy weight loss. This product was removed from the market. As far as I’m concerned there is no legitimate product that will safely reduce cortisol levels, nor should there be. The body regulates production of cortisol very carefully because it is such a potent hormone with potential to help and harm in major ways. I believe you would be safer letting your body decide what your cortisol level should be rather than trying to do it yourself. You can check out another of my blogs on the subject of adrenal function. My book Metabolism.com includes a section where I review the controversy about adrenal fatigue as well.

Hope this information helps.

Thanks

Dr. P

Infertility to Acne: Treatment and Prevention of Polycystic Ovarian Syndrome. Part 2

Worried about pregnancyIn part one of this series we looked at the cause of polycystic ovarian syndrome (PCOS) and the many complications it causes. Weight gain, acne, excess hair growth on the face and body,  high cholesterol and high blood sugar due to insulin resistance are among the problems associated with PCOS.  One particular area of concern for PCOS sufferers is infertility due to lack of ovulation. PCOS is the cause of anovulatory infertility in  3 out of 4 cases. Before the acceptance of medical therapy for infertility due to PCOS  a surgical approach referred to as a wedge resection of the ovary was performed which allowed patients with PCOS to ovulate and conceive normally. Low success rates with this procedure, complications of surgery and improved medical therapies have all resulted in the end of this type of treatment in most situations.  At present, treatment of infertility associated with PCOS generally consists of using a drug to combat insulin resistance known as metformin often in combination with the fertility drug clomid, which has a high rate of success.

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

Polycystic Ovarian Syndrome Is Common in Adolescent Girls

Polycystic Ovarian Syndrome (PCOS) sounds like a rare disorder but it is surprisingly common. This is a disorder with onset in early adolescence effecting up to 10% of young women. Characteristic signs and symptoms include increasing facial and body hair, hair loss from the scalp, muscular or heavy build, acne, thickening and darkening of the skin known as acanthosis nigricans, blood sugar problems including type 2 diabetes, high cholesterol and irregular menstrual cycles and infertility. In older women with PCOS coronary artery disease is more common. In severe cases deepening of the voice and enlargement of the clitoris (clitoromegaly) can be seen. Before the underlying hormone disorders were clarified, the main method of diagnosing this disorder was by finding multiple cysts on the ovary. We now understand that the main problem is not the ovarian cysts but metabolic disorders including insulin resistance and elevated male hormone levels (testosterone) in the blood.

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

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