As a physician in private practice familiar with highly skilled pharmaceutical representatives pitching the latest (and most expensive) medications, I am fairly good at separating truth from salesmanship. These clear cut interactions with the drug reps visiting my office are relatively harmless. Drug maker’s are now changing up the game however, with a new, more subversive tactic to influence doctors’ prescribing habits.
I have been compiling a “medical propaganda” file, consisting of emails directed to my work and personal address offering cash for my time. In less than a year, I count over 500 of these emails. Here are twenty from the past week. Some details are blacked out for legal reasons. (more…)
According to government estimates, 4.6% of the US population aged 12 or more has hypothyroidism (low thyroid function). Based on treatment guidelines published in 2012 by the American Association of Clinical Endocrinologists (AACE), only synthetic thyroid hormone (levothyroxine, Synthroid, Levoxyl) is an appropriate therapy for this condition. According to these guidelines, the biologic product Armour Thyroid, is unfit for this treatment purpose. Armour Thyroid, an extract of porcine thyroid, has been available as a treatment for hypothyroidism for about 100 years. It was first used in the U.S. to treat hypothyroidism in 1892, a year after it was introduced into the United Kingdom. The impact of the AACE guidelines is more than symbolic (more…)
From one of our readers: I’ve searched the web but found nothing that tells me how to
distinguish if my metabolism is healthy. I’ve found plenty of
ways to tell me how to improve my metabolism but nothing
that explains what is normal. Are there outward signs that
will tell you if your metabolism is healthy?
Metabolism.com member
According to Webster’s Dictionary, metabolism is defined as a chemical and physical processes continuously going on in living organisms, But when most people think about metabolism they focus on one specific process , the process that releases and stores energy from the food we eat. This is because this type of metabolism not only affects how efficiently your body burns fuel but also influences how easily our bodies gain or lose weight.
Turning Food into Energy
In simple terms, your metabolism is the rate at which your body breaks down nutrients from the foods you eat and converts them into a form the body can use. After you’ve eaten a bowl of cereal or a sandwich, chemicals produced in the digestive tract, known as enzymes, break down all of the complex molecules that make up the food into smaller, more usable nutrients. Proteins are broken down into amino acids, fats into fatty acids, and carbohydrates into simple sugars like glucose. These nutrients are then absorbed into the blood where they are transported all over the body.
At this point the nutrients can be used in different processes. Amino acids are usually used to build and repair tissues, while glucose enters cells and is metabolized for energy. Any extra nutrients left over after these processes are generally stored in body tissues, especially the liver, muscles and body fat, and used for energy at a later date if the body needs it. (Think of it like a squirrel stocking up nuts for the winter.)
In this way, the process of metabolism really is a balancing act between two very different types of activities: (1) building up body tissues and energy stores, and (2) breaking down energy-rich nutrients, body tissues and energy stores to produce fuel that will power the body.
Anabolism, or constructive metabolism, focuses on building tissues and storing energy. During this process, small molecules are converted into larger, more complex molecules. For example, small molecules of glucose become larger, more complex storage molecules called glycogen. Amino acids are organized into proteins. And fatty acids are combined to create dreaded fat molecules. Anabolism is a very important process in the body, as it supports the growth and repair of cells and tissues and helps the body store energy so it can be used sometime in the future.
On the other hand, catabolism, or destructive metabolism, breaks down large molecules (mostly carbohydrates and fats) to release energy. We mostly refer to this energy burning as metabolism, even though this is not the only type of metabolism. This is the process that fuels all of the activity in our cells and keeps our body running. It also provides the energy needed for anabolic, energy-storing processes, helps heat the body and enables our muscles to contract so we can move.
The Importance of Hormones
Hormones are chemical substances in the body that control and regulate the activity of certain cells or organs, as well as specific chemical and physical processes. Several important hormones are involved in controlling the rate and direction of metabolism:………..
Interested to learn more about what makes your metabolism tick, what makes it run fast or slow? Are you curious if your thyroid gland is working and healthy? How about how to avoid developing diabetes or if you have diabetes, how to avoid paying for expensive but ineffective treatments? If so, you can purchase the complete book, Metabolism.com, in the Kindle section of Amazon.com
Layla inquires about how to approach this common situation in the treatment of hypothyroidism:
Hello, I am a 23-year-old girl, and at the beginning of 2013 I started rapidly putting on weight, where I ballooned from 128 lbs to 155 within a few months, despite extremely healthy eating and exercise. I had my TSH tested and it was 4.71. I was put on 25 mcg of levothyroxine, which was eventually increased to 50 mcg (I am still currently taking this). It decreased my TSH to 0.69 and increased my free T4 t0 1.2, but recently my weight loss has slowed and I put on a little fat despite an extremely low carb diet. I retested and it showed that my TSH had gone up to 2.1, and my free T4 had gone down to 1.0. My endo was not tested T3, but she finally gave in when I asked, though she refused to test free T3. My total T3 came in at 40 (range 50 – 180, though I’ve seen 80 as the lowest amount for health), which is extremely low. I have always had incredibly slow metabolism, and even when I was at 128 lbs, I had a lot of body fat. I keep asking for Cytomel, and the endo is almost there in giving it to me, but she insists that my low T3 is due to some mystery illness that she thinks is temporary, and wants me to retest. My question is this: how much T3 should I end up taking, to get rid of my excess weight and body/belly fat, and improve my symptoms (dizziness, extreme fatigue, depression, PCOS)? I want to be around 115 – 120 lbs. I figure the starting dose will be around 5 mcg, but do I need more than this for optimal functioning and metabolism? Should I split the dose? Any advice is appreciated.
The old saying, “The way to a man’s heart is through his stomach†implies there is a deep connection between emotions and eating. My guess is  no one is really surprised by this idea. Both men and woman can identify ways in which their mood and appetite are intertwined and it is no mere quirk of man’s personality that this is true.
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.
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
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
