My ebook Metabolism.com is now available; I think you will find it a great resource for many of the common problems members have asked me about over the past 15 years. Buy it now and use it for years to come. Don’t forget to check out the Weight Loss and Weight Gain Programs included for free!
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. Fictionâ€”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 Newsâ€”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 Newsâ€”What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Chapter 7: Hormone Treatments 99
Hormone Replacement Therapyâ€”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
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
Probably the major cause for concern regarding post menopausal HRT (hormone replacement therapy) highlighted by the WHI study was an increased risk for breast cancer. This finding applied to women in the WHI who were using combination estrogen and progesterone replacement. Progesterone is given to counteract the effect of estrogen to cause uterine (endometrial) cancer but is not crucial for relief of post-menopausal symptoms. Interestingly, women who used estrogen replacement alone (without the progesterone) actually showed no increase and possibly even a reduction in invasive breast cancer after 7 years on treatment. In the group of women who started â€œestrogen onlyâ€ replacement more than 5 years after entering menopause, the reduction in breast cancer was even more pronounced. Experts therefore conclude that â€œestrogen onlyâ€ HRT is likely to be considerably safer from a breast cancer point of view, and starting estrogen 5 years after menopause reduces the cancer risk even further.
The relationship between estrogen use and breast cancer risk is further complicated by the finding that post-menopausal women using HRT who develop breast cancer appear to have better survival and less aggressive tumors than post-menopausal women who are diagnosed with breast cancer who never used HRT. Breast cancer may not be caused by estrogen, but cancer may grow more rapidly in the presence of estrogen. This doesnâ€™t sound like an advantage but small undetected cancers may grow rapidly with HRT so that they can be seen on mammography and removed before they can spread.
New drug combinations in development offer hope to women who are looking for HRT alternatives. A class of drugs known as SERMS of which Evista is a member, used in combination with estrogen has shown promising results in clinical studies. A SERM will protect against the uterine cancer causing effect of estrogen so progesterone is no longer needed with HRT. This immediately reduces many of the undesirable effects of HRT found in the WHI including breast cancer risk and producing better cholesterol effects. This combination of drugs is referred to as a tissue-selective estrogen complex (TSEC). Other advantages of TSEC treatment are improvement in bone density (lower osteoporosis risk) and possible reduction in coronary artery disease development. Although TSEC treatment is not yet FDA approved for treatment of post-menopausal symptoms, individual doctors can prescribe this if they feel the available information is favorable and the risk/benefit ratio is in favor of the patientâ€™s well being.
Finally, there is the issue of blood clots associated with estrogen treatment. This is likely due to the effect of estrogen to alter the balance of certain blood proteins that favor blood clot development. My thought is that adding a simple baby aspirin daily may reverse or significantly reduce risks associated with increased blood clotting with estrogen, just as baby aspirin is now recommended for those at increased risk of heart attack. Aspirin is unlikely to be helpful to prevent blood clots in veins referred to as DVT but this is not completely certain. As with all medications there are downsides to aspirin such as gastric irritation and ulcer bleeding but these risks can be assessed by the individual and their doctor.
(This information is for educational purposes only and does not constitute medical advise or establish a doctor patient relationship)
Gary Pepper, M.D.
Once a common solution for the Miseries of Menopause, hormone replacement therapy (HRT) with estrogen was abandoned almost overnight in 2002 with the publication of the Women’s Health Initiative (WHI) results. The WHI did not dispute the fact that HRT is the best method of reversing post-menopausal symptoms such as hot flashes and insomnia but it did overturn some cherished beliefs as far as women’s heart health is concerned.
Women have a much lower risk of heart attack then men until they reach menopause. At menopause when the ovaries stop making estrogen the risk of heart attack climbs rapidly until it equals that of men. Common sense suggests that if losing estrogen causes increased heart attack risk then replacing the estrogen should prevent this. What the WHI appears to show is that HRT does not protect women from heart disease, but may actually increase the risk above the normal post-menopausal risk. Worse yet is the WHI conclusion that HRT increases the risk of breast cancer and of blood clot complications (thromboembolic disease). It is no wonder that in 2002 HRT took its place with smoking as the scourge of womens’ health.
Since that time scientists have reevaluated the WHI data and more work on HRT risk versus benefit has been done. What is evolving from this reassessment is that the use of progesterone in the WHI participants and the time from onset of menopause until the time HRT was started, both play important roles in how often women developed heart disease or cancer. Additionally, a new class of drugs when use together with HRT may block the cancer risks associated with HRT. In Part 2 of this article I will be covering these aspects. Stay tuned!
Gary Pepper, M.D.
Editor-in- Chief, metabolism.com
A potential new treatment for type 2 diabetes, dapagliflozin, recently failed to gain approval from the FDA. What makes this rejection noteworthy is that the new medication works by a completely new mechanism causing the kidney to excrete sugar from the blood into the urine. Reasons for the rejection were the increased risk of bladde and breast cancer in those taking the medication, increased urine and genital infections and possible liver toxicity. That list of problems seems pretty convincing to me. This is unfortunate because the drug appears to cause weight loss and does not cause low blood sugar (hypoglycemia). However, a drug that works by “poisoning” the kidney so that it dumps sugar into the urine strikes me as a drug that is going to cause a lot of other problems.
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
Researchers at the Harvard School of Public Health studied the diets of more than 83,000 women who entered the Nurses’ Health Study in 1980. By 1994, 2,697 of those women were diagnosed with breast cancer. One of the key findings was that premenopausal women who had an immediate family member with breast cancer, that consumed at least 5 servings of fruits and vegetables per day, had a 70% lower risk of developing breast cancer compared with those that consumed less than 2 servings per day. The interesting component of the study was that only premenopausal women with a family history were protected. A hypothesis presented by one of the researchers (Shumin Zhang) was that these women may have a higher requirement for the carotenoids in fruits and vegetables, since their cells may proliferate more, and carotenoids may inhibit cell proliferation.
Source: Journal of the National Cancer Institute, 91: 547,1999.