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Re: maybe Dr. Sam can help - On Glucophage and weight loss (very long reply to Muriel)From: SusieQ (anonymous@obgyn.net)Wed, 7 Nov 2001 10:47:10 -0600 (CST)
Hello Muriel, I realize now that your problem isn't really with us. It's with your husband. His attitude is will certainly destroy any emotional or medical advances you make. An unsupportive partner, much less one who doesn't believe in pcos, will kill anyone's enthusiasm. I hope the two of you find some serious marital counseling before you get pregnant. Pregnancy will not reverse or cure his poor attitude. You sound very young. While it is very altruistic of you to be a philosopher, we are your best source for medical information. Even local doctors are not as knowledgeable about pcos, as many of the ladies on this board are. We appreciate each and every post from Dr. Sam, because his education and knowledge far exceeds many of the answers we find in our own docs office. Your doctor, inappropriately, prescribed met for weight loss. That is an irresponsible and unsubstantiated reason for prescribing met. Most studies show that some women lose on met, but the majority do not. JAMA and NEJM both have abstracts available for your use online that show this. Why does it not cause weight loss? Because it does not directly effect blood sugar levels. Metformin is used to increase sensitivity to blood glucose in the liver and muscles. It does not work in the pancreas (which puts out the excess insulin). Metformin will not lower the free-flowing glucose/insulin in the blood. Metformin is designed to enhance insulin sensitivity, it does not directly affect the pancreas, and it's insulin action. Some women respond to metformin quickly...when the liver processes insulin more efficiently, it reduces the signal to the pancreas to create more insulin. Thus, hopefully, reducing the free flowing insulin in the body. While this seems like it should then reduce weight, it is only a side effect for under 33% of pcos sufferers. See NEJM for these statistics. The excess insulin in our system throws off more than just the pancreas or liver function. Obviously the ovaries are affected, but so can the pituitary and adrenal glands. The entire endocrine system is connected together, and all those glands are affected by the excess insulin/insulin sensitivity. This is the reason many women do not lose weight on metformin. Other glands, like the adrenals or pituitary, can still be malfunctioning. Excess estrogen and testosterone are also common factors, which can exacerbate weight gain. There are unlimited numbers of acids and lipids in the body that may be affected by the insulin problems. So, why take met? Increased insulin sensitivity can reverse many of the affects of pcos, but not all of them. Some women don't ovulate on met, others do. Met has worked wonders for me. But I have not lost one pound, despite strict diet and exercise. My theory about the weight problem, is that time is of the essence. I suffered for 20 years with no dx, while the excess insulin and IR ravaged my body and disturbed all those delicate balances our endocrine system tries to maintain. Those of us who have been undx'd for a longer period of time, seem to have more trouble reversing the problems of pcos...our endocrine systems are just going to need more time to repair. I take met to feel better - I have more energy, clearer skin, fewer migraines, and a better overall quality of life. I am also trying to prevent diabetes later in life. While weight loss would benefit all those things, my body just won't let loose of those extra pounds. And, unfortunately, there are many thin diabetics and pcos cysters too. I am glad you are being proactive, we need as many women as possible to get the word out. But you are missing a big piece of the picture. The entire endocrine system must be addressed if we are to successfully treat all the symptoms of pcos. So, what comes first the excess insulin or the IR? That's like asking the chicken/egg question...the docs are working on it. Fight for PCOS research all you like, but please don't fight with us. I hope you find what you're looking for, SusieQ
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