A letter from my Uncle Jim, the doc
From: Monica (anonymous@obgyn.net)
Fri, 7 Jul 2000 12:12:03 -0500 (CDT)
Hi everyone,
I wrote a letter to my family about PCOS (on our family onelist site via
the internet). My cousin Julie wrote back about her PCOS. Then my
Uncle Jim, who is a doctor, wrote the following. I thought it was very
helpful and wanted to pass it on to you. I hope the length doesn't put
you off! p.s. I also sent a copy to the PCOS Medication Forum.
p.s.s The "medical facts" he referres to are ones I passed on from both
PCOS Forums.
Dear Monica, Julie, and everyone else,
--
Monica and Julie, I want to congratulate you on your excellent
discussion
of PCOS (POLYCYSTIC OVARY SYNDROME). Your medical facts are perfectly
right. PCOS is gentically determined but not everyone has exactly the
same genetic make-up so not everyone has exactly the same symptoms.
Women your age are usually bothered by symptoms such as irregular
periods, infertility, hair growth, etc. I see an older group of people
who have diabetes, high blood pressure, high triglycerides, low HDL
cholesterol, and heart disease.
PCOS is just part of a larger syndrome called the Insulin Resistance
Syndrome. People with this syndrome inherit a gene or genes that cause
a
resistance to the effect of insulin, which is mainly to keep the blood
sugar in a normal range. The body responds to this by making more
insulin. So long as the body can make enough insulin to overcome the
resistance, the blood sugar will stay normal. Once the resistance gets
so bad that the body can no longer make enough insulin to overcome the
resistance, then the blood sugar stays high and you have diabetes. The
problem is that these people always have too much insulin. The high
insulin levels drive the body to make too many triglycerides. The high
triglycerides cause a decrease in the HDL cholesterol (the good
cholesterol). Also many people with the insulin resistance syndrome
also
develop high blood pressure. The diabetes, high blood pressure, and low
HDL cholesterol lead to the development of arteriosclerosis (hardening
of
the arteries), which leads to heart attacks, strokes, gangrene,
aneurysms, etc.
Insulin resistance is inherited and probably runs in the
family. However, the manifestations of the disease usually don't happen
until you gain weight. Any excess fat on the body increases the
resistance to insulin. Although it is more complicated than that, in a
sense when blood circulates through fat, the insulin resistance gets
worse, and when blood circulates through muscle, the insulin resistance
is lowered. The best treatment for insulin resistance is to lose
weight,
or, more accurately, to lose fat and gain muscle. The main thing that
makes that happen is exercise. Diet is also important. However, if you
lose weight only by dieting, you lose muscle as well as fat and you
don't
really make a significant change in the proportion of fat to muscle on
the body. When you lose weight by dieting and exercising, you lose only
fat and you gain muscle and you actually correct the problem. Insofar
as
diet is concerned, calories are the main culprit. Any time you take in
more calories than you burn up, everything gets worse. Probably some
calories are worse than others. Anything that stimulates your body to
make insulin can make things worse. Sugar is what stimulates the
production of insulin. So it is advisable to avoid sugar, pop with
sugar, candy, ice cream, pies, cakes, cookies, donuts, and anything that
has sugar in it. For some people with severe insulin resistance they
should also avoid bread, potatoes, rice, cereal, pasta, and other
carbohydrates which are broken down in the body to form sugar. The goal
is to acheive a normal % of body fat, which is 15-20% for men and 20-25%
for women. That is very difficult to acheive without getting regular
exercise.
There are medicines that help to combat the insulin resistance. As
Monica mentioned, Glucophage is perhaps the best one. Actos and Avandia
also help. They are related to Rezulin, which Julie took before
becoming
pregnant with the twins. Rezulin has been taken off the market and is
no
longer available, but Actos and Avandia are probably just as good. There
is some evidence that a group of medicines called ACE Inhibitors are
also
beneficial for people with insulin resistance.
Again, Monica and Julie, you are to be commended on the excellent
information you have given everyone on this important topic. If you
have
any questions about this, let me hear from you.
Love,
Jim
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