Re: HELP NEEDED!!! - an even longer reply
From: Celeste (anonymous@obgyn.net)
Wed, 29 Aug 2001 20:31:09 -0500 (CDT)
At Wed, 29 Aug 2001, SusieQ wrote:
>
I too am sorry Susie, I still disagree. The articles you mentioned
specifically are written by those who believe that a high carbohydrate
diet is correct for all people. Medical journals specifically call out
the fact that lowcarb plans are a potent weapon for lowering insulin in
insulin resistant patients. In fact it was just such an article that
inspired Dr. Atkins to come up with his book.
When a doctor disagrees with a diet plan, it's always incrediby
interesting to ask them if they read the book or even tried it
themselves. They usually answer no if they are truthful, or say that
they "don't have to" if they just don't want to admit this. One fact
that is undisputed is that in medical school today as always, usually no
more than one-half to one day is devoted to dietetics and nutrition.
Dieticians are schooled in the high-carb food pyramid and can't even
advise someone how to follow a low carb plan other than to avoid eating
candy.
Ketosis (the burning of fat) is completely different from diabetic
ketoacidosis (a life threatening condition since diabetics cannot
readily access their fat stores when carbohydrate intake drops too low).
They are completely different. In fact the technical term for ketosis
is "benign dietary ketosis". Links to medical journal articles on this
are found at the Atkins support site (http://www.atkinsfriends.com) for anyone
who is interested in further research.
Those of us who have found relief from our symptoms using low
carbohydrate eating plans form a very large group, and our experiences
should not be discounted. I can say this because I am in this group. I
have changed the way I will eat for the rest of my life. I am not on a
fad diet. And my endocrinologist is behind me all the way.
A way of eating is just one of many tools we can try to get relief from
our symptoms, and I would have to say that if you try it and are unhappy
with it, then you should certainly stop it. I would never tell somebody
not to try Metformin or bcps any more than I would tell them not to try
a lowcarb diet.
Regarding lowcarbing on Metformin, that is such a personal choice. There
is a small army of women on the http://www.inciid.org PCOS Cafe portion of the
board who did not lose weight on Met or lose the side effects of GI
disruption until they learned to cut refined sugar from their diets.
It's certainly something a person can experiment with to make sure she
feels she has gained the maximum benefit from taking a drug.
It's true that doctors perform liver and sometimes kidney monitoring on
their patients who take Metformin or any insulin sensitizing medication.
It's a very conservative thing to do in the wake of how damaging Rezulin
turned out to be to peoples' livers. Metformin is regarded as a much
safer drug; for one thing it is milder than Rezulin, and for another it
has been used in Europe for over 35 years--Rezulin did not have that
kind of track record, and now it seems it never will. However Metformin
is so much milder that it is becoming clear that it is just not the
single answer for all PCOS patients.
It can take someone on a high carb diet a few days to get into ketosis
(and the fact of the matter is that all humans can slip into ketosis
during sleep, since we are fasting) but it's also true that if you want
out of it, all you have to do is eat carbohydrate at yoru next meal.
This way of eating has not been proven dangerous to women who are ttc or
pregnant; the Atkins board has several women whose PCOS resolved enough
on lowcarb to resume ovulation and become pregnant. All of the babies
who have arrived are healthy. I will admit that all of them added back
sufficient carbs to stay just on the other side of ketosis just in case;
nobody went back to eating sugar and refined grain products because they
didn't want to take a chance of higher insulin levels messing things up.
I will also admit that the Atkins diet is low in Vitamin C and potassium
and the simple fact is that Atkins himself, in his books, says it's
imperative to use supplements (a multivitamin is plenty) when you do
this plan to be in your best position of health. Anybody who gets on
ANY diet plan without fully understanding, from the source, what is
required is making a big mistake with her health.
One of the greatest sources of misinformation anywhere is when people
who have not read the source of something come out and say why it is
wrong. I have read Dr. Atkins' book twice, and I have read every other
lowcarb plan out there (the Zone, Sugar Busters, Suzanne Somers, and my
all time favorite for its fantastic description of insulin resistance,
Protein Power). Anyone who is interested in learning more can read a
synopsis of these major plans (as well as similar plans) on
http://www.holdthetoast.com. I would never have gone on this plan without
fully researching it, and I wholeheartedly recommend that anyone who is
interested do the same for her own peace of mind.
I thank you for the opportunity to discuss this further because I
believe we all need to be as completely informed as we possibly can to
get the care that is best for us, including self-care with diet and
exercise. The latest developments in PCOS medical treatment are so new
that the doctors are scrambling just as hard as we are to find out what
can be done. None of us are specialists in this, but we are all in it
together to find the most relief.
Anyone who reads this, I hope your day's a great one! :o)
>I am sorry Celeste, I must respectfully disagree. Metformin is already
>difficult on the kidneys and adding a low carb regimine is not
>recommended by most diabetes/pcos specialists. Instead they recommend a
>National Diabetes Foundation diet. Since my RE specifically told me not
>to dip below 70 grams of carbs per day while taking Metformin, I hope
>you will not be offended if I stick with his recommendation.
>
>This article outlines a professionals opinion about low carbing (under
>50 grams per day): PCOS and DIET by Martha McKittrick, Registered
>Dietician, Certified Diabetes Educator, OBGYN.net Editorial Advisor,
>found here:
>http://www.obgyn.net/pcos/articles/pcos_and_diet_mckittrick.htm. She
>specifically recommends not to low carb for PCOSers.
>
>Metformin is metabolized by the kidneys, and uric acid provides a source
>for kidney stones in a ketogenic/high protein diet, together they put
>the kidneys at risk. Our friend Paula has made a comment in support as
>well here: http://forums.obgyn.net/pcos/PCOS.0009/1384.html.
>
>The National Institute of Diabetes & Digestive & Kidney Diseases says:
>"It overworks your kidneys, and can cause dehydration, headaches, and
>bad breath. It can also make you feel nauseous, tired, weak, and dizzy.
>A buildup of ketones in your blood (called ketosis) can cause your body
>to produce high levels of uric acid, which is a risk factor for gout (a
>painful swelling of the joints) and kidney stones. Ketosis can be very
>risky for pregnant women and people with diabetes.
>
>By following a reduced-calorie diet that is well-balanced between
>carbohydrates, proteins, and fats, you will still lose weight--without
>hurting your body. You will also be more likely to keep the weight
>off." Found here:
>http://www.niddk.nih.gov/health/nutrit/pubs/myths/index.htm
>
>Researchers are scrutinizing the kidneys need for carbohydrates and
>their importance in renal function. Another reason not to overwork your
>kidneys by denying them important carbs. Read the research, Renal
>Gluconeogenesis Its importance in human glucose homeostasis by
>John E. Gerich, MD, Christian Meyer, MD, Hans J. Woerle, MD and
>Michael Stumvoll, MD here:
>http://care.diabetesjournals.org/cgi/content/abstract/24/2/382?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=kidney+low+carbohydrate&searchid=999130068467_7text=kidney+low+carbohydrate&searchid=999130068467_7=kidney+low+carbohydrate&searchid=999130068467_792&stored_search=&FIRSTINDEX=40
>
>Another research article that implicates low-carb diets can increase
>"insulin resistence" called, "A possible mechanism of insulin resistance
>in the rat adipose cell with high-fat/low-carbohydrate feeding.
>Depletion of intracellular glucose transport systems" by PJ Hissin, E
>Karnieli, IA Simpson, LB Salans and SW Cushman found here:
>http://diabetes.diabetesjournals.org/cgi/content/abstract/31/7/589?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=kidney+low+carbohydrate&searchid=9991309762fulltext=kidney+low+carbohydrate&searchid=9991309762text=kidney+low+carbohydrate&searchid=999130976263_824&stored_search=&FIRSTINDEX=70
>
>As you can see, I do not agree with low carbing COMBINED with
>Metformin...this is not an argument, nor an attack. I feel that
>everyone should have all the information necessary to make the correct
>decision for themselves. Personally I feel miserable on met and low
>carbing. I hope everyone taking insulin lowering medications will talk
>with their doc before starting any diet regimen. All our test results
>are different, and all our needs are different. Urban Legends are not
>my cup of tea; double-blind, placebo controlled studies are. Again,
>Randi, I urge you to talk with your doc about your test results and
>possible treatment options (including diets).
>
>--
>SusieQ
>
>>At Wed, 29 Aug 2001, SusieQ wrote:
>>>
>>Lowcarbing is definitely NOT an issue for your kidneys UNLESS you are
>>somebody who has existing kidney disease AND you fail to drink water
>>throughout the day. People with normal kidney function do not get
>>kidney trouble from Atkins or any other lowcarb plan. I searched and
>>searched the medical journals on this issue and there is nothing to
>>substantiate lowcarb causing kidney problems in healthy people. It's an
>>urban legend.
>>
>>That said, Weight Watchers was actually a lowcarb diet 40 years ago when
>>it was started, but now it is a lowfat diet based on the Food Pyramid
>>that puts carbohydrates as the thing that you should be eating the most
>>of each day. If you are insulin resistant, as I am, you will most
>>likely gain on this plan. Check out http://www.atkinsfriends.com for support
>>and fantastic info on any of the various lowcarb plans; there is sure to
>>be one that will work for you. There are lots of PCOSers there being
>>helped by carbo restriction; I have lost 48 lbs on it and have had my
>>cycle come back without any meds. This never happened when I lost
>>weight on other methods. It's thrilling not to have to use bcps to
>>cycle. I feel a lot better, too. I think that within a couple of weeks
>>of starting lowcarb you too will know for sure if it helps you (and I
>>think it quite possible that it could help you). And if you are not
>>happy with it, all you need to do is quit. BTW, my cholesterol went
>>from 307 on WW to 184 on Atkins. I'm pleased about that too!
>>
>>>Hi Randi,
>>>
>>>I think you definitely need to talk with your pcos specialist about your
>>>tests and physical symptoms. Low carbing is hard on the kidneys and is
>>>not recommended when taking met. However, there are some things you can
>>>discuss with your doc. The first is increasing your met dosage...the
>>>upper dosing limits are 2000 - 2500mgs a day. Second is your test
>>>results. It is possible that the met no longer works for you. This
>>>does happen to some people. The next choice would be to do a
>>>combination therapy with another insulin sensitiser, or switching
>>>medications entirely. With the met, your results should be improving.
>>>Has there been any improvement between your results before starting met,
>>>and the recent results? You have a lot to talk about with your doc. I
>>>hope he/she can give you some guidance, IMVVHO.
>>>
>>>luck and love, SusieQ
>>>
>>>>I just increase my Glucophage to 2000mg (1000mg 2x a day) from 1700mg
>>>>(850mg 2x a day). DO you think I will feel any difference with the
>>>>300mg increase? I'm assuming no, but thought I'd ask.
>>>>
>>>>Also, I as very upset about something and hoping you guys can help. I
>>>>was eating pretty badly for a while, and decided to get my act together
>>>>and start to eat healthy. I joined Weight Watchers and lost only 1.6
>>>>pounds the first week. I went yesterday to find out that I gained back
>>>>1.2 pounds...I don't understand. I am positive that my eating structure
>>>>changed for the better ...I have been on Glucophange for over a year...I
>>>>had lost about 20 pounds at the beginning...I have since gained it back.
>>>>I am afraid that I am not going to lose anything this time...I have 100
>>>>to lose!
>>>>In addition, I am somewhat depressed and my hormones (of course) are
>>>>flying all over the place...I cry at the stupidist things.
>>>>
>>>>Can you guys give me some advice? My most recent bloodwork from a few
>>>>weeks ago is shitty...
>>>>
>>>>Fasting insulin -> 42.3
>>>>Glucose -> 104
>>>>Cholesterol-> 329 (i know...horrible)
>>>>Triglicerides -> 419 (i know also)
>>>>
>>>>Please tell me what I am doing wrong. I have loved this site for well
>>>>over a year and look to you guys for support.
>>
>>--
>>Celeste
>>
--
Celeste
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